1
|
Siribumrungwong B, Wilasrusmee C, Orrapin S, Srikuea K, Benyakorn T, McKay G, Attia J, Rerkasem K, Thakkinstian A. Interventions for great saphenous vein reflux: network meta-analysis of randomized clinical trials. Br J Surg 2021; 108:244-255. [PMID: 33793723 PMCID: PMC10364879 DOI: 10.1093/bjs/znaa101] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/12/2020] [Accepted: 11/01/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND A variety of endovascular and open surgical interventions exist to treat great saphenous vein reflux. However, comparisons of treatment outcomes have been inconsistent. METHODS A systematic review and network meta-analysis of RCTs was performed to compare rates of incomplete stripping or non-occlusion of the great saphenous vein with or without reflux (anatomical failure) at early, mid- and long-term follow-up; and secondary outcomes (reintervention and clinical recurrence) among intervention groups. The surface under the cumulative ranking curve (SUCRA) method was used to estimate the probability of the intervention with the lowest anatomical failure rates. RESULTS Some 72 RCTs were included. Comparisons of endothermal techniques with open surgery were mostly not significantly different, except for endovenous laser ablation (EVLA), which had higher long-term anatomical failure rates (pooled risk ratio (RR) 1.87, 95 per cent c.i. 1.14 to 3.07). Mechanochemical ablation had higher anatomical failure rates than radiofrequency ablation (RFA) (pooled RR 2.77, 1.38 to 5.53), and cyanoacrylate closure (CAC) had a RR 0.56 (0.34 to 0.93) times lower than either RFA or EVLA at the early term. Ultrasound-guided foam sclerotherapy had a higher risk of anatomical failure and reintervention than open surgery, with the lowest SUCRA value, and CAC was ranked first, third and first for best intervention for anatomical failure at early, mid and long term respectively. However, clinical recurrence rates were not significantly different between all comparisons. CONCLUSION Mechanochemical ablation and ultrasound-guided foam sclerotherapy performed poorly, with higher anatomical failure rates in the long term. The other treatment modalities had similar rates of anatomical failure in the short and mid term.
Collapse
Affiliation(s)
- B Siribumrungwong
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thammasat University Hospital, Pathum Thani, Thailand.,Centre of Excellence in Applied Epidemiology, Thammasat University Hospital, Thammasat University, Pathum Thani, Thailand
| | - C Wilasrusmee
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S Orrapin
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thammasat University Hospital, Pathum Thani, Thailand
| | - K Srikuea
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thammasat University Hospital, Pathum Thani, Thailand
| | - T Benyakorn
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thammasat University Hospital, Pathum Thani, Thailand
| | - G McKay
- Centre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - J Attia
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, and Hunter Medical Research Institute, NSW, Australia
| | - K Rerkasem
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine; Non-Communicable Disease Centre of Excellence, Research Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - A Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
2
|
Balcı AB, Sanrı US, Özsin KK, Tatlı AB, Özyazıcıoğlu AF, Yavuz Ş. Early period results of radiofrequency ablation and cyanoacrylate embolization for great saphenous vein insufficiency. Vascular 2021; 30:771-778. [PMID: 34116619 DOI: 10.1177/17085381211026154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the 6 months efficacy and safety of cyanoacrylate closure for the treatment of incompetent great saphenous veins (GSVs) in comparison with radiofrequency ablation (RFA). METHODS In this multicenter, retrospective, clinical trial, 398 symptomatic subjects with incompetent GSVs were assigned to either cyanoacrylate closure or RFA. The primary endpoint, complete closure of the target GSV, was determined using duplex ultrasound examination starting from one-, three-, and six-month visits. RESULTS All patients were followed for 6 months and there was no difference between the groups in terms of mean follow-up time. Hospital stay and return to work/activity were shorter in the cyanoacrylate ablation (CAA) group, and these differences between the groups were statistically significant. Ecchymosis was observed higher in the RFA group and was statistically significant. CONCLUSIONS In this study, in which we examined the CAA and RFA methods, we found that both methods were effective and reliable; however, we found that patients in the CAA group had a more comfortable postoperative period and returned to work earlier.
