Efficacy of Cyanoacrylate Glue Ablation of Primary Truncal Varicose Veins Compared to Existing Endovenous Techniques: A Systematic Review of the Literature

Abstract

<jats:title>Abstract</jats:title><jats:p> Introduction One-third of adults in the United States and United Kingdom suffer from varicose veins. n-butyl-2-cyanoacrylate (NBCA) glue is a novel endovascular, nontumescent, nonthermal ablation technique for treatment of this condition. It has proved effective in multiple studies since its first use in 2013. The aim of this systematic review is to assess the efficacy of NBCA in ablating primary truncal varicose veins and eliminating reflux compared with existing endovascular techniques. Secondary outcomes include complications and quality of life.</jats:p><jats:p> Methods PRISMA was used as a guide and studies were screened for risk of bias and methodological quality. Subjects had to be ≥18 years of age and followed-up posttreatment with color Duplex ultrasound (DUS). Eligibility criteria included saphenofemoral junction (SFJ) or saphenopopliteal junction (SPJ) incompetence with reflux down truncal veins lasting &gt;0.5 seconds on DUS interrogation and a Clinical, Etiological, Anatomical, and Pathophysiological classification of venous disorders ranging between C1 and C6.</jats:p><jats:p> Results Out of 2,910 patients (3,220 veins) in 17 studies, 1,981 were administered NBCA, 445 radiofrequency ablation (RFA), and 484 endovenous laser ablation (EVLA) with mean procedure times of 25.7, 23.2, and 28.7 minutes, respectively. Mean recruitment period was 9 months (1–36 months) and followed-up for an average of 12.3 months (1–36 months). The majority were C2 to C3. Two-year occlusion rates were 93.7, 90.9, and 91.5% for NBCA, RFA, and EVLA, respectively. NBCA-treated patients experienced the least complications, with bruising, phlebitis, and pain being the most prevalent. Quality of life improved equally in all three modalities.</jats:p><jats:p> Conclusion NBCA is simple to administer, safe, and effective even without compression stockings. Further studies are required to assess longer-term benefit and the effect of anticoagulation on vein obliteration.</jats:p>

Venous Segmental Flow Changes after Superficial Venous Intervention Demonstrating by Quantitative Phase-Contrast Magnetic Resonance Analysis: Preliminary Data from a Longitudinal Cohort Study

“…The introduction of endovenous techniques almost 20 years ago changed the treatment of varicose veins [ 11 , 12 , 13 ]. Minimally invasive technology, such as segmental radiofrequency, hemoglobin-specific lasers, water-specific lasers, endovenous steam, and mechanochemical and cyanoacrylate ablation, has been proven to be safe and is becoming more popular than the standard surgical method (high ligation and stripping) [ 11 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

Two-Year Follow-Up after Endovenous Closure with Short-Chain Cyanoacrylate versus Laser Ablation in Venous Insufficiency

“…Since the first approval of n-butyl cyanoacrylate for the treatment of truncal venous insufficiency in 2011, cyanoacrylate-mediated vein ablation was announced as a fast, painless and effective method in that indication [6][7][8][9][10][11][12][13][18][19][20]. The first two mentioned advantages result from no need for a time-consuming tumescent anesthesia.…”

“…In that case, the lack of tumescent anesthesia, although emphasized as the main benefit of cyanoacrylate-based procedures, does not prevent the presence of blood persisting in some segments of the vein after treatment. Since persisting blood will coagulate, subsequent fibrinolysis may result in recanalization, which may then be considered as the method-specific finding of treatment failure [10,18]. This assumption could be supported by the higher prevalence of recanalization in the VenaBlock group, observed even in the short-term assessment [14].…”

Strategies and challenges in treatment of varicose veins and venous insufficiency

“…CAE is a novel endovascular NTNT ablation technique for treatment of incompetent truncal veins with n -butyl-2-cyanoacrylate (NBCA) glue[ 56 - 58 ]. Multiple studies have shown the effectiveness of CAE since its first use in 2013.…”

“…The mean followed-up was 12.3 mo (1–36 mo). Two-year occlusion rates were 93.7, 90.9, and 91.5% for NBCA, RFA, and EVLA, respectively[ 58 ]. CAE had higher anatomic closure rates at 30 d than EVLA[ 16 ].…”