# 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.

## Key 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.