Collapse
Affiliation(s)
- Abdullah B Balcı
- Department of Cardiovascular Surgery, Şırnak State Hospital, Şırnak, Turkey
| | - Umut S Sanrı
- Department of Cardiovascular Surgery, 147003Bursa Yüksek İhtisas Training and Research Hospital, Health Science University, Bursa, Turkey
| | - Kadir K Özsin
- Department of Cardiovascular Surgery, 147003Bursa Yüksek İhtisas Training and Research Hospital, Health Science University, Bursa, Turkey
| | - Ahmet B Tatlı
- Department of Cardiovascular Surgery, 584778Bursa City Hospital, Bursa, Turkey
| | - Ahmet F Özyazıcıoğlu
- Department of Cardiovascular Surgery, 147003Bursa Yüksek İhtisas Training and Research Hospital, Health Science University, Bursa, Turkey
| | - Şenol Yavuz
- Department of Cardiovascular Surgery, 147003Bursa Yüksek İhtisas Training and Research Hospital, Health Science University, Bursa, Turkey
| |
Collapse
|
3
|
Ko H, Min S, Ahn S, Han A, Kim J, Min SK. Stump Length Changes after Endovenous Cyanoacrylate Closure or Radiofrequency Ablation for Saphenous Vein Incompetence. Vasc Specialist Int 2021; 37:14-21. [PMID: 33795549 PMCID: PMC8021488 DOI: 10.5758/vsi.210006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose The aim of this study was to analyze changes in stump length over time in patients with saphenous vein incompetence treated with cyanoacrylate closure (CAC) or radiofrequency ablation (RFA). Methods Materials and We retrospectively analyzed data collected from patients with saphenous vein incompetence who underwent either CAC or RFA at Seoul National University Hospital between November 2015 and December 2018. The stump lengths were measured using duplex ultrasonography (DUS) within 1 month and 6 months after treatment. The Venous Clinical Severity Score (VCSS) and Aberdeen Varicose Vein Questionnaire (AVVQ) score were used to assess clinical outcomes. Results A total of 97 veins (64 great saphenous veins and 33 small saphenous veins) were analyzed. The stump length was not significantly different between the two groups at <1 month (P=0.311). However, the stump length in the CAC group was significantly longer than that in the RFA group at 6 months (P=0.004). At 6 months, the mean change in stump length was 1.41±2.28 cm in the CAC group and 0.51±0.54 cm in the RFA group (P=0.006). The VCSSs and AVVQ scores significantly improved after both procedures but were not significantly different between the two groups. Conclusion DUS at 6 months after treatment showed that the stump length in the CAC group increased more than that in the RFA group. No other factors affected the changes in stump length.
Collapse
Affiliation(s)
- Hyunmin Ko
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sangil Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghyun Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ahram Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jungsun Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
4
|
Proebstle T, Alm J, Dimitri S, Rasmussen L, Whiteley M, Lawson J, Davies AH. Three-year follow-up results of the prospective European Multicenter Cohort Study on Cyanoacrylate Embolization for treatment of refluxing great saphenous veins. J Vasc Surg Venous Lymphat Disord 2020; 9:329-334. [PMID: 32599306 DOI: 10.1016/j.jvsv.2020.05.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Cyanoacrylate closure of refluxing saphenous veins has demonstrated excellent safety and effectiveness results in feasibility and pivotal studies. This article provides the 36-month follow-up results of a prospective, multicenter, nonrandomized cohort study. METHODS A total of 70 patients were enrolled in a prospective, multicenter study conducted at seven centers in four European countries and underwent treatment of a solitary refluxing great saphenous vein with endovenous cyanoacrylate embolization without the use of tumescent anesthesia or postprocedure compression stockings. The primary effectiveness end point was freedom from recanalization (closure rate) of the great saphenous vein at 6 months. Safety was assessed by occurrence of adverse events after the procedure and during the 6-month follow-up period. Quality of life and clinical improvement parameters were measured before and after the procedure and through a 12-month follow-up period. Anatomic success and clinical improvement were assessed through 36 months after the procedure. RESULTS Of 70 treated patients, 64 (91%) were available for the 3-year follow-up. The closure rates by Kaplan-Meier life table methods at 6-, 12-, 24-, and 36-month time points were 91.4%, 90.0%, 88.5%, and 88.5%, respectively. Through 36 months, the improvement in change of the mean venous clinical severity score over time was statistically significant by dropping from 4.3 at baseline to 0.9 at the 36-month follow-up (P < .001). CONCLUSIONS The 3-year follow-up results of the prospective, multicenter eSCOPE study demonstrated the continued anatomic and clinical effectiveness of cyanoacrylate embolization over an extended follow-up period.
