A multicenter randomized controlled trial of cyanoacrylate closure and surgical stripping for incompetent great saphenous veins

Joh, Jin Hyun; Lee, Taeseung; Byun, Seung Jae; Cho, Sungsin; Park, Hyung Sub; Yun, Woo‐Sung; Yang, Shin‐Seok; Kim, Hyangkyoung; Kim, Woo-Shik; Jung, In Mok

doi:10.1016/j.jvsv.2021.08.012

Cited by 19 publications

(8 citation statements)

References 23 publications

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“…Endovenous cyanoacrylate ablation was compared to surgical stripping in a randomized controlled trial with 63 patients in each group [5]. The 12-month closure rate was 100% in both groups, but the pain and bruising scores were significantly lower in the NBCA group.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies have demonstrated the efficacy and safety of endovenous cyanoacrylate ablation for the treatment of superficial venous insufficiency. A randomized controlled trial of surgical stripping vs. endovenous cyanoacrylate ablation found 100% target vein closure at 3 months in both groups, with similar quality-of-life improvements but significantly less pain and bruising in the cyanoacrylate group [5]. Another randomized controlled trial compared endovenous cyanoacrylate ablation to radiofrequency ablation [6].…”

Section: Introductionmentioning

confidence: 99%

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Cyanoacrylate Glue for Treating Chronic Saphenous Vein Insufficiency: A Retrospective Observational Single-Center Study

Falvo¹,

Latreche²,

Chevallier³

et al. 2023

Diagnostics

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Endovenous thermal methods are superseding surgical stripping for treating chronic superficial venous disease but require tumescent anesthesia and can cause heat-related nerve injuries. Endovenous cyanoacrylate ablation is a more recent technique that does not share these drawbacks. A retrospective observational study of consecutive adults managed with endovenous cyanoacrylate was conducted in 2018–2021 at a single university center. The follow-up was 18 months. We identified factors associated with target vein closure at 18 months and measured changes in quality of life using the generic 36-item Short-Form (SF-36) tool and the venous disease-specific VEINES-QOL/Sym questionnaire. Adverse events were collected. In the 55 study patients with 67 treated veins, the closure rate at 18 months was 94% (95% CI, 85–98%). Target vein diameter ≥9.5 mm had 81% sensitivity and 75% specificity for predicting recanalization. Quality-of-life scores improved significantly (p < 0.001 for both surveys). The only adverse event was a type IV allergic reaction to cyanoacrylate that was resolved with corticosteroid and histamine-antagonist therapy. Endovenous cyanoacrylate ablation was highly effective and is safe in experienced hands. Studies are warranted to determine whether changes in the protocol increase the closure rate in patients with target veins ≥9.5 mm in diameter.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cyanoacrylate Glue for Treating Chronic Saphenous Vein Insufficiency: A Retrospective Observational Single-Center Study

Falvo¹,

Latreche²,

Chevallier³

et al. 2023

Diagnostics

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“…В сроки 3 мес. частота окклюзии составила 100%, но показатели послеоперационной боли и экхимозов были значимо ниже в группе ЦКО [28].…”

Section: цианоакрилатная клеевая облитерация в американских клиническ...unclassified

Cyanoacrylate adhesive closure in the European and American 2022 clinical practice guidelines

Shirinbek¹

2023

Ambulatornaya khirurgiya

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Over the last decade non-thermal non-tumescent (NTNT) methods of truncal reflux elimination in chronic venous disease (CVD) are becoming increasingly popular. The main NTNT modalities are mechanochemical ablation and cyanoacrylate adhesive closure (CAC). The advantages of non-thermal ablation are avoidance of tumescent anesthesia, low periprocedural pain and bruising, high patient comfort and satisfaction rates. CAC method has an additional benefit of avoiding the postprocedural compression. CAC is one of promising non-thermal ablation procedures, that leads to truncal vein occlusion and reflux elimination via endovenous delivery of n-butyl-2-cyanoacrylate. This review is aimed at assessment of the updated European and American clinical practice guidelines on CVD management, particularly the role of CAC. Current evidence shows high efficacy and safety of the CAC, its advantages regarding the periprocedural pain and ecchymoses, risk of adverse events, closure rates in the long-term, procedure and recovery time and patients’ quality of life. Therefore, along the current gold standard of varicose vein treatment – thermal ablation, the updated 2022 European and American clinical practice guidelines have significantly emphasized the role of NTNT modalities in general and CAC in particular. Specifically, the European Society for Vascular Surgeons guidelines recommend CAC for patients with great saphenous vein (GSV) incompetence when the NTNT technique is preferred. American guidelines recommend both thermal and non-thermal ablation for the patients with symptomatic axial reflux of the GSV, depending on the available expertise of the treating physician and the preference of the patient.

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“…Our initial experience showed that this inflammatory reaction occurred in 1 of 21 patients (4.7%) who underwent CAC for bilateral GSV reflux [ 12 ]. The CASS trial comparing the clinical outcomes between the CAC and surgical stripping groups showed that 3 of 63 patients (4.8%) experienced this complication after the CAC procedure [ 10 ]. A lower incidence of phlebitis (3.2%) than that in our findings was reported by Tekin et al [ 13 ].…”

Section: Prevalencementioning

confidence: 99%

“…This trial demonstrated that both CAC and surgical stripping achieved complete occlusion of the target vein (TV) at 3 months. Postoperative pain and ecchymosis grades were significantly lower in the CAC group than in the conventional surgical stripping group [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Complex Hypersensitivity and Irritation Reaction (CHAIR) Phenomenon after Cyanoacrylate Closure of Varicose Vein

Joh,

Joo

2023

Vasc Specialist Int

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Cyanoacrylate glue is a non-thermal, non-tumescent agent used to treat saphenous reflux. It was introduced to overcome heat-related discomfort and complications. Multiple randomized controlled trials using this therapy have demonstrated excellent clinical outcomes at long-term follow-up. However, diffuse injection-site inflammation and systemic urticaria are worrisome complications. In preclinical studies, serial histopathological findings demonstrated acute inflammatory reaction, subacute vasculitis, chronic granulomatous foreign body reaction, fibrotic changes with partial vascular recanalization, and chronic foreign body-type inflammatory response. While the exact nature of this unique complication remains undefined, complex hypersensitivity and irritation reaction phenomena have been suggested based on reported clinical presentations. The incidence of this complication has been reported as ranging from 0.3%-25.4%. Typically, erythematous reactions can occur near treatment sites, with symptoms ranging from mild pruritus and/or erythema that resolves without treatment to recurrent severe inflammation and pruritus requiring nonsteroidal anti-inflammatory drugs, antihistamines, and/or corticosteroids. Surgical excision has been rarely reported in patients with severe intractable inflammation or treatment-site infections. Although several anecdotal studies reported on using antihistaminics or corticosteroids, no effective strategies have been established to prevent this complication.

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A multicenter randomized controlled trial of cyanoacrylate closure and surgical stripping for incompetent great saphenous veins

Cited by 19 publications

References 23 publications

Cyanoacrylate Glue for Treating Chronic Saphenous Vein Insufficiency: A Retrospective Observational Single-Center Study

Cyanoacrylate Glue for Treating Chronic Saphenous Vein Insufficiency: A Retrospective Observational Single-Center Study

Cyanoacrylate adhesive closure in the European and American 2022 clinical practice guidelines

Complex Hypersensitivity and Irritation Reaction (CHAIR) Phenomenon after Cyanoacrylate Closure of Varicose Vein

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