ClariVein mechanochemical ablation: background and procedural details.

OBJECTIVES: The 2 primary objectives of this publication are to provide a practical step-by-step procedure for the ClariVein system and a focused literature review of endovenous ablation. MATERIALS AND METHODS: The ClariVein system is the first venous ablation technique to employ a hybrid (dual-injury) technique built into 1 catheter-based delivery system. Endomechanical abrasion is produced by the tip of the catheter's rotating wire (mechanical component); and endovenous chemical ablation (EVCA) is via simultaneous injection of sclerosant over the rotating wire (chemical component). The author is an early adopter of this technique and via experience has developed a detailed step-by-step protocol. DISCUSSION: To date, there have been 2 pivotal clinical studies published using the ClariVein system. These data are compared with the results using other methods of endovenous ablation. CONCLUSIONS: The ClariVein system is an exciting addition to the phlebologist's toolbox and has the potential to become a first-line treatment.

First-generation agents: aspirin, heparin and coumarins.

Aspirin, heparin and the coumarins are the classical anti-thrombotic agents. They represent the platform upon which newer drugs holding the promise of greater efficacy and less toxicity are being developed. Even as such newer drugs arrive into clinical practice, the older agents remain remarkable for their decades-long pre-eminence. All derive from natural sources, and none from a search for therapeutic anti-thrombotic agents; they have saved countless lives but also served as essential probes into basic mechanisms of thrombosis. Testament to their clinical importance is that these agents are the only drugs profiled on a regular basis in special scientific statements by the American Heart Association/American College of Cardiology and by the American College of Chest Physicians. This chapter reviews their biology, uses and limitations.