# Comparing venous wall effects using the empty vein ablation technique with VELEX catheter, endovenous laser ablation and foam sclerotherapy in an animal model

## TL;DR

This study compares three vein treatment techniques in sheep, finding that empty vein ablation causes more vein wall damage than laser ablation and foam sclerotherapy.

## Contribution

The study introduces new insights into the effectiveness of empty vein ablation in reducing residual vein wall layers compared to established techniques.

## Key findings

- Empty vein ablation (EVA) showed significantly less residual intima and media thickness compared to EVLA and FS.
- FS-Val had lower residual media thickness than standard FS, but still higher than EVA.
- EVA demonstrated superior vein wall damage reduction in both intima and media layers.

## Abstract

To describe residual intima and the average media thickness persisted after the empty vein ablation (EVA) technique, endovenous laser ablation (EVLA), and foam sclerotherapy (FS) in a sheep in vivo model.

Six iliofemoral and two jugular sheep vein axes were treated as follows: four with EVA (using polidocanol [POL] 0.5% or 1% with 1 or 3 minutes as contact time), two with FS (FS-1 and FS during Valsalva maneuver [FS-Val], POL1% for 10 minutes), and two with EVLA (1470 nm radial, 80 J/cm2).

The average percentage of residual intima layer was 2% (interquartile range [IQR]: 1%-4%) for EVA-POL0.5%-1 minute, 1% (IQR: 0%-3.5%) for EVA-POL0.5%-3 minutes, 2% (IQR: 0%-4%) for EVA-POL1%-1 minute, 0 for EVA-POL1%-3 minutes, 13% (IQR: 13%-15.7%) for FS, 1% (IQR: 0%-3%) for FS-Val, and 1% (IQR: 0%-6%) for EVLA. The average percentage of residual media thickness was 13% (IQR: 8%-15%) for EVA-POL0.5%-1 minute, 6% (IQR: 4%-9%) for EVA-POL0.5%-3 minutes, 13% (IQR: 10%-27%) for EVA-POL1%-1 minute, 6% (IQR: 5%-12%) for EVA-POL1%-3 minutes, 51% (IQR: 40%-62%) for FS, 29% (IQR: 23%-35%) for FS-Val, and 62% (IQR: 41%-75%) for EVLA.

EVA demonstrated better results in vein wall damage compared with EVLA and FS, both in intima and media layers.

This study provides crucial insights into the effectiveness of different vein treatment techniques, particularly the empty vein ablation method, in minimizing residual intima and media thickness. By evaluating these outcomes in a sheep model, it highlights how empty vein ablation may lead to more vein wall damage compared with endovenous laser ablation and foam sclerotherapy. For clinicians, understanding the comparative efficacy of these treatments is vital for optimizing patient care in managing venous diseases. As the field evolves, these findings could influence clinical decision-making, encouraging the adoption of techniques that promote better long-term outcomes for patients.