Endovenous chemical ablation and trendelenburg’s (eCAT) operation for treating great saphenous vein varicosities: a single-arm open-label interventional study

TL;DR

A new hybrid procedure called eCAT was developed and tested for treating varicose veins in the great saphenous vein, showing high success rates and minimal complications.

Contribution

The eCAT procedure combines Trendelenburg’s operation with polidocanol foam sclerotherapy to offer a minimally invasive treatment for varicose veins.

Findings

GSV ablation succeeded in all 500 patients, with 88% full occlusion at 1 week and 88% at 1 year.

Postoperative complications like oedema and hyperpigmentation resolved within a year.

Pain scores significantly decreased after the eCAT procedure.

Abstract

Varicose veins of the lower limbs, particularly involving the great saphenous vein (GSV), are a common vascular condition often requiring intervention. Conventional surgeries entail higher morbidity and prolonged recovery. To minimize complications while ensuring efficacy, a novel hybrid technique —Endovenous Chemical Ablation and Trendelenburg’s operation (eCAT) —was developed. This study aimed to evaluate the efficacy and safety of the eCAT operation for treating GSV varicosities.

A single-arm open-label interventional study was conducted on 500 patients with primary lower limb varicose veins (2014–2021). The eCAT procedure, developed by Walied Khereba at Al-Azhar University (New Damietta), combined Trendelenburg’s operation with polidocanol foam sclerotherapy under local anaesthesia. The primary outcome was GSV ablation efficacy at 1 week, 3 months, and 1 year. Secondary outcomes included postoperative complications, pain reduction, and factors influencing success.

GSV ablation succeeded in all cases (100%). At 1 week, 88% of veins were fully occluded and 12% partially; at 3 months, full occlusion decreased to 76%, then improved to 88% at 1 year. Postoperative complications included oedema (30%), hyperpigmentation (20%), and residual varicosities (40%), all resolved by 1 year. Median pain scores decreased from 4 (IQR: 1) preoperatively to 2 (IQR: 1) at 1 week and 1 (IQR: 0) at both 3 months and 1 year (P = 0.001). Age, gender, and standing occupation significantly impacted early surgical success.

The eCAT is a safe, effective, and minimally invasive procedure for GSV varicosities treatment, achieving durable clinical outcomes with minimal complications and significant pain reduction.

Figures