Cyanoacrylate adhesive embolization and sclerotherapy for primary varicose veins

Abstract

Various treatment methods are available for the treatment of varicose veins, and there has been a recent surge in the usage of cyanoacrylate glue for treating varicose veins. Purpose To investigate the technical possibility, efficiency and safety of cyanoacrylate adhesive embolization and sclerotherapy using commonly available n-butyl cyanoacrylate glue for the treatment of primary varicose veins due to great saphenous vein reflux with or without incompetent perforators. Materials and Methods One hundred forty-five limbs of 124 patients with varicose veins due to great saphenous vein reflux were subjected to cyanoacrylate adhesive embolization and sclerotherapy - adhesive embolization of great saphenous vein in the thigh and perforators using cyanoacrylate followed by sclerotherapy of any residual varicose veins in the leg. Procedural success, venous closure rates and clinical improvement were assessed. Follow-up for 1, 3, 6, 9 and 12 months was obtained. Results Technical success rate was 100%. Saphenous vein closure rate was 96.5% at one year. There was no femoral venous extension of cyanoacrylate in any of the patients. Posterior tibial vein extension of cyanoacrylate was seen in three patients (2.6%) without untoward clinical effect.Significant improvement was found in venous clinical severity score (VCSS) from a baseline mean of 7.98 ± 4.42 to 4.74 ± 3, 1.36 ± 1.65 and 0.79 ± 1.19 at 1, 6 and 12 months' follow-up. Ulcer healing rate was 100%. Conclusion Cyanoacrylate adhesive embolization and sclerotherapy for the treatment of primary varicose veins is efficacious and can be performed as an outpatient procedure, but has a guarded safety profile due to its propensity to cause deep venous occlusion if not handled carefully.

A systematic review and meta-analysis comparing the efficacy of cyanoacrylate ablation over endovenous thermal ablation for treating incompetent saphenous veins

“…In the published prospective studies, including the case series, almost all studies had a set maximum size of included veins, which ranged in diameter from 15 mm 17 as the maximum size to 8 mm as the minimum. 18 Although there were slight differences in the included diameters, the closure rates of CA were similar (one-year occlusion rates of 92–96.8% 6,7,12,16,18–21 ) However, Chan’s study 22 reported that the one-year occlusion rate of 108 legs was 75.7%, among which the rate was 90% for veins with an average diameter <6.6 mm and 58.6% for veins with a diameter ≥6.6 mm. Chan et al.…”

Management of Lower Extremity Pain from Chronic Venous Insufficiency: A Comprehensive Review

“…Subsequent studies have demonstrated promising outcomes for patients treated with CAE, especially with regard to symptomatic improvement. VCSS scores were improved by > 50%, with continued favorable safety profiles [ 230 – 232 ].…”

Infective thrombophlebitis after great saphenous vein cyanoacrylate embolization

“…The safety of CAE has been established in multiple trials 6, 7, 10, . Beyond the early postoperative period, infection related to CAE has not previously been reported at studies out to 36 months follow up [3][4][5][6][12][13][14][15][16][17][18] . Phlebitis and erythema have been reported as late complications; however, these have not been specifically attributed to infection in the studies appraised.…”