A comparison of cyanoacrylate closure to radiofrequencyablation techniques for treatment of truncal venousinsufficiency

Aim: Cyanoacrylate closure (CAC) has become an alternative to endothermal ablative therapies for chronic venous insufficiency. In this study, we aimed to present our experience with CAC in comparison with radiofrequency ablation (RFA) and discuss the application techniques thereof. Materials and Methods: A retrospective review was performed for adult patients who underwent CAC or RFA for great saphenous vein insufficiency during two years to identify baseline patient and disease characteristics, procedural details and outcomes. The primary outcome was a complete occlusion rate. Secondary outcomes were adverse events/complications and the quality of recovery. Results: In this study, 36 patients (mean age 48.3 ± 11.2 years with 27 women) were treated with either CAC (n =19) or RFA (n = 17) during the defined period. At follow-up, after a mean duration of 8.5 ± 2.2 months, the closure rates were similar at 18/19 vs. 17/17, respectively. Apart from phlebitis and pigmentation, the incidences of bruising, skin burn and paresthesia were lower in the CAC group compared to the RFA group. The mean procedural times were shorter for CAC. In both groups, the Venous Clinical Severity Score significantly improved from baseline to last follow-up, somewhat better in the RFA group. The satisfaction level with the treatment was moderately higher among RFA patients than CAC patients, as well. Conclusion: The findings suggest that while it shortens the procedural time and does not require postoperative stockings, CAC is not a miraculous alternative for those who can duly administer tumescent anesthesia.

PDF

___

1. Wittens C, Davies AH, Bækgaard N, et al. Editor's Choice - Management of chronic venous disease: Clinical practice guidelines of the European Society for Vascular Surgery (ESVS) Eur J Vasc Endovasc Surg 2015;49:678-737.
2. Lawson J, Gauw S, van Vlijmen C, et al. Sapheon: the solution?. Phlebology 2013;28:2-9.
3. Eroglu E, Yasim A. A randomised clinical trial comparing n-butyl cyanoacrylate, radiofrequency ablation and endovenous laser ablation for the treatment of superficial venous ıncompetence: two year follow up results. Eur J Vasc Endovasc Surg 2018;56:553-60.
4. Koramaz İ, El Kılıç H, Gökalp F, et al. Ablation of the great saphenous vein with nontumescent n-butyl cyanoacrylate versus endovenous laser therapy. J Vasc Surg Venous Lymphat Disord 2017;5:210-5.
5. Bozkurt AK, Yılmaz MF. A prospective comparison of a new cyanoacrylate glue and laser ablation for the treatment of venous insufficiency. Phlebology 2016;31:106-13.
6. Puggioni A, Kalra M, Carmo M, et al. Endovenous laser therapy and radiofrequency ablation of the great saphenous vein: analysis of early efficacy and complications. J Vasc Surg 2005;42:488-93.
7. Rasmussen LH, Lawaetz M, Bjoern L, et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg 2011;98:1079-87.
8. Almeida JI, Javier JJ, Mackay EG, et al. Two-year follow-up of first human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. Phlebology 2015;30:397-404.
9. Toonder IM, Lam YL, Lawson J, et al. Cyanoacrylate adhesive perforator embolization (CAPE) of incompetent perforating veins of the leg, a feasibility study. Phlebology 2014;29:49-54.
10. Proebstle TM, Alm J, Dimitri S, et al. The European multicenter cohort study on cyanoacrylate embolization of refluxing great saphenous veins. J Vasc Surg Venous Lymphat Disord 2015;3:2-7.
11. Proebstle T, Alm J, Dimitri S, et al. Three-year followup results of the prospective European Multicenter Cohort Study on Cyanoacrylate Embolization for treatment of refluxing great saphenous veins. J Vasc Surg Venous Lymphat Disord 2021;9:329-34.
12. Yasim A, Eroglu E, Bozoglan O, et al. A new nontumescent endovenous ablation method for varicose vein treatment: Early results of N-butyl cyanoacrylate (VariClose®). Phlebology 2017;32:194-9.
13. Calik ES, Arslan U, Ayaz F, et al. N-butyl cyanoacrylate in the treatment of venous insufficiency--the effect of embolisation with ablative polymerisation. Vasa 2016;45:241-6.
14. Tok M, Tuydeş O, Yuksel A, et al. Early-Term Outcomes for Treatment of Saphenous Vein Insufficiency with N-Butyl Cyanoacrylate: A Novel, Non-Thermal, and Non-Tumescent Percutaneous Embolization Technique. Heart Surg Forum 2016;19:118-22.
15. Dimech AP, Cassar K. Efficacy of Cyanoacrylate Glue Ablation of Primary Truncal Varicose Veins Compared to Existing Endovenous Techniques: A Systematic Review of the Literature. Surg J (N Y) 2020;6:e77-86.
16. Morrison N, Gibson K, McEnroe S, et al. Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous veins (VeClose). J Vasc Surg 2015;61:985- 94.
17. Morrison N, Gibson K, Vasquez M, et al. VeClose trial 12-month outcomes of cyanoacrylate closure versus radiofrequency ablation for incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord 2017;5:321-30.
18. Morrison N, Gibson K, Vasquez M, et al. Five-year extension study of patients from a randomized clinical trial (VeClose) comparing cyanoacrylate closure versus radiofrequency ablation for the treatment of incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord 2020;8:978-89.
19. Yang GK, Parapini M, Gagnon J, et al. Comparison of cyanoacrylate embolization and radiofrequency ablation for the treatment of varicose veins. Phlebology 2019;34:278-83.
20. Kolluri R, Gibson K, Cher D, et al. Roll-in phase analysis of clinical study of cyanoacrylate closure for incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord 2016;4:407-15.
21. Gibson K, Morrison N, Kolluri R, et al. Twenty-four month results from a randomized trial of cyanoacrylate closure versus radiofrequency ablation for the treatment of incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord 2018;6:606-13.
22. O'Banion LAA, Reynolds KB, Kochubey M, et al. Treatment of Superficial Venous Reflux in CEAP 6 Patients: A Comparison of Cyanoacrylate Glue and Radiofrequency Ablation Techniques. J Vasc Surg 2020;72:e336-37.
23. Tekin Aİ, Tuncer ON, Memetoglu ME, et al. Nonthermal, Nontumescent Endovenous Treatment of Varicose Veins. Ann Vasc Surg 2016;36:231-5.
24. Chan YC, Law Y, Cheung GC, et al. Cyanoacrylate glue used to treat great saphenous reflux: Measures of outcome. Phlebology 2017;32:99-106.
25. Park I. Initial Outcomes of Cyanoacrylate Closure, VenaSeal System, for the Treatment of the Incompetent Great and Small Saphenous Veins. Vasc Endovascular Surg 2017;51:545-9.
26. Bademci MS, Tayfur K, Ocakoglu G, et al. A new percutaneous technique: N-butyl cyanoacrylate adhesive for the treatment of giant saphenous vein insufficiency. Vascular 2018;26:194-7.
27. Yavuz T, Acar AN, Aydin H, et al. A retrospective study of a new n-butyl-2-cyanoacrylate glue ablation catheter incorporated with application guiding light for the treatment of venous insufficiency: Twelvemonth results. Vascular 2018;26:547-55.
28. Bekci T, Tosun A. Mechanochemical ablation of varicose veins with N-Butyl Cyanoacrylate: Six-month follow-up. Ann Med Res 2019;26:104-7.