Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202301432
Jornal Vascular Brasileiro
Study Protocol

Mechanochemical ablation (MOCA) for superficial venous insufficiency: a protocol for a systematic review with meta-analysis

Ablação mecanoquímica (MOCA) para insuficiência venosa superficial: protocolo de revisão sistemática e meta-análise

Simone Pedroso Jardim; Vinicius Farina Sartori; Iana Kátia Araújo Gonçalves; Carolina Dutra Queiroz Flumignan; Jorge Eduardo de Amorim; Ronald Luiz Gomes Flumignan; Luis Carlos Uta Nakano

http://dx.doi.org/10.1590/1677-5449.202301432 J Vasc Bras, vol.24, e20230143, 2025
PDF
Downloads: 0
Views: 39

Abstract

Varicose veins are a common disease worldwide, mainly affecting adults, and are estimated to be the 7th most common reason for physician referral in the USA. There is no ideal technique for treatment of varicose veins. Several techniques have emerged in recent years: the most widely used are thermal techniques such as laser and radio frequency and non-thermal techniques such as chemical and mechanochemical ablation (MOCA). MOCA employs a combination of physical damage to the vessel with infusion of a sclerosant fluid with the objective of improving the effects and avoiding disadvantages of thermal ablation such as pain and nerve injuries. The aim of this study will be to evaluate the effects of MOCA for treatment of superficial varicose veins in the lower limbs. We will search randomized controlled trials of MOCA for treatment of varicose veins. The search strategy will include free text terms and controlled vocabulary terms (e.g. Emtree, MeSH) for ‘varicose veins’, ‘varices’, ‘ablation’, ‘mechanical ablation’, ‘chemical ablation’, and ‘mechanochemical ablation’. We will search at least the following databases: Medline (via Pubmed), Embase, Cochrane Central Register of Controlled Trials, Lilacs, Ibecs, WHO Clinical Trials Platform, and Clinicaltrials.com. The risks of bias will be evaluated with the Cochrane tool. We will report structured summaries of the included studies and conduct meta-analyses if possible. Development of new treatments such as MOCA must be encouraged and validation by systematic reviews is required to demonstrate their effects and support better clinical treatment decisions.

Keywords

varicose veins, veins, saphenous vein, ablation techniques, sclerosis, sclerosing solutions, sclerotherapy, review, evidence-based medicine, meta-analysis

Resumo

As varizes são uma das doenças mais comuns no mundo, afetando principalmente adultos, e estima-se que representem o sétimo motivo mais frequente de encaminhamento médico nos EUA. Embora não haja consenso sobre a técnica ideal para o tratamento de varizes, várias abordagens surgiram nos últimos anos. As técnicas térmicas, como laser e radiofrequência, e as técnicas não térmicas, como ablação química e mecanoquímica (MOCA), estão entre as mais usadas. A MOCA combina o dano físico ao vaso com a infusão de uma solução esclerosante, buscando potencializar os efeitos e evitar as desvantagens associadas às técnicas térmicas, como dor e lesões nervosas. O objetivo deste estudo é avaliar os efeitos da MOCA no tratamento de veias varicosas superficiais nos membros inferiores. Serão incluídos ensaios clínicos randomizados e controlados que investiguem a técnica para o tratamento de varizes. A estratégia de pesquisa abrangerá termos controlados (por exemplo, Emtree, MeSH) e de texto livre relacionados a “varizes”, “ablação”, “ablação mecânica”, “ablação química” e “ablação mecanoquímica”. Serão consultadas, no mínimo, as seguintes bases de dados: Medline (via PubMed), Embase, Cochrane Central Register of Controlled Trials, LILACS, IBECS, WHO Clinical Trials Platform e Clinicaltrials.com. Os riscos de viés serão avaliados por meio da ferramenta da Cochrane. Serão apresentados resumos estruturados dos estudos incluídos e, quando possível, realizadas metanálises. O desenvolvimento de novos tratamentos, como a MOCA, deve ser incentivado, e sua validação por meio de revisões sistemáticas é essencial para demonstrar seus efeitos e orientar uma melhor tomada de decisão clínica.

Palavras-chave

varizes, veias, veia safena, técnicas de ablação, esclerose, soluções esclerosantes, escleroterapia, revisão, medicina baseada em evidências, metanálise

References

1 Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health. 1999;53(3):149-53. https://doi.org/10.1136/jech.53.3.149. PMid:10396491.

2 Rabe E, Berboth G, Pannier F. Epidemiology of chronic venous diseases. Wien Med Wochenschr. 2016;166(9–10):260-3. https://doi.org/10.1007/s10354-016-0465-y. PMid:27277219.

3 Fan C-M. Epidemiology and pathophysiology of varicose veins. Tech Vasc Interv Radiol. 2003;6(3):108-10. https://doi.org/10.1053/S1089-2516(03)00060-X. PMid:14614693.

