Efficiency and Midterm Results of Glue Ablation with Cyanoacrylate and Endovenous Thermal Ablation with Radiofrequency of Great Saphenous Vein Under Warfarin Therapy

ABSTRACT INTRODUCTION: The number of articles examining the percutaneous treatment of chronic venous insufficiency in patients receiving warfarin therapy is insufficient especially for glue ablation. The aim of our study was to evaluate the early and midterm postprocedural outcomes of glue ablation with cyanoacrylate closure and endovenous thermal ablation with radiofrequency and to compare these techniques in a group of patients with uninterrupted warfarin therapy. METHODS: From January 2013 to January 2018, a total of 306 patients who underwent glue ablation or endovenous thermal ablation with radiofrequency of the great saphenous vein under either tumescent or local anesthesia due to chronic venous insufficiency were included in this study. Of 306 patients, 30 patients (12 males, 18 females; mean age 63,28±3,46 years; range 51 to 72 years) underwent either glue ablation (11 patients) or endovenous thermal ablation (19 patients) under warfarin therapy. RESULTS: Recanalization was observed in 5 patients (16.6%) during the follow-up period. Of these 5 patients, 4 patients (21%) underwent endovenous thermal ablation with radiofrequency and 1 patient (9%) underwent glue ablation. One-year success rate of glue ablation with cyanoacrylate closure and endovenous thermal ablation with radiofrequency were 90,9% and 78,9%, respectively (P=0.047). Five patients with recanalization have treated with glue ablation with 100% success. DISCUSSION and CONCLUSION: Glue ablation could be safely and effectively performed in patients with uninterrupted warfarin therapy without postprocedural bleeding or deep vein thrombosis and, it was associated with superior mid and longterm results compared to the endovenous thermal ablation with radiofrequency.

Büyük Safen Venin Siyanoakrilat ile Glue Ablasyon ve Radyofrekans ile Endovenöz Termal Ablasyon İşlemlerinin Varfarin Tedavisi Alan Hastalarda Verimliliği ve Orta Dönem Sonuçları

ÖZ GİRİŞ ve AMAÇ: Varfarin tedavisi alan hastalarda kronik venöz yetmezliğinin perkütan tedavisi sonuçlarını araştıran çalışma sayısı özellikle glue ablasyon açısından yetersizdir. Çalışmamızın amacı, siyanoakrilat ile glue ablasyon veya radyofrekans ile endovenöz termal ablasyon tedavilerinin, erken ve orta dönem sonuçlarını değerlendirmek ve bu teknikleri varfarin tedavisi alan hasta grubunda karşılaştırmaktır. YÖNTEM ve GEREÇLER: Ocak 2013 ile Ocak 2018 tarihleri arasında, kronik venöz yetmezliği tanısı ile büyük safen venin tümesan veya lokal anestezi altında, siyanoakrilat ile glue ablasyon veya radyofrekans ile endovenöz termal ablasyon tedavisi yapılan toplam 306 hasta çalışmaya dahil edildi. 306 hastanın 30'una (12 erkek, 18 kadın; ort. yaş 63,28 ± 3.46 yıl; dağılım 51-72 yıl) varfarin tedavisi altında glue ablasyon (11 hasta) veya endovenöz termal ablasyon (19 hasta) tedavisi uygulandı. BULGULAR: Takip süresi içerisinde 5 hastada (% 16.6) rekanalizasyon gözlendi. Bu 5 hastadan 4'üne (% 21) radyofrekans ile endovenöz termal ablasyon, 1'ine (% 9) ise glue ablasyon tedavisi uygulanmıştı. Siyanoakrilat ile glue ablasyon ve radyofrekans ile endovenöz termal ablasyon tedavilerinin bir yıllık başarı oranları sırasıyla % 90,9 ve% 78,9 bulundu (P = 0,047). Rekanalizasyon gelişen beş hasta ise glue ablasyon ile % 100 başarı ile tedavi edilmiştir. TARTIŞMA ve SONUÇ: İşlem sonrası kanama veya derin ven trombozu olmaksızın glue ablasyon işlemi varfarin tedavisi altında güvenli ve etkili bir şekilde yapılabilmekle beraber, radyofrekans ile endovenöz termal ablasyon tedavisine kıyasla orta dönem sonuçları daha üstün bulunmuştur.

