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Varicose VeinsPhase 4LAMANCT02627846

Laser Ablation Versus Mechanochemical Ablation Trial

A Phase 4 study testing EVLA, ClariVein® and Lidocaine with 1:200,000 epinephrine solution in people with Varicose Veins, run by Hull University Teaching Hospitals NHS Trust at 1 site in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

A randomised clinical trial comparing endovenous laser ablation and mechanochemical ablation (ClariVein®) in the management of superficial venous insufficiency. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Varicose Veins
What is being tested?
EVLA, ClariVein® and Lidocaine with 1:200,000 epinephrine solution
Could I receive a placebo?
No, everyone receives an active treatment
How many people
150 participants
Where
1 siteUnited Kingdom
Study dates
1 Jun 2015to 4 Sep 2023
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Aged 18 or over
  • Symptomatic SVI which will likely benefit from treatment in the opinion of an experienced specialist and the participant
  • Clinical grades C2-C6 on the CEAP system
  • Superficial axial incompetence with proposed treatment lengths of at least 10cm
  • Treatment with either endovenous laser ablation or mechanochemical ablation is technically feasible in the view of an experienced endovenous specialist
  • Patient is willing to participate (including acceptance of randomisation to either treatment) and give valid, informed consent in the English language

Who cannot join

  • One of the treatments is thought to be preferable by either the patient or an experienced endovenous specialist
  • Unwilling or inability to comply with the requirements for follow-up visits
  • Known allergy to medications or dressings used in the treatment
  • Known right to left circulatory shunt
  • Evidence of acute deep venous thrombosis or complete ipsilateral occlusion
  • Pelvic vein insufficiency
Show all 12Show fewer
  • Active or recent thrombophlebitis (within 6 weeks)
  • Impalpable foot pulses with an Ankle-Brachial Pressure Index of less than 0.8
  • Pregnancy or breast feeding
  • Active malignancy
  • Immobility
  • Involvement in other CTIMP trials within the last 6 months

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • Hull and East Yorkshire Hospitals NHS Trust

    Hull, HU3 2JZ

Other trials in United Kingdom

About this study

Official title: A Randomised Clinical Trial Comparing Endovenous Laser Ablation and Mechanochemical Ablation (ClariVein®) in the Management of Superficial Venous Insufficiency

A randomised clinical trial comparing endovenous laser ablation and mechanochemical ablation (ClariVein®) in the management of superficial venous insufficiency.

Read the detailed description

Varicose veins, a very common problem in UK, may cause symptoms including pain, heaviness and itching in the lower legs. Overtime, bleeding and damage to surround soft tissues may develop, leading to venous ulcer which can be very painful, debilitating, difficult to heal and very expensive to treat.

Newer minimally invasive techniques are preformed using local anaesthetic. The recovery has been shown to be more rapid, due to less pain and disability when compared to open surgery. These techniques use either heat or a chemical/medicine injected inside the varicose veins to close them permanently. In 2013 National Institute of Health and Care Excellence (NICE) recommended that methods using heat such as endovenous laser ablation (EVLA) should be first choice as the chemical methods have been shown to have a significantly lower treatment success rates in closing varicose veins permanently. Chemical methods however do have their advantages, as they require far fewer injections of local anaesthetic than the heat methods and these injections can be a source of significant discomfort.

Since NICE guidelines, a new treatment technique known as mechanochemical ablation (MOCA) using ClariVein® has been developed. This device injects a chemical into the vein through a rotating hollow wire, which causes the vein to narrow and damages the lining of the vein, making the chemical more effective. This new treatment technique aims to match the success rates of the heat method, but with less pain since it avoids most of the local anaesthetic injections. Both treatments are currently used in the UK, however there is insufficient evidence as to whether one is better, or the same.

This trial will randomly allocate volunteer patients to have their varicose veins treated with either EVLA or MOCA. The investigators will assess a range of outcomes including pain scores, success rates, complications, quality-of-life and costs to see which, if any, of these treatments offer better results. Long term follow-ups will occur at 5 and 10 years.

