Treatment of incompetent perforators in recurrent venous insufficiency with adhesive embolization and sclerotherapy

Abstract

Recurrent lower limb venous insufficiency is often a challenge in clinical practice and is most commonly due to incompetent perforators. Many of these patients do not have adequate symptom relief with compression and require some form of treatment for incompetent perforator interruption. Various treatment methods have been tried with different efficiencies. Objective To evaluate the feasibility, efficiency and safety of an outpatient combined cyanoacrylate adhesion-sodium tetradecyl sulphate sclerotherapy for treatment of patients with symptoms of persistent or recurrent lower limb venous insufficiency secondary to incompetent perforators. Methods Eighty-three limbs of 69 patients with symptoms of persistent or recurrent lower limb venous insufficiency secondary to incompetent perforators were treated with cyanoacrylate embolization of incompetent perforators and sclerotherapy of dilated collateral veins (surface branch varicose veins). Technical success, procedural pain, perforator occlusion, venous occlusion, clinical improvement and ulcer healing were assessed. Follow-up was done three- and six-month post-procedure. Results Procedure could be successfully performed in all patients. One hundred and ninety-one perforators were treated in total. Perforator and varicose veins occlusion rate was 100%. Deep venous extension of cyanoacrylate occurred in four (4.8%) patients, with no adverse clinical outcome. Venous clinical severity score improved from a baseline of 8.18 ± 3.60 to 4.30 ± 2.48 on three-month follow-up and 2.42 ± 1.52 on six-month follow-up (p < 0.0001). All ulcers showed complete healing within three months. Significant prolonged thrombophlebitis occurred in 38.5% of limbs. Conclusion Combined cyanoacrylate adhesion and setrol sclerotherapy is technically easy, has a lot of advantages including being an outpatient procedure and highly efficacious but with a guarded safety profile.

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

“…One concern is the inadequate control of the junction during application of the glue, resulting in glue extension past the sapheno-femoral junction (SFJ)/saphenopopliteal junction (SPJ) into the deep system, as shown in similar CAG-based glue devices. 6 In this scenario, there is a theoretical risk of developing deep vein thrombosis (DVT), along with potentially lifethreatening complications such as pulmonary embolism. As such, current instructions for use (IFU) suggest an arbitrary safety distance to commence glue administration 50 mm caudal to the SFJ for the great saphenous vein (GSV) and SPJ for the small saphenous vein (SSV), respectively, with ultrasound compression 3 cm away from the junction.…”

Factors related to the size of venous leg ulcers

“…Prasad et al also reported a group of patients with recurrent CVI with a minimum diameter of 3 mm of PVs in the fascial layer. [21] In our study, the average diameter of the PVs of ulcers ≤2 cm was 3.2 ± 1.4 mm, the average diameter of the PVs of ulcers >2 cm was 3.8 ± 1.1 mm, and the comparison between the two groups was statistically significant ( P < .001). Single factor and multiple factor logistic regression analyses were used, confirming that the diameter of PVs around ulcers was an independent risk factor for ulcer diameter.…”

Cyanoacrylate adhesive embolization and sclerotherapy for primary varicose veins

“…In a previous study on the usage of undiluted glue for perforator occlusion, the incidence of deep venous extension was 4.8%. 32 Although the method of delivery of cyanoacrylate was different compared to treatment of varicose veins using specialized proprietary cyanoacrylate, the principle is the same, and it could be expected that the results be comparable. Different studies on proprietary cyanoacrylate glue occlusion of saphenous veins have shown different occlusion rates as presented in Table 4.…”