Clarivein® might have a role in the treatment of truncal pelvic vein reflux, but not in the treatment of pelvic varicosities – results from an ovine model.

Aims: Pelvic vein embolisation is the recognised treatment for symptomatic pelvic vein reflux. There is a requirement to ablate incompetent pelvic veins without using an implantable device. The aim of this study was to assess the use of the Clarivein® device as a potential method of ablating incompetent pelvic veins.

Methods: An ovine model was employed that utilised a freshly euthanased female adult sheep (ewe). At post-mortem examination, the ovarian veins were identified on each side. A Clarivein® catheter was then introduced directly into both right and left ovarian veins proximally and passed caudally. The device was activated and withdrawn at 7sec/cm. The same methodology was used in a nearby retro-peritoneal mesenteric vein for comparison.

Results: In the ewe, the distal ovarian veins lie in a peritoneal fold similar to the broad ligament in the human. In this area, the vein is relatively unsupported compared to the ovarian vein trunk which is retroperitoneal, but lying on the posterior abdominal wall. In the unsupported section, the vein rotated instantly with the wire, entangling itself and ensnaring the device. However, the mesenteric vein that lay directly on the posterior abdominal wall allowed passage and treatment by the rotating wire, without any ensnaring of the device.

Conclusion: The rotation of the Clarivein® wire tip requires the vein to have sufficient supporting tissue to resist being rotated with the wire, becoming entangled with the device. This was not found in the pelvic veins lying within the peritoneal folds around the ovaries, but was found in retroperitoneal veins lying on the posterior abdominal wall. This suggests that the Clarivein® catheter should not be used in pelvic varicosities, but there might be a place for this or similar devices to treat retroperitoneal veins that are held against the abdominal or pelvic wall by the parietal peritoneum.

Whiteley, M. S., Nemchand, J. L., La Ragione, R. M., & Beckett, D. (2023, June 21). Clarivein® might have a role in the treatment of truncal pelvic vein reflux, but not in the treatment of pelvic varicosities – results from an ovine model. https://doi.org/10.31219/osf.io/byfvg