Conditions
Varicose Veins
Being tested
EVLA, ClariVein®, Lidocaine with 1:200,000 epinephrine solution, Sodium Bicarbonate, Sodium Tetradecyl Sulphate
Medical subject headings
Varicose Veins

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • EVLADevice

    Also called Endovenous Laser Ablation

    1% Lidocaine with 1:200,000 epinephrine will be used for skin infiltration. The EVLA fibre is introduced into the vein using the Seldinger technique and its tip will be positioned under duplex ultrasound (DUS). Then tumescent anaesthetic, made of a solution of 100ml of 1% Lidocaine with 1:200,000 epinephrine in 900ml of 0.9% Sodium Chloride and buffered to pH 7.4 with 10ml of 8.4% Sodium Bicarbonate, will be infiltrated around the target axial vein under DUS using a spinal needle and a peristaltic pump. Following deployment of appropriate laser safety precautions, the laser energy will be delivered via the fibre. The wavelength used is 1470nm, with NeverTouch Gold-Tip fibre, at 10W power. This laser light energy is converted into heat inducing a permanent, non-thrombotic occlusion.

  • ClariVein®Device

    Also called Mechanochemical Ablation

    1% Lidocaine with 1:200,000 epinephrine will be used for skin infiltration. MOCA is performed by a device called ClariVein® (Vascular Insights, UK) which is a long thin catheter that is passed up inside the vein, with a rotating wire that protrudes at an angle from the end when deployed. This is motorised via an electric motor in the handle and rotates at approximately 3500 revolutions per minute. In addition, liquid sclerotherapy is injected at the handle end by a syringe. This sclerotherapy liquid emerges from the end of the catheter and is present in the area of the rotating tip. The sclerosant will be Sodium Tetradecyl Sulphate (STS), marketed as Fibrovein. Concentration of 1.5% Fibrovein will be used, and maximum of 12ml.

  • Lidocaine with 1:200,000 epinephrine solutionDrug

    Also called Lignocaine with 1:200,000 adrenaline solution

    It is used as local anaesthetic given via subcutaneous injection, so that the skin is numb prior to the introduction of either endovenous laser ablation or mechenochemical ablation catheter. Typically 1-2ml is required.

  • Lidocaine with 1:200,000 epinephrine solutionDrug

    Also called Lignocaine with 1:200,000 adrenaline solution

    100ml of 1% lidocaine with 1:200,000 epinephrine is diluted into 900ml of 0.9% Sodium Chloride to make the tumescent anaesthetic solution, which is required when using endovenous laser ablation.

  • Sodium BicarbonateDrug

    10ml of 8.4% Sodium Bicarbonate is added into the tumescent anaesthetic solution, to buffer the pH to 7.4. Tumescent anaesthetic solution is required when using endovenous laser ablation.

  • Sodium Tetradecyl SulphateDrug

    Also called Fibrovein Solution for Injection

    1.5% of Sodium Tetradecyl Sulphate, marketed as Fibrovein, will be used with the mechanochemical ablation device (ClariVein®). This is a sclerosing agent with Manufacturer Authorisation, and it will be used unmodified. Intravenous injection causes intima inflammation and thrombus formation. This usually occludes the injected vein.

Study groups in NCT02627846
Study groupRoleWhat they receive
EndoVenous Laser AblationActive comparatorEndoVenous Laser Ablation (EVLA) involves the delivery of laser light through a glass fibre placed into the lumen of a refluxing vein. This energy is converted into heat inducing a permanent, non-thrombotic occlusion.
Receives: Device: EVLA; Drug: Lidocaine with 1:200,000 epinephrine solution; Drug: Sodium Bicarbonate
MechanoChemical Ablation (ClariVein®)Active comparatorMechanochemical ablation (MOCA) is performed by a device called ClariVein® which is a long thin catheter that is passed up inside the vein, with a rotating wire that protrudes at an angle from the end when deployed. This is motorised via an electric motor in the handle and rotates at approximately 3500 revolutions per minute. In addition, liquid sclerotherapy is injected at the handle end by a syringe. This sclerotherapy liquid emerges from the end of the catheter and is present in the area of the rotating tip.
Receives: Device: ClariVein®; Drug: Lidocaine with 1:200,000 epinephrine solution; Drug: Sodium Tetradecyl Sulphate

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Intra-procedural Pain

    Patient is asked immediately after the procedure of their level of pain experienced during the intervention; measured on a standardised visual analogue scale (VAS).

