Ultrasound-guided cyanoacrylate injection for the treatment of incompetent perforator veins

Mordhorst, Alexa; Yang, Gary K.; Chen, Jerry C.; Lee, Shung; Gagnon, Joël

doi:10.1177/02683555211015564

Cited by 7 publications

(4 citation statements)

References 23 publications

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“…При этом открытые хирургические вмешательства из нашего арсенала практически исключены и пациентам не предлагаются. Cледует отметить, что помимо бассейна магистральных подкожных вен клеевая технология находит успешное применение и в облитерации несостоятельных перфорантных вен нижних конечностей [11][12][13].…”

Section: показания к процедуре и отбор пациентовunclassified

“…По данным РКИ, частота окклюзии вен после ЦКО в сроки через год составила 92,1-92,9% [1, 3], через 3 года -88,5-94,7% [29,30] и через 5 лет -91,4% [2], что перекликается и с нашими собственными результатами лечения [21]. Частота окклюзии несостоятельных перфорантных вен после клеевой облитерации, по данным разных авторов, варьирует от 76-86,5 до 100% [11][12][13].…”

Section: техника клеевой облитерацииunclassified

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From the experience of more than 1000 glue ablation procedures for varicose veins: how to do it

Shirinbek

2024

Ambulatornaya khirurgiya

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Cyanoacrylate adhesive closure (CAC) is currently one of the main non-thermal ablation modalities of incompetent saphenous veins. High efficacy and safety of the method is supported by international clinical practice guidelines as well as the real-world practice. In contrast to thermal ablation, CAC is advantageous in terms of low periprocedural pain and bruising, fast procedure time and postprocedural recovery, high patient comfort and satisfaction rates as well as avoidance of postprocedural compression. This publication summarises the practical tips and tricks of glue ablation procedure based on 5-year experience (2019–2023) at the “SM-Clinic” Phlebology Centre, Moscow. Indications for the preferred use of CAC are formulated, such as: low pain threshold; contraindications (or unwillingness) to postprocedural compression; extensive comorbidity and fragile patients; concomitant morbid obesity; the presence of axial reflux along the saphenous veins; the need for simultaneous ablation of several incompetent truncal veins; below-the-knee incompetence of saphenous veins, including recurrent varicose veins; extensive lipodermatosclerosis and/or venous leg ulcer; patient’s HIV and viral hepatitis positive status. A step-by-step interventional protocol of glue ablation is described, including the modified protocols of the procedure. The immediate and long-term outcomes of the CAC according to current data are discussed. Special attention is paid to adverse events following CAC, as well as technical aspects of their prevention. Despite high efficacy and safety profile, today’s limitations for adoption and wider use of CAC are cost issues and lack of reimbursement.

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Section: показания к процедуре и отбор пациентовunclassified

Section: техника клеевой облитерацииunclassified

From the experience of more than 1000 glue ablation procedures for varicose veins: how to do it

Shirinbek

2024

Ambulatornaya khirurgiya

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“…A further advantage of CAG over MOCA is that it can be used directly down a needle into an IPV, using a TRLOP technique. 113 , 130 However, the leading CAG product is currently expensive compared to EVTA and there have been several reports of inflammation, sometimes very severe, as well as extension into the deep veins. 131–134 As with MOCA, good proof of cost effectiveness is required for CAG ablation to become a major competitor to EVTA.…”

Section: Treatmentsmentioning

confidence: 99%

Current Best Practice in the Management of Varicose Veins

Whiteley¹

2022

CCID

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This article outlines the current best practice in the management of varicose veins. “Varicose veins” traditionally means bulging veins, usually seen on the legs, when standing. It is now a general term used to describe these bulging veins, and also underlying incompetent veins that reflux and cause the surface varicose veins. Importantly, “varicose veins” is often used for superficial venous reflux even in the absence of visible bulging veins. These can be simply called “hidden varicose veins”. Varicose veins usually deteriorate, progressing to discomfort, swollen ankles, skin damage, leg ulcers, superficial venous thrombosis and venous bleeds. Patients with varicose veins and symptoms or signs have a significant advantage in having treatment over conservative treatment with compression stockings or venotropic drugs. Small varicose veins or telangiectasia without symptoms or signs can be treated for cosmetic reasons. However, most have underlying venous reflux from saphenous, perforator or local “feeding veins” and so investigation with venous duplex should be mandatory before treatment. Best practice for investigating leg varicose veins is venous duplex ultrasound in the erect position, performed by a specialist trained in ultrasonography optimally not the doctor who performs the treatment. Pelvic vein reflux is best investigated with transvaginal duplex ultrasound (TVS), performed using the Holdstock-Harrison protocol. In men or women unable to have TVS, venography or cross-sectional imaging is needed. Best practice for treating truncal vein incompetence is endovenous thermal ablation. Increasing evidence suggests that significant incompetent perforating veins should be found and treated by thermal ablation using the transluminal occlusion of perforator (TRLOP) approach, and that incompetent pelvic veins refluxing into symptomatic varicose veins in the genital region or leg should be treated by coil embolisation. Bulging varicosities should be treated by phlebectomy at the time of truncal vein ablation. Monitoring and reporting outcomes is essential for doctors and patients; hence, participation in a venous registry should probably be mandatory.

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“…1 Research has shown a clear association between the presence of IPVs and recurrent varicose veins/venous ulcers. 2,3 Certain measures such as ligation of the IPV at the fascia, sub-fascial endoscopic perforator vein surgery (SEPS), 4 TRansLuminal Occlusion of Perforators (TRLOP) 5 techniques, and the use of cyanoacrylate products 6 are utilized in IPV treatment. As an open surgery, ligation of the IPV at the fascia carries the risk of infection and delayed wound healing.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of incompetent perforator vein excision using stab avulsion

et al. 2022

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Objectives Whether incompetent perforator veins (IPVs) require treatment remains controversial. We retrospectively evaluated the feasibility of IPV excision performed using the stab avulsion technique without ligation and sutures in patients undergoing endovenous ablation (EA). Methods This was a single-center, retrospective, observational cohort study. EA was performed in 1503 consecutive patients, including 33 patients with ulcers, between December 2014 and May 2021. Varicectomy was performed using the stab avulsion technique; IPV cases were included. Results Stab avulsion was performed at a mean number of 11.4 ± 7.8 sites. No deep vein thromboses or pulmonary emboli were noted. The incidence of nerve injury was 0.3%. All 33 (100%) patients with ulcers achieved healing by 1 year (median: 55.5 days; range: 13–365 days). Conclusions IPV excision via stab avulsion may be a viable option for treating varicose veins and ulcers. This technique offers multiple advantages, including simplicity, safety, and reduced healthcare costs.

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Ultrasound-guided cyanoacrylate injection for the treatment of incompetent perforator veins

Cited by 7 publications

References 23 publications

From the experience of more than 1000 glue ablation procedures for varicose veins: how to do it

From the experience of more than 1000 glue ablation procedures for varicose veins: how to do it

Current Best Practice in the Management of Varicose Veins

Feasibility of incompetent perforator vein excision using stab avulsion

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