Comparison Between Cyanoacrylate Embolization and Radiofrequency Ablation for Superficial Venous Incompetence: A Systematic Review and Meta-analysis

Abstract

BACKGROUND Chronic venous disease is a debilitating condition involving great saphenous vein (GSV) incompetence. OBJECTIVE To investigate the efficacy and effectiveness of cyanoacrylate embolization (CAE) versus radiofrequency ablation (RFA) in patients with incompetent GSVs. MATERIALS AND METHODS PubMed, Embase, and the Cochrane library were searched. The primary outcomes were the Venous Clinical Severity Score (VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ), closure rate, and visual analog scale (VAS) for pain. RESULTS This meta-analysis included 378 and 590 patients who underwent CAE and RFA, respectively. Cyanoacrylate embolization was comparable with RFA in VCSS (weighted mean difference [WMD] = −0.03, 95% confidence interval [CI]: −0.18 to 0.12, p = .686), AVVQ (WMD = −0.08, 95% CI: −0.38 to 0.21, p = .570), closure rate (odds ratio [OR] = 0.61, 95% CI: 0.18–2.01, p = .414), and VAS (standardized mean difference [SMD] = 0.24, 95% CI: −0.59 to 1.06, p = .523). There were no significant differences between CAE and RFA regarding the occurrence of phlebitis (OR = 1.22, 95% CI: 0.70–2.13, p = .479) and pigmentation (OR = 0.48, 95% CI: 0.18–1.31, p = .153), but CAE had a lower risk of ecchymosis (OR = 0.45, 95% CI: 0.25–0.81, p = .007) and paresthesia (OR = 0.16, 95% CI: 0.03–0.99, p = .049). CONCLUSION Cyanoacrylate embolization and RFA demonstrated no significant differences in VCSS, AVVQ, closure rate, and pain score for patients with incompetent GSVs. Patients in the CAE group had a lower risk of ecchymosis and paresthesia compared with the RFA group.

Outcomes of cyanoacrylate closure of the truncal varicose vein insufficiency: A comparison between young and elderly patients

“…Furthermore, while severe complications such as DVT and PE are less common with CAC procedure compared to other approaches, it should be highlighted that these complications may directly contribute to morbidity and mortality rates, particularly in the elderly population. 29,30 Major complications were more prevalent in the elderly than in the younger group in our study cohort. One of these patients (86-year-old female) was intubated after DVT related PE and died on postoperative day 7.…”

“…24,27,28 Encouraging occlusion rates of target veins after CAC procedure have been reported in several studies and meta-analyses. 29,30 However, an age-specific randomized-controlled study of the outcomes of CAC procedures has not yet been published. It may be considered that CAC procedures for superficial trunk varices may be performed with low risk rates in the elderly population.…”

Efficiency of endovenous laser and glue ablation methods in comparison with conventional surgery for the treatment of venous ulcers

“…Various research studies compared the efficiency of different techniques in the literature. [25][26][27][28][29][30] However, none of the methods were significantly proven to be superior over the others as well as compression therapy alone in means of ulcer healing as well as duration of healing 31 . The choice of treatment has changed to less invasive methods in time rather than conventional surgical techniques for enhanced patient comfort, no necessity for general or spinal/epidural anesthesia, less pain, lesser wound complications, and less loss of work days.…”

Large Diameter Is Associated With High Recanalization Rate During Cyanoacrylate Closure Treatment of Great Saphenous Vein Insufficiency

“…However, the CAC group provides better results than the RFA group with lower risk of ecchymosis and paresthesia. 3 Although the occlusion rate is similar between the groups, great saphenous vein (GSV) diameter at baseline is seen as exclusion data in the study. Cyanoacrylate is known to polymerize with blood and cause mechanical obstruction without causing wall adhesion.…”

“…1 Skincare influencers constitute most posts with dermatologic subcategorical hashtags; by contrast, few board-certified dermatologists, physicians, and dermatology residents use their reach to dispel skincare myths and debunk popular trends. 2,3 One such trend, the hyaluron pen, is an example of a booming skincare fad that has already reached millions of views on TikTok. Hyaluron pens are pen-sized devices that shoot hyaluronic acid filler using "pressure technology" of 1.4 to 1.7 Pa into the dermal layer of the skin's surface (Figure 1).…”