    Measured: Up to end of intervention

  2. Technical Efficacy assessed by successful procedure defined as complete occlusion of the target vein segment.

    Measured: At 1 year

Secondary outcomes (15)
  1. Aberdeen Varicose Vein Questionnaire (AVVQ)

    Disease Specific quality of life

    Measured: 1 week, 6 weeks, 6 months, 1 year

  2. Chronic Venous disease quality of life Questionnaire (CIVIQ-20)

    Disease Specific quality of life

    Measured: 1 week, 6 weeks, 6 months, 1 year

  3. VEnous INsufficiency Epidemiological and Economic Study to evaluate Quality of Life and Symptoms (VEINES-QOL/Sym)

    Disease Specific quality of life

    Measured: 1 week, 6 weeks, 6 months, 1 year

  4. Short Form 36

    Generic quality of life

    Measured: 1 week, 6 weeks, 6 months, 1 year

  5. EuroQol (EQ5D)

    Generic quality of life

    Measured: 1 week, 6 weeks, 6 months, 1 year

  6. Post-procedural Pain

    One week pain diary

    Measured: Throughout the first week after the procedure

  7. Analgesia Use

    One week analgesia diary

    Measured: 1 week

  8. Bruising visual analogue scale

    Appreciation of the severity of bruising

    Measured: 1 week, 6 weeks, 6 months, 1 year

  9. Satisfactory visual analogue scale

    Satisfaction with treatment

    Measured: 1 week, 6 weeks, 6 months, 1 year

  10. Cosmesis visual analogue scale

    Satisfaction with cosmetic result from treatment

    Measured: 1 week, 6 weeks, 6 months, 1 year

  11. Recovery time

    Time taken to return to work (if employed) and daily activity

    Measured: 1 week, 6 weeks, 6 months, 1 year

  12. Complications

    Any numbness, persistent bruising, tenderness, skin loss/ulceration, lumpiness, development of thread, skin staining, wound infection, deep vein thrombosis, pulmonary embolus, stroke, loss of vision, damage to major artery, vein or nerve.

    Measured: 1 week, 6 weeks, 6 months, 1 year

  13. Recurrence of Varicose Veins

    Combination of history taking, clinical examination and duplex ultrasound assessment.

    Measured: 1 week, 6 weeks, 6 months, 1 year

  14. Disease Progression

    Comparison of clinical and duplex ultrasound findings between follow-ups.

    Measured: 1 week, 6 weeks, 6 months, 1 year

  15. Need for Further Treatment

    Comparison of clinical and duplex ultrasound findings between follow-ups is made and should there be failure of intervention or recurrence of varicose veins, there would be consultation between surgeon and patient to decide whether further intervention is required.

    Measured: 1 week, 6 weeks, 6 months, 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Dec 2015 (estimated)
  2. Study start1 Jun 2015
  3. Primary completion1 Aug 2018
  4. Study completion4 Sep 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
150 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02627846
Sponsor's protocol ID
R1788
Acronym
LAMA
Status last verified
Aug 2023
First submitted
1 Dec 2015
Last updated
21 Sep 2023
Results posted
No
Data monitoring committee
Yes

Publications

  • Mohamed AH, Leung C, Wallace T, Smith G, Carradice D, Chetter I. A Randomized Controlled Trial of Endovenous Laser Ablation Versus Mechanochemical Ablation With ClariVein in the Management of Superficial Venous Incompetence (LAMA Trial). Ann Surg. 2021 Jun 1;273(6):e188-e195. doi: 10.1097/SLA.0000000000003749.

    PubMed 31977509
  • Leung CC, Carradice D, Wallace T, Chetter IC. Endovenous laser ablation versus mechanochemical ablation with ClariVein((R)) in the management of superficial venous insufficiency (LAMA trial): study protocol for a randomised controlled trial. Trials. 2016 Aug 24;17(1):421. doi: 10.1186/s13063-016-1548-1.

    PubMed 27552990

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing EVLA, ClariVein® and Lidocaine with 1:200,000 epinephrine solution in people with Varicose Veins, run by Hull University Teaching Hospitals NHS Trust at 1 site in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 21 Sep 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Intra-procedural Pain (time frame: Up to end of intervention). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02627846, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Sep 2023.

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