Collapse
Affiliation(s)
| | - Jens Alm
- Dermatologikum, Hamburg, Germany
| | | | | | | | | | | |
Collapse
|
5
|
Homs-Romero E, Romero-Collado A. Development of a Minimum Data Set Registry for Chronic Venous Insufficiency of the Lower Limbs. J Clin Med 2019; 8:E1779. [PMID: 31653084 PMCID: PMC6912835 DOI: 10.3390/jcm8111779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Abstract
The purpose of this study was to develop a minimum data set (MDS) registry for the prevention, diagnosis and treatment of chronic venous insufficiency (CVI) of the lower limbs. We designed the instrument in two phases, comprising a literature review and an e-Delphi study to validate the content. We obtained a total of 39 documents that we used to develop a registry with 125 items grouped in 7 categories, as follows: Patient examination, venous disease assessment methods, diagnostic tests to confirm the disease, ulcer assessment, treatments to manage the disease at all its stages, patient quality of life, and patient health education. The instrument content was validated by 25 experts, 88% of whom were primary healthcare and hospital nurses and 84% had more than 10 years' experience in wound care. Using a two-round Delphi approach, we reduced the number of items in the MDS-CVI to 106 items. The categories remained unchanged. We developed an MDS for CVI with seven categories to assist healthcare professionals in the prevention, early detection, and treatment history of CVI. This tool will allow the creation of a registry in the primary care setting to monitor the venous health state of the population.
Collapse
Affiliation(s)
- Erica Homs-Romero
- Figueres Basic Healthcare Area (Àrea Bàsica de Salut de Figueres), Catalan Health Institute (Institut Català de la Salut), C/Tramuntana 2, 17600 Figueres (Girona), Spain.
| | - Angel Romero-Collado
- Nursing Department, University of Girona, C/Emili Grahit 77, 17071 Girona, Spain.
| |
Collapse
|
6
|
McGuinness B, Elias F, Ali KP, Ahmad MS, Namburi J, Chan B, Szalay D, Rapanos T. A comparison of duplex ultrasound findings after cyanoacrylate embolization versus endovenous laser ablation of the great saphenous vein. J Vasc Surg Venous Lymphat Disord 2019; 7:824-831. [PMID: 31495764 DOI: 10.1016/j.jvsv.2019.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 05/18/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Whereas numerous studies have demonstrated noninferiority of cyanoacrylate embolization (CAE) relative to endovenous laser ablation (EVLA), little is known about the natural history of the vein or the glue that is implanted. This study provides the first description of duplex ultrasound changes of the great saphenous vein (GSV) after CAE relative to EVLA as well as a pragmatic view of outcomes in clinical practice. METHODS Patients treated with CAE and EVLA at our institution were matched by time of procedure and vein size. GSV diameter was measured at the saphenofemoral junction, midthigh, and knee. Duplex ultrasound imaging was repeated after treatment in the same noninvasive laboratory with an identical protocol. Clinical data were collected by retrospective chart review. RESULTS Of 481 eligible patients, 119 underwent postoperative duplex ultrasound imaging. Although there was a trend toward decreased vein diameter over time in CAE patients relative to their preoperative vein diameter, this failed to reach statistical significance at the midthigh (P = .32) or at the knee (P = .511). In EVLA patients, as follow-up interval increased, the vein was less frequently visualized on ultrasound at the midthigh (P = .046) and knee (P = .038). At >2 years of follow-up, >80% of EVLA patients had no visible vein segment. Anatomic recurrence was observed in 10.5% of CAE patients and 8.2% of EVLA patients, which was not statistically significantly different (P = .60). The majority of recurrence was observed in the presence of incompetent tributaries. CONCLUSIONS After CAE of the GSV, our results indicate that the glue cast remains for at least 3 years. Although our results suggest that the glue is broken down over time, this process is much slower than expected. In contrast, after EVLA, the vein tissue is remodeled and is no longer visible with time. In our study, which represents a pragmatic clinical population with a large (median, 9.2 mm) vein diameter, we again demonstrate no statistically significant difference in recurrence rates. Whereas CAE offers an attractive treatment option for GSV incompetence, the glue cast remains for a prolonged time, and longer follow-up studies than those currently available are indicated.