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1. Maurins U, Hoffmann BH, Lösch C, et al. Distribution and prevalence of reflux in the superficial and deep venous system in the general population-results from the Bonn Vein Study, Germany. J Vasc Surg. 2008; 48:680-687.

2. Heller J. Treatment of chronic venous insufficiency. Endovascular Today 2011 (October Suppl);12–5.

3. Theivacumar NS, Dellagrammaticas D, Beale RJ, Mavor AI, Gough MJ. Factors influencing the effectiveness of endovenous laser ablation (EVLA) in the treatment of great saphenous vein reflux. Eur J Vasc Endovasc Surg 2008;35:119-23.

4. Ravi R, Trayler EA, Barrett DA, Diethrich EB. Endovenous thermal ablation of superficial venous insufficiency of the lower extremity: singlecenter experience with 3000 limbs treated in a 7-year period. J Endovasc Ther 2009;16:500-5.

5. Inderhaug E, Schelp CH, Glambek I, Kristiansen IS. Cost-effectiveness analysis of five procedures for great saphenous vein reflux in a Norwegian healthcare setting or societal setting. SAGE Open Med. 2018 Sep 24;6:2050312118801709.

6. Park I. Initial Outcomes of Cyanoacrylate Closure, VenaSeal System, for the Treatment of the Incompetent Great and Small Saphenous Veins. Vasc Endovascular Surg. 2017 Nov;51(8):545-549.

7. Sharifi M, Mehdipour M, Bay C, Emrani F, Sharifi J. Effect of anticoagulation on endothermal ablation of the great saphenous vein. J Vasc Surg 2011;53:147-9.

8. Almgren B, Eriksson E. Valvular incompetence in superficial, deep and perforator veins of limbs with varicose veins. Acta Chirurg Scand. 1990; 156:69–74.

9. Riesenman PJ, de Fritas DJ, Konigsberg SG, Kasirajan K. Noninterruption of Warfarin Therapy is Safe and Does not Compromise Outcome in Patients Undergoing Endovenous Laser Therapy (EVLT). Vasc Endovascular Surg. 2011 Aug;45(6):524-6.

10. Yang GK, Parapini M, Gagnon J. Comparison of cyanoacrylate embolization and radiofrequency ablation for the treatment of varicose veins. Phlebology. 2018 Aug 16:268355518794105.

11. Bozkurt AK, Yilmaz MF. A prospective comparison of a new cyanoacrylate glue and laser ablation for the treatment of venous insufficiency. Phlebology 2016;31:106-13.

12. Theivacumar N, Gough M. Influence of warfarin on the success of endovenous laser ablation of the great saphenous vein. Eur J Vasc Endovascular Surg 2009;38:506-10.

13. Faltas B, Kouides PA. Update on perioperative bridging in patients on chronic oral anticoagulation. Expert Rev Cardiovasc Ther. 2009;7(12):1533-1539.

14. Sharifi M, Mehdipour M. Percutaneous therapy of acute on chronic lower extremity venous occlusive disease. Catheteriz Cardiovasc Interv 2010;75: 685-9.

15. Gabriel V, Jimenez JC, Alktaifi A, et al. Success of Endovenous Saphenous and Perforator Ablation in Patients With Symptomatic Venous Insufficiency Receiving Long-Term Warfarin Therapy. Ann Vasc Surg. 2012 Jul;26(5):607-11.

16. Delaney CL, Russell DA, Iannos J. Is endovenous laser ablation possible while taking warfarin? Phlebology. 2012 Aug;27(5):231-4.