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

Abstract

Introduction The VenaSeal™ Closure System is a non-thermal, non-tumescent venous closure device that employs a cyanoacrylate adhesive to occlude incompetent veins for superficial truncal reflux. The aim was to examine patient, Duplex-defined venous characteristics and treatment-related factors that may predict variances in remnant stump length at the sapheno-femoral and sapheno-popliteal junctions in the peri-procedural period. Methods A total of 73 patients (87 legs; 85 great saphenous veins; 11 small saphenous veins) of median age 63 years (range 26–86 years) underwent VenaSeal™ Closure System ablation. 44/85 (52%) great saphenous veins were treated with a modified instructions-for-use technique of using double-dose injection of glue (0.3 cc) at initial deposition for great saphenous veins diameters >6 mm. Median great saphenous veins and small saphenous veins lengths ablated were 48.0 cm (range 13–69 cm) and 32.0 cm (range 19–40 cm), respectively. A total of 62/87 (71.3%) legs had CEAP classification 4–6. A completion Duplex scan was performed immediately and 1 week post-procedure to measure remnant stump lengths at the sapheno-femoral and sapheno-popliteal junctions. Multivariate regression modelling was used to look for predictors of remnant stump length. Results Mean sapheno-femoral and sapheno-popliteal junctions stump lengths immediately post procedure were 33.0 mm (range 0–58 mm) and 27 mm (range 5–33 mm), –17.0 mm and –23.0 mm less than the expected 50-mm baseline length, respectively. At 1 week post-procedure, mean sapheno-femoral and sapheno-popliteal junctions stump lengths were 25.0 mm and 25.0 mm, respectively, the former found to be shorter compared to immediately post-procedure (25 mm vs 33 mm; p < 0.05). Multivariate analysis found larger upper thigh great saphenous veins diameter at sapheno-femoral junction to be predictive of shorter remnant stump lengths immediately post-procedure (<30 mm stump distance). Larger sapheno-femoral junction diameters and pre-existing ischemic heart disease for the sapheno-femoral junction and larger small saphenous veins diameters and age for the sapheno-popliteal junction were predictive of interval shortening of the measured remnant lengths found at the completion of the procedure and 1 week later. Initial double-dosing application of glue was not found to be predictive of shorter stump lengths. Conclusion In patients undergoing VenaSeal™ Closure System ablation for superficial truncal reflux, larger upper thigh great saphenous veins diameters predicted shorter remnant sapheno-femoral junction stump lengths immediately post-procedure. Comparing stump lengths at one week to immediately after procedure, larger sapheno-femoral junctions and ischemic heart disease predicted shorter stump lengths at the sapheno-femoral junction, while larger small saphenous vein diameters predicted shorter stump lengths at the sapheno-popliteal junction.

Modification of protocol with one extra drop of endovascular cyanoacrylate improved closure rates in incompetent great saphenous veins

“…In additional, this extra drop did not predispose to development of thrombus extrusion into the deep vein or deep vein thrombosis. Contrary to the studies by Kim et al 13 and Lee et al , 14 we did not find any correlation between week-1 stump length and subsequent recanalization. Although our EGIT rate was slightly high at 8.64% (21/243)), most of the EGITs were Class 1 (9/243, 3/7%) and Class 2 (7/243, 2.88%), and only five legs had EGIT Class 3 (5/243, 2.06%).…”

Catheter-guided endovenous cyanoacrylate closure is effective and safe in chronic venous insufficiency of the lower extremity: A Comparative Analysis

“…Recently, one of the prominent NTNT techniques has been the catheter-guided cyanoacrylate adhesive closure (CAC) system 19,20 . In this system, n-butyl cyanoacrylate (NBCA) is injected intravenously.…”