Collapse
Affiliation(s)
- Brandon McGuinness
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Fadi Elias
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Khatija Pinky Ali
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Princeton Innovation Center, Princeton University, Princeton, NJ
| | - Mirza Shahzaib Ahmad
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - James Namburi
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Beverley Chan
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - David Szalay
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| | - Theodore Rapanos
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
7
|
Jones AD, Boyle EM, Woltjer R, Jundt JP, Williams AN. Persistent type IV hypersensitivity after cyanoacrylate closure of the great saphenous vein. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:372-374. [PMID: 31440717 PMCID: PMC6699189 DOI: 10.1016/j.jvscit.2019.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022]
Abstract
The VenaSeal (Medtronic, Minneapolis, Minn) cyanoacrylate closure system is a nonthermal technique for ablating saphenous veins using a proprietary n-butyl cyanoacrylate. One possible side effect is an allergic reaction to cyanoacrylate. We report the case of a 49-year-old woman treated with cyanoacrylate closure who developed a persistent type IV hypersensitivity reaction. The patient elected to have the vein excised, and the histologic features were consistent with a type IV hypersensitivity reaction.
Collapse
Affiliation(s)
| | | | - Randy Woltjer
- Department of Pathology, Oregon Health Sciences University, Portland, Ore
| | | | | |
Collapse
|
8
|
Parsi K, Roberts S, Kang M, Benson S, Baker L, Berman I, Bester LJ, Connor DE, Dinnen P, Grace J, Stirling A, Ibrahim N, Lekich C, Lim A, Matar L, Nadkarni S, Paraskevas P, Rogan C, Thibault PK, Thibault S, van Rij A, Yang A. Cyanoacrylate closure for peripheral veins: Consensus document of the Australasian College of Phlebology. Phlebology 2019; 35:153-175. [PMID: 31368408 DOI: 10.1177/0268355519864755] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Cyanoacrylates are fast-acting adhesives used in procedural medicine including closure of superficial wounds, embolization of truncal vessels pre-operatively, vascular anomalies, visceral false aneurysms, endoleaks, gastrointestinal varices and gastrointestinal bleeding. More recently, catheter-directed cyanoacrylate adhesive closure was introduced as an alternative to endovenous thermal ablation (ETA) to occlude superficial veins of the lower limbs. Objectives To formulate policies for the safe and effective delivery of cyanoacrylate adhesive closure procedures in Australasia, based on current experience and evidence. Methods A panel of phlebologists including vascular surgeons, interventional radiologists, dermatologists and research scientists systematically reviewed the available data on cyanoacrylate products used in medicine and shared personal experience with the procedure. The reviewed material included bibliographic and biomedical data, material safety data sheets and data requested and received from manufacturers. Results and recommendations: Cyanoacrylate adhesive closure appears to be an effective treatment for saphenous reflux with occlusion rates at 36 months of 90–95%. We recommend a maximum dose of 10 mL of cyanoacrylate per treatment session. Serious complications are rare, but significant. Hypersensitivity to acrylates is reported in 2.4% of the population and is an important absolute contraindication to cyanoacrylate adhesive closure. 1 Post-procedural inflammatory reactions, including hypersensitivity-type phlebitis, occur in 10–20% of patients. 2 In the long term, cyanoacrylate adhesive closure results in foreign-body granuloma formation within 2–12 months of the procedure. We recommend against the use of cyanoacrylate adhesive closure in patients with uncontrolled inflammatory, autoimmune or granulomatous disorders (e.g. sarcoidosis). Caution should be exercised in patients with significant active systemic disease or infection and alternative therapies such as thermal ablation and foam sclerotherapy should be considered. Conclusions Cyanoacrylate adhesive closure appears to be an effective endovenous procedure, with short-term closure rates comparable to ETA and therefore greater efficacy than traditional surgery for treating superficial veins of the lower limbs. Ongoing data collection is required to establish the long-term safety.
