ClariVein Sclerotherapy

ClariVein is a relatively new technique to treat diseased saphenous veins. It is even less invasive than Endovenous Laser Ablation (EVLA) and it is more effective than ultrasound-guided sclerotherapy (UGS). All endovenous techniques act by destroying the inner lining of the vein or intima allowing the vein to seal off and turn into fibrous tissue which is gradually removed by the body.

The ClariVein catheter has two components - a wire rotating at high speed that damages the inner lining combined with injection of liquid sclerosant to complete venous occlusion.This mechanical-chemical ablation technique is unique. The combination is a very efficient and painless way to seal the vein.

What are the advantages and disadvantages for ClariVein?

Advantages

Minimal discomfort during the procedure with no need for local anaesthesia.
No admission to hospital or general anaesthesia.
No time off work nor interference with normal home duties.
No chance of injury to adjacent nerves.
Less post-operative discomfort than for any other technique.

Disadvantages

The dose limit for sclerosant limits the number of veins that can be treated in one session - the device is not reusable.
This means that multiple treatment sessions may be required.
Results regarding long-term efficacy for this new technique are not available. However, our early results show 85% successful vein closure at one year.

What should you do before ClariVein?

Advice will have been given about the type and use of compression garments.

Do not shave the legs.
Do not apply moisturiser on the day of treatment.
Wear slacks or loose trousers and sandals or loose shoes to allow for the thickness of the compression garments.
Do not have treatment within four weeks of travelling overseas or two weeks after return.

What happens during ClariVein?

A sonographer may perform a limited ultrasound scan similar to the initial screening scan to familiarise us with the veins.
You are awake with no need for anaesthesia apart from one small injection to introduce the device.
The ClariVein catheter is inserted into the vein under ultrasound control, the tip is positioned at the top of the vein and the device is activated.
The tip rotates as the device is slowly withdrawn destroying the inner lining. At the same time, sclerosant solution is infused through the end of the catheter.
Compression is then applied by a compression garment.
You will need to return later to complete treatment with ultrasound-guided sclerotherapy of the residual varices.

What should you do after ClariVein?

Walk for 15 minutes immediately after treatment.
Arrange for someone to drive you home or go home by taxi or public transport - it is essential that patients do not drive on the day of treatment. Driving can resume on the following day.
Walk for 15 minutes each day.
Wear the support garments continuously until going to bed. Wear the support garments only through the day, remove them at night and replace them in the morning after the shower. Continue this for approximately 7-10 days or longer if pain develops after they are discarded.
Maintain normal daytime activities and avoid standing still for long periods. Continue with normal exercise activities.
Avoid flights of greater than 4 hours duration for 4 weeks after treatment. If travel is unavoidable, then the flight should be covered by subcutaneous heparin injections given before departure and after arrival.
Return for a check ultrasound scan within a few days after treatment to ensure that the treated vein is occluded, determine whether any further veins require treatment, and exclude the small risk of deep vein occlusion.
Bring your compression garments to every follow-up visit.

What can you expect following ClariVein?

The following features are expected. They are not a cause for concern although they should be reported at review:

Mild pain persists for several days and shows that treatment is working. The degree is related to the initial size of the veins. Pain is usually improved by walking or by Panadol or Nurofen. Soreness can occur behind the knee from rubbing by the compression garment.
Discolouration and tender lumps over tributaries may develop particularly after subsequent sclerotherapy. They usually disappear within 4-6 weeks. This indicates that treatment has been successful. Lumps may need to be pricked to let out "trapped blood".
Recurrence. Treated veins can reopen or new veins can develop. For this reason, regular ultrasound surveillance is offered so that recurrent veins can be detected and easily treated by UGS before they become too large.

What are the possible complications from ClariVein?

Complications can occur even with perfect technique.

Deep vein thrombosis. Clots extending into the deep veins can occur. This potentially serious complication is very uncommon if the protocol of compression and regular daily walking is followed. If this is demonstrated on the postoperative scan then you may require treatment with daily heparin injections until further scans show the clot is resolving.
Allergic reaction to the sclerosant is rare. It can present immediately as an anaphylactic reaction with generalised rash, constriction in the throat or difficulty with breathing, and this is successfully treated by injecting cortisone or adrenaline. Allergy may cause a skin rash requiring antihistamines. Allergy is slightly more likely in asthmatics. Patients should stay in the building for 20 minutes after any form of treatment to ensure that no allergic reactions occur.

Complications after ClariVein.

