Three-year Outcomes of Aspiration-assisted Foam Mechanochemical Ablation for Saphenous Vein Insufficiency: A Retrospective Comparative Study

Abstract

Mechanochemical ablation (MOCA) is an established non-thermal treatment for saphenous vein insufficiency. However, long-term durability remains limited by recanalization. This study evaluated the long-term outcomes of aspiration-assisted foam MOCA compared with conventional MOCA and investigated factors associated with anatomical failure. This retrospective comparative cohort study included 220 consecutive patients with symptomatic great or small saphenous vein insufficiency. The first 110 patients underwent conventional MOCA using liquid polidocanol, whereas the subsequent 110 patients were treated with aspiration-assisted foam MOCA. All patients completed a 36-month clinical and duplex ultrasound follow-up. The primary endpoint was anatomical success, defined as complete vein occlusion without partial or complete recanalization. At 36 months, anatomical success was achieved in 83 of 110 patients (75.5%) treated with conventional MOCA and in 95 of 110 patients (86.4%) treated with aspiration-assisted foam MOCA. Recanalization occurred in 24.5% and 13.6% of patients, respectively. Both groups demonstrated significant clinical improvement. Preoperative vein diameter was strongly associated with anatomical failure, with recanalization rates increasing from 6.0% in veins measuring ≤ 8 mm to 83.3% in veins larger than 12 mm. Multivariate analysis identified preoperative vein diameter as the strongest independent predictor of recanalization (OR 1.87 per 1-mm increase, p < 0.001). Two cases of deep vein thrombosis and no cases of pulmonary embolism were observed. Aspiration-assisted foam MOCA was associated with higher anatomical success than conventional MOCA at 36 months. Preoperative vein diameter was the most powerful predictor of recanalization and should be considered when selecting patients for mechanochemical ablation.