Collapse
Affiliation(s)
- Kurosh Parsi
- Department of Dermatology, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales.,Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | | | - Mina Kang
- Department of Dermatology, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales.,Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | | | - Luke Baker
- Department of Medical Imaging, Westmead Hospital, Sydney, Australia
| | | | | | - David E Connor
- Department of Dermatology, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales.,Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | - Paul Dinnen
- Gold Coast Vascular Centre, Gold Coast, Australia
| | | | | | - Nabeel Ibrahim
- Sydney Centre for Venous Disease, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia
| | | | - Adrian Lim
- Department of Dermatology, The Royal North Shore Hospital, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | | | | | | | - Christopher Rogan
- Macquarie University Hospital, Sydney, Australia.,Department of Medical Imaging, Sydney Adventist Hospital, Sydney, Australia.,Department of Medical Imaging, Royal Prince Alfred Hospital, Sydney, Australia
| | - Paul K Thibault
- Central Vein and Cosmetic Medical Centre, Newcastle, Australia
| | - Simon Thibault
- Central Vein and Cosmetic Medical Centre, Newcastle, Australia
| | - Andre van Rij
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Anes Yang
- Department of Dermatology, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales.,Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, Australia
| |
Collapse
|
9
|
Yang GK, Parapini M, Gagnon J, Chen JC. Comparison of cyanoacrylate embolization and radiofrequency ablation for the treatment of varicose veins. Phlebology 2018; 34:278-283. [PMID: 30114987 DOI: 10.1177/0268355518794105] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review clinical outcomes of varicose vein patients treated with cyanoacrylate embolization and radiofrequency ablation at our institution. METHODS A retrospective review of patients who underwent cyanoacrylate embolization and radiofrequency ablation during a three-year period. Patient records were reviewed to assess demographics, location and severity of disease, treatment details and outcome at short- and mid-term follow-ups. Outcome parameters included treatment success and complications. RESULTS Between January 2014 and December 2016, 335 patients with 476 veins were treated with either cyanoacrylate embolization (n = 148) or radiofrequency ablation (n = 328) at the Vancouver General Hospital Vascular Surgery Vein Clinic. The average age of patients were 57 ± 1 years with the majority being female (78%) and an average BMI of 24.8 ± 0.5. CEAP classes were 2 (49%), 3 (26%), 4a (22%) and >4b (3%). Of the veins treated with cyanoacrylate embolization, the vein types were as follows: 76% were great saphenous vein, 16% were small saphenous vein, 5% were anterior accessory great saphenous vein and 1.4% were perforator veins. The vein types for radiofrequency ablation were 88%, 9%, 3% and 0%, respectively. The average amount of cyanoacrylate embolization delivered for great saphenous vein treatment was 1.8 ± 0.1 ml with a treatment length of 43 ± 1 cm. Subgroup comparison was done for great saphenous vein segments. Treatment success was 100% in cyanoacrylate embolization and 99% in radiofrequency ablation. Superficial phlebitis was the most common complication noted at mid-term follow-up in 5% of cyanoacrylate embolization and 16% of radiofrequency ablation treatments (P < 0.05). One patient in each group had asymptomatic proximal thrombus extension treated with anticoagulation for 2-3 weeks. Three superficial infections from glue clumps were noted in the cyanoacrylate embolization group requiring excision and drainage. Five patients in the radiofrequency ablation group had persistent numbness and one wound complications at the access site. CONCLUSION Cyanoacrylate embolization offers equivalent success rates with lower mid-term complication rates as radiofrequency ablation.
Collapse
Affiliation(s)
- Gary K Yang
- Division of Vascular Surgery, University of British Columbia, Vancouver, Canada
| | - Marina Parapini