Pigmentation along the treated veins consists of haemosiderin, a form of iron from the blood. Most disappears within 12 months but there is permanent staining in about 2-3% and this is of cosmetic significance. Persistent pigmentation may be able to be managed by laser treatment.
Nerve damage We are not aware of any reports of damage to major nerves.
Stroke There have been no reported cases after ClariVein

What are the advantages and disadvantages for ClariVein?

Advantages

· Minimal discomfort during the procedure with no need for local anaesthesia.

· No admission to hospital or general anaesthesia.

· No time off work nor interference with normal home duties.

· No chance of injury to adjacent nerves.

· Less post-operative discomfort than for any other technique.

Disadvantages

· The dose limit for sclerosant limits the number of veins that can be treated in one session - the device is not reusable.

· This means that multiple treatment sessions may be required.

· Results regarding long-term efficacy for this new technique are not available. However, our early results show 85% successful vein closure at one year.

What should you do before ClariVein?

Advice will have been given about the type and use of compression garments.

· Do not shave the legs.

· Do not apply moisturiser on the day of treatment.

· Wear slacks or loose trousers and sandals or loose shoes to allow for the thickness of the compression garments.

· Do not have treatment within four weeks of travelling overseas or two weeks after return.

What happens during ClariVein?

· A sonographer may perform a limited ultrasound scan similar to the initial screening scan to familiarise us with the veins.

· You are awake with no need for anaesthesia apart from one small injection to introduce the device.

· The ClariVein catheter is inserted into the vein under ultrasound control, the tip is positioned at the top of the vein and the device is activated.

· The tip rotates as the device is slowly withdrawn destroying the inner lining. At the same time, sclerosant solution is infused through the end of the catheter.

· Compression is then applied by a compression garment.

· You will need to return later to complete treatment with ultrasound-guided sclerotherapy of the residual varices.

What should you do after ClariVein?

· Walk for 15 minutes immediately after treatment.

· Arrange for someone to drive you home or go home by taxi or public transport - it is essential that patients do not drive on the day of treatment. Driving can resume on the following day.

· Walk for 15 minutes each day.

· Wear the support garments continuously until going to bed. Wear the support garments only through the day, remove them at night and replace them in the morning after the shower. Continue this for approximately 7-10 days or longer if pain develops after they are discarded.

· Maintain normal daytime activities and avoid standing still for long periods. Continue with normal exercise activities.

· Avoid flights of greater than 4 hours duration for 4 weeks after treatment. If travel is unavoidable, then the flight should be covered by subcutaneous heparin injections given before departure and after arrival.

· Return for a check ultrasound scan within a few days after treatment to ensure that the treated vein is occluded, determine whether any further veins require treatment, and exclude the small risk of deep vein occlusion.

· Bring your compression garments to every follow-up visit.

What can you expect following ClariVein?

The following features are expected. They are not a cause for concern although they should be reported at review:

· Mild pain persists for several days and shows that treatment is working. The degree is related to the initial size of the veins. Pain is usually improved by walking or by Panadol or Nurofen. Soreness can occur behind the knee from rubbing by the compression garment.

· Discolouration and tender lumps over tributaries may develop particularly after subsequent sclerotherapy. They usually disappear within 4-6 weeks. This indicates that treatment has been successful. Lumps may need to be pricked to let out "trapped blood".

· Recurrence. Treated veins can reopen or new veins can develop. For this reason, regular ultrasound surveillance is offered so that recurrent veins can be detected and easily treated by UGS before they become too large.

What are the possible complications from ClariVein?

Complications can occur even with perfect technique.

· Deep vein thrombosis. Clots extending into the deep veins can occur. This potentially serious complication is very uncommon if the protocol of compression and regular daily walking is followed. If this is demonstrated on the postoperative scan then you may require treatment with daily heparin injections until further scans show the clot is resolving.

· Allergic reaction to the sclerosant is rare. It can present immediately as an anaphylactic reaction with generalised rash, constriction in the throat or difficulty with breathing, and this is successfully treated by injecting cortisone or adrenaline. Allergy may cause a skin rash requiring antihistamines. Allergy is slightly more likely in asthmatics. Patients should stay in the building for 20 minutes after any form of treatment to ensure that no allergic reactions occur.

Complications after ClariVein.

· Pigmentation along the treated veins consists of haemosiderin, a form of iron from the blood. Most disappears within 12 months but there is permanent staining in about 2-3% and this is of cosmetic significance. Persistent pigmentation may be able to be managed by laser treatment.

· Nerve damage We are not aware of any reports of damage to major nerves.

Stroke There have been no reported cases after ClariVein