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

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.