- Division of Vascular Surgery, University of British Columbia, Vancouver, Canada
| | - Joel Gagnon
- Division of Vascular Surgery, University of British Columbia, Vancouver, Canada
| | - Jerry C Chen
- Division of Vascular Surgery, University of British Columbia, Vancouver, Canada
| |
Collapse
|
10
|
Abstract
ZusammenfassungEinführung: Zur Behandlung der Stammvarikose mit dem VenaSeal™ Closure-System ist eine Narkoseform oder Tumeszenzanästhesie nicht erforderlich. Ebenfalls kann auf das Tragen von Kompressionsstrümpfen verzichtet werden. Über die Anwendung, erste Erfahrungen und 2 Jahresergebnisse wird berichtet.Material und Methode: In der Zeit von März 2012 bis Mai 2014 wurden 218 Patienten an 274 Stammvenen mit dem VenaSeal™ Closure-System therapiert. Doppler und Duplexuntersuchungen erfolgten nach 7 Tagen, 6 Wochen, 1 Jahr und 2 Jahren. Erhoben wurde die Verschluss- und Komplikationsrate, der visuelle analoge Schmerz-Score und der Venous Clinical Severity Score(VCSS).Ergebnisse: Nachuntersucht wurden 227 Stammvenen der Vena saphena magna (VSM) und 24 Stammvenen der Vena saphena parva (VSP). Die Verschlussrate der VSM betrug 99,5 % (n= 227) nach 7 Tagen, 96,5 % nach 6 Wochen (n= 172), 93,4 % nach 1 Jahr (n= 61) und 100 % nach 2 Jahren (n= 20). Die Verschlussrate der VSP betrug jeweils 100 % nach 7 Tagen (n= 24), 6 Wochen (n= 12) und nach 1 Jahr (n=4). Majorkomplikationen traten nicht auf. Als Minorkomplikationen traten nach Behandlung der Vena saphena magna inflammatorische Reaktionen bei 44 Beinen und Phlebitiden bei 32 Beinen auf. Der Pain Score entwickelte sich unter der Behandlung von 1,4 auf 1,5 (3. Tag), 2,1 (5. Tag), 1,6 (10. Tag), 0,2 (4 Wochen) auf 0,1 (6 Wochen). Der VCSS betrug präoperativ 4,4 und sank auf 2,9 (7. Tag), 2,1 (6 Wochen) auf 1,8 (1 und 2 Jahr)Diskussion: Die VenaSeal™ Closure-Behand-lung der Stammvarikose ist sicher und effektiv. Die Ergebnisse sind vergleichbar denen der thermischen Ablationsverfahren. Ohne die Anwendung der Tumeszenz-Anästhesie haben die Patientin deutlich weniger Beschwerden im Vergleich zu den thermischen Ablationsverfahren, sowohl während der Behandlung, als auch postoperativ.
Collapse
|
11
|
Bellam Premnath KP, Joy B, Raghavendra VA, Toms A, Sleeba T. Cyanoacrylate adhesive embolization and sclerotherapy for primary varicose veins. Phlebology 2017; 33:547-557. [PMID: 28956692 DOI: 10.1177/0268355517733339] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Various treatment methods are available for the treatment of varicose veins, and there has been a recent surge in the usage of cyanoacrylate glue for treating varicose veins. Purpose To investigate the technical possibility, efficiency and safety of cyanoacrylate adhesive embolization and sclerotherapy using commonly available n-butyl cyanoacrylate glue for the treatment of primary varicose veins due to great saphenous vein reflux with or without incompetent perforators. Materials and Methods One hundred forty-five limbs of 124 patients with varicose veins due to great saphenous vein reflux were subjected to cyanoacrylate adhesive embolization and sclerotherapy - adhesive embolization of great saphenous vein in the thigh and perforators using cyanoacrylate followed by sclerotherapy of any residual varicose veins in the leg. Procedural success, venous closure rates and clinical improvement were assessed. Follow-up for 1, 3, 6, 9 and 12 months was obtained. Results Technical success rate was 100%. Saphenous vein closure rate was 96.5% at one year. There was no femoral venous extension of cyanoacrylate in any of the patients. Posterior tibial vein extension of cyanoacrylate was seen in three patients (2.6%) without untoward clinical effect.Significant improvement was found in venous clinical severity score (VCSS) from a baseline mean of 7.98 ± 4.42 to 4.74 ± 3, 1.36 ± 1.65 and 0.79 ± 1.19 at 1, 6 and 12 months' follow-up. Ulcer healing rate was 100%. Conclusion Cyanoacrylate adhesive embolization and sclerotherapy for the treatment of primary varicose veins is efficacious and can be performed as an outpatient procedure, but has a guarded safety profile due to its propensity to cause deep venous occlusion if not handled carefully.