4 Brand FN, Dannenberg AL, Abbott RD, Kannel WB. The epidemiology of varicose veins: the Framingham Study. Am J Prev Med. 1988;4(2):96-101. https://doi.org/10.1016/S0749-3797(18)31203-0. PMid:3395496.

5 Kaplan RM, Criqui MH, Denenberg JO, Bergan J, Fronek A. Quality of life in patients with chronic venous disease: San Diego population study. J Vasc Surg. 2003;37(5):1047-53. https://doi.org/10.1067/mva.2003.168. PMid:12756353.

6 Van den Oever R, Hepp B, Debbaut B, Simon I. Socio-economic impact of chronic venous insufficiency: an underestimated public health problem. Int Angiol J Int Union Angiol. 1998;17(3):161-7. PMid:9821029.

7 Whiteley MS. Glue, steam and Clarivein: best practice techniques and evidence. Phlebology. 2015;30(2, Suppl):24-8. https://doi.org/10.1177/0268355515591447. PMid:26556699.

8 Leung CCM, Carradice D, Wallace T, Chetter IC. Endovenous laser ablation versus mechanochemical ablation with ClariVein(®) in the management of superficial venous insufficiency (LAMA trial): study protocol for a randomised controlled trial. Trials. 2016;17(1):421. https://doi.org/10.1186/s13063-016-1548-1. PMid:27552990.

9 Bishawi M, Bernstein R, Boter M, et al. Mechanochemical ablation in patients with chronic venous disease: a prospective multicenter report. Phlebology. 2014;29(6):397-400. https://doi.org/10.1177/0268355513495830. PMid:23820117.

10 van Eekeren RRJP, Boersma D, de Vries J-PPM, Zeebregts CJ, Reijnen MM. Update of endovenous treatment modalities for insufficient saphenous veins: a review of literature. Semin Vasc Surg. 2014;27(2):118-36. https://doi.org/10.1053/j.semvascsurg.2015.02.002. PMid:25868763.

11 Boersma D, Smulders DLJ, Bakker OJ, van den Haak RF, Verhoeven BA, Koning OH. Endovenous laser ablation of insufficient perforating veins: energy is key to success. Vascular. 2016;24(2):144-9. https://doi.org/10.1177/1708538115587214. PMid:25972028.

12 Vun SV, Rashid ST, Blest NC, Spark JI. Lower pain and faster treatment with mechanico-chemical endovenous ablation using ClariVein®. Phlebology. 2015;30(10):688-92. https://doi.org/10.1177/0268355514553693. PMid:25300311.

13 Paravastu SCV, Horne M, Dodd PDF. Endovenous ablation therapy (laser or radiofrequency) or foam sclerotherapy versus conventional surgical repair for short saphenous varicose veins. Cochrane Database Syst Rev. 2016;11(11):CD010878. https://doi.org/10.1002/14651858.CD010878.pub2. PMid:27898181.

14 Higgins GS, editor. Cochrane handbook for systematic reviews of interventions version 5.1.0. Copenhagen; 2011 cited 2016 Feb 21]. http://handbook.cochrane.org/

15 Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. https://doi.org/10.1186/2046-4053-4-1. PMid:25554246.

16 Katz J, Melzack R. Measurement of pain. Surg Clin North Am. 1999;79(2):231-52. https://doi.org/10.1016/S0039-6109(05)70381-9. PMid:10352653.

17 Sousa FAEF, da Silva TCR, Siqueira HBOM, et al. Pain from the life cycle perspective: evaluation and measurement through psychophysical methods of category estimation and magnitude estimation. Rev Lat Am Enfermagem. 2016;24(0):e2769. https://doi.org/10.1590/1518-8345t.0714.2769. PMid:27556875.

18 Cochrane. Review Manager (Revman). Version 5.3.5 [software]. Copenhagen: Nordic Cochrane Centre; 2014.

19 Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-60. https://doi.org/10.1136/bmj.327.7414.557. PMid:12958120.

20 Higgins JPT, Whitehead A, Simmonds M. Sequential methods for random-effects meta-analysis. Stat Med. 2011;30(9):903-21. https://doi.org/10.1002/sim.4088. PMid:21472757.

21 Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924-6. https://doi.org/10.1136/bmj.39489.470347.AD. PMid:18436948.

22 GRADEpro. GRADEpro GDT. Hamilton: McMaster University, Evidence Prime Inc.; 2015 [cited 2017 Feb 22]. http://gradepro.org/

23 Schunemann HJ, Santesso N. Choosing comparisons and outcomes for the “summary of findings’ tables. 2011 [cited 2017 Mar 1]. https://www.cochrane.org/learn/courses-and-resources/cochrane-methodology/grade-approach/introduction-grade

Submitted date:
10/11/2024

Accepted date:
08/05/2025

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
69a979c8a953952c513ad91b jvb Articles
Links & Downloads
1677-7301 (Electronic)
J Vasc Bras ©2026 All rights reserved.

J Vasc Bras

Share this page
Page Sections