Institution of a Double-Dosing Protocol Using Cyanoacrylate Glue for Larger Diameter Refluxing Superficial Truncal Veins

Predictive factors for changes in remnant stump length during and after the treatment of incompetent truncal saphenous veins using cyanoacrylate

“…Mean GSV diameter was defined as the average of the above three measurements in keeping with previous methodology used. 5,8 Inclusion criteria were 1. Age >21 years and able to give informed consent for the procedure 2.…”

“…All procedures were performed by a single operator (TYT) and followed a modified IFU VenaSeal TM ablation protocol as previously described. 5,8 Important aspects of the technique to highlight are the tip of the introducer sheath/delivery catheter complex was advanced to the SFJ/SPJ under ultrasonic guidance and withdrawn 5 cm caudal to the junction. With regard to the SPJ, the tip was never placed past the fascial curve in order to minimize spillage of CAG into the deep system.…”

“…The main difference from IFU guidance is the double-dose injection of CAG after the initial 1 cm pullback (total 0.30 cc CAG deposited) at the beginning before the initial compression of 3 min -a technique we term as double treatment. 8 A completion Duplex scan was performed immediately and 1 week post-procedure in the standing position.…”

“…Phlebology 35 (8) SSV diameter for SPJ stump length <30 mm immediately post-procedure. Ischemic heart disease (p < 0.01), maximum diameter of SFJ (p < 0.01) and immediate post-op stump length <30 mm (p < 0.01) were found to be predictive of shorter remnant stump lengths at 1 week compared to immediately post procedure at the SFJ (Table 5).…”

Re: “Modification of protocol with one extra drop of endovascular cyanoacrylate improved closure rates in incompetent great saphenous veins”—time to rethink the instructions for use for VenaSeal™?

“…Our group has previously described a similar double-dosing regimen to counter this re-opening effect in incompetent GSVs after we found early recurrences in our early experience using the same device. 2 Our double-dosing regimen was slightly different from the one described here and followed the manufacturer’s IFU except that at the SFJ, rather than the usual 0.1 mL, 0.2 mL is injected immediately after the initial 1-cm pullback of the delivery catheter. Furthermore, where the GSV was focally dilated (>6 mm), at the level where significant branches came in and where incompetent perforators were located, double-dosing of CAG was injected with simultaneous gentle external massage using the ultrasound probe, to deliberately allow for glue dispersion into these incompetent venous reservoirs to cause occlusion.…”