Collapse
Affiliation(s)
| | - Binu Joy
- Department of Radiology, Rajagiri Hospital, Aluva, Kerala, India
| | | | - Ajith Toms
- Department of Radiology, Rajagiri Hospital, Aluva, Kerala, India
| | - Teena Sleeba
- Department of Radiology, Rajagiri Hospital, Aluva, Kerala, India
| |
Collapse
|
12
|
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. [PMID: 26916777 DOI: 10.1177/0268355516632652] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Cyanoacrylate ablation is the newest nonthermal vein ablation technique. The one-year results of a prospective comparative study of a new cyanoacrylate glue versus endovenous laser ablation for the treatment of venous insufficiency is presented. MATERIAL AND METHODS A total of 310 adult subjects were treated with cyanoacrylate ablation or endovenous laser ablation. The primary endpoint of this study was complete occlusion of the great saphenous vein. Secondary endpoints were procedure time, procedural pain, ecchymosis at day 3, adverse events, changes from baseline in Venous Clinical Severity Score, and Aberdeen Varicose Vein Questionnaire. RESULTS Operative time was shorter (15 ± 2.5 versus 33.2 ± 5.7, <0.001), and periprocedural pain was less (3.1 ± 1.6 versus 6.5 ± 2.3, <0.001) in cyanoacrylate ablation group compared to the endovenous laser ablation group. Ecchymosis at the third day was also significantly less in cyanoacrylate ablation group (<0.001). Temporary or permanent paresthesia developed in seven patients in endovenous laser ablation group and none in cyanoacrylate ablation group (p = 0.015). One, three, and 12 months closure rates were 87.1, 91.7, and 92.2% for endovenous laser ablation and 96.7, 96.6, and 95.8% for cyanoacrylate ablation groups. Closure rate at first month was significantly better in cyanoacrylate ablation group (<0.001). Although there is a trend of better closure rates in cyanoacrylate ablation patients, this difference did not reach to the statistical difference at sixth and 12th month (p = 0.127 and 0.138, respectively). Both groups had significant improvement in Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire postoperatively (<0.001), but there was no significant difference in Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire scores between the groups at first, sixth, and 12 months. Only a slightly better well-being trend was noted in cyanoacrylate ablation group in terms of Aberdeen Varicose Vein Questionnaire scores (p = 0.062). CONCLUSIONS The efficacy and safety analysis shows that cyanoacrylate ablation is a safe, simple method which can be recommended as an effective endovenous ablation technique. The follow-up data more than one year will clarify the future role of cyanoacrylate ablation for the treatment incompetent great saphenous veins.
Collapse
Affiliation(s)
| | - Muhammet Fatih Yılmaz
- Department of Cardiovascular Surgery, Kayseri Research and Training Hospital, Kayseri, Turkey
| |
Collapse
|
13
|
Witte ME, Holewijn S, van Eekeren RR, de Vries JP, Zeebregts CJ, Reijnen MMPJ. Midterm Outcome of Mechanochemical Endovenous Ablation for the Treatment of Great Saphenous Vein Insufficiency. J Endovasc Ther 2016; 24:149-155. [PMID: 27742900 DOI: 10.1177/1526602816674455] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To report the midterm results of mechanochemical ablation (MOCA) for treating great saphenous vein (GSV) insufficiency. METHODS In a 1-year period, 85 consecutive patients (median age 51.4 years; 71 women) undergoing MOCA with polidocanol in 104 limbs were enrolled in a prospective registry. The patients were evaluated at baseline and during follow-up (4 weeks and 1, 2, and 3 years) using duplex ultrasound, the CEAP (clinical, etiologic, anatomic and pathophysiologic) classification, the Venous Clinical Severity Score (VCSS), the RAND Short Form 36-Item Health Survey (RAND-SF36), and the Aberdeen Varicose Vein Questionnaire (AVVQ). Primary outcome measures were clinical and anatomic success. Secondary outcome measures included general and disease-specific quality of life and reinterventions. RESULTS Technical success (99%) was achieved in all but 1 patient in whom technical problems with the device led to conversion to another method for treatment of 2 limbs. After a median follow-up of 36 months (interquartile range 12.5, 46.3), recanalization occurred in 15 (15%) of 102 successfully treated vein segments. Anatomic success was 92%, 90%, and 87% after 1, 2, and 3 years, respectively. The VCSS improved at all time intervals compared to the preprocedure median. The clinical success at 3 years was 83%. The AVVQ and RAND-SF36 scores showed an improvement at all time intervals compared to baseline values. Between 12 and 36 months, however, a significant deterioration was observed in VCSS, which was accompanied by worsening of disease-specific and general quality of life. CONCLUSION In the longest follow-up of MOCA to date, this study shows MOCA to be an effective treatment modality for GSV insufficiency at midterm follow-up, but clinical results seem to drop over time.
