Inframalleolar access in endovenous treatment of venous ulcers and C5 disease with nonthermal nontumescent techniques

Maya Avrahami, Daniel Silverberg, Steve Elias, Ralf Kolvenbach, Noa Shufutinsky, Galit Sivak, Michael Tal, Ram Avrahami*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: To evaluate the use of inframalleolar access for endovenous ablation when treating advanced venous disease with nonthermal nontumescent (NTNT) techniques. Methods: This single-center retrospective study included 109 patients with advanced venous disease, treated using inframalleolar access between May 2018 and March 2020. NTNT techniques included ClariVein (Merit Medical Systems, South Jordan, Utah) and ScleroSafe (VVT Medical, Kefar Sava, Israel). Outcomes measured were postprocedure pain, leg edema, ulcer healing and recurrence rates, and venous insufficiency recurrence. Results: Seventy-seven patients (70%) were treated with ClariVein and 32 (30%) with ScleroSafe. Postprocedure pain score (range, 0-10) after 1 week decreased from a preprocedure median of 5 (interquartile range, 3-6) to 1 ((interqartiel range, 0-2) (P =.0001). Complete wound healing was achieved in 38 patients (43.7%) after 30 days and in 71 patients (81.6%) after 90 days. One patient developed an ulcer recurrence and six developed venous insufficiency recurrence. There was no reported nerve or skin injuries. Conclusions: NTNT ablation techniques using inframalleolar access are effective and safe without risk of nerve damage. Their use facilitates ulcer healing and limits pain in patients with advanced disease.

Original languageEnglish
Pages (from-to)417-422
Number of pages6
JournalJournal of Vascular Surgery: Venous and Lymphatic Disorders
Issue number2
StatePublished - Mar 2022


  • ClariVein
  • Inframalleolar
  • Nonthermal nontumescent
  • Recurrent ulcer
  • ScleroSafe
  • Vein ablation
  • Venous leg ulcer


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