Collapse
Affiliation(s)
- Marianne E Witte
- 1 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Suzanne Holewijn
- 1 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | | | | | - Clark J Zeebregts
- 3 Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | | |
Collapse
|
14
|
Shaidakov EV, Grigoryan AG, Ilyukhin EA, Bulatov VL, Rosukhovskiy DA. Radiofrequency ablation or stripping of large-diameter incompetent great saphenous varicose veins with C2 or C3 disease. J Vasc Surg Venous Lymphat Disord 2016; 4:45-50. [DOI: 10.1016/j.jvsv.2015.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022]
|
15
|
Lopez AJ. Female Pelvic Vein Embolization: Indications, Techniques, and Outcomes. Cardiovasc Intervent Radiol 2015; 38:806-20. [PMID: 25804635 PMCID: PMC4500858 DOI: 10.1007/s00270-015-1074-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 02/08/2015] [Indexed: 12/21/2022]
Abstract
Until recently, the main indication for pelvic vein embolization (PVE) in women was to treat pelvic venous congestion syndrome (PVC) but increasingly, patients with refluxing pelvic veins associated with leg varicosities are also being treated. A more unusual reason for PVE is to treat pelvic venous malformations, although such lesions may be treated with sclerotherapy alone. Embolotherapy for treating PVC has been performed for many years with several published studies included in this review, whilst an emerging indication for PVE is to treat lower limb varicosities associated with pelvic vein reflux. Neither group, however, has been subjected to an adequate randomized, controlled trial. Consequently, some of the information presented in this review should be considered anecdotal (level III evidence) at this stage, and a satisfactory ‘proof’ of clinical efficacy remains deficient until higher-level evidence is presented. Furthermore, a wide range of techniques not accepted by all are used, and some standardization will be required based on future mandatory prospective studies. Large studies have also clearly shown an unacceptably high recurrence rate of leg varicose veins following venous surgery. Furthermore, minimally or non-invasive imaging is now revealing that there is a refluxing pelvic venous source in a significant percentage of women with de novo leg varicose veins, and many more with recurrent varicosities. Considering that just over half the world’s population is female and a significant number of women not only have pelvic venous reflux, but also have associated leg varicosities, minimally invasive treatment of pelvic venous incompetence will become a common procedure.
Collapse
Affiliation(s)
- Anthony James Lopez
- The Imaging Clinic, Thursley Hall, Farnham Lane, Haslemere, Surrey, GU27 1HA, UK,
| |
Collapse
|
16
|
|
17
|
McHugh S, Leahy A. What next after thermal ablation for varicose veins: Non-thermal ablation? Surgeon 2014; 12:237-8. [DOI: 10.1016/j.surge.2014.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 06/20/2014] [Indexed: 10/24/2022]
|
18
|
Foam sclerotherapy: Positioning within non-thermal ablation treatment. PHLEBOLOGIE 2014. [DOI: 10.12687/phleb2230-5-2014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ZusammenfassungDie ultraschallgestützte Schaumsklerosierung hat sich in den letzten Jahren fest in der Behandlung der Varikose etabliert und bietet viele Vorteile im Vergleich zu anderen Ablationsverfahren. Sie wird ohne jegliche Form von Anästhesie angewandt, da das Verfahren für den Patienten schmerzlos ist. Im Gegensatz hierzu benötigen die thermischen Ablationsverfahren eine Tumeszenzanästhesie, um umliegende Strukturen zu schützen und ungewollte Nervenschädigungen zu verhindern. Dies ist bei der Schaumverödung nicht nötig. Die Schaumsklerosierung bietet eine schnelle und einfache Behandlungsmethode für kleine und große Varizen, die im phlebologischen Untersuchungsraum durchgeführt werden kann. Der Patient kann nach Duplexdiagnostik und ausführlicher Besprechung der Behandlung noch in derselben Sitzung behandelt werden. Des Weiteren können neben den Standardindikationen auch Rezidive und geschlängelte Gefäßabschnitte mittels der Schaumverödung behandelt werden. In den letzten Jahren sind neben der Schaumsklerosierung auch andere non-thermale Techniken entwickelt worden.Es wird ein Überblick gegeben über die Position der Schaumsklerosierung und der verschiedenen nicht-thermischen Ablationstechniken im Hinblick auf ihre Wirkung, Sicherheit und Nebenwirkungen.
Collapse
|
19
|
Toonder IM, Lam YL, Lawson J, Wittens CHA. Cyanoacrylate adhesive perforator embolization (CAPE) of incompetent perforating veins of the leg, a feasibility study. Phlebology 2014; 29:49-54. [DOI: 10.1177/0268355514529696] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Consideration of treating incompetent perforating veins remains a conundrum based on scientific evidence available till date. While subfascial endoscopic perforator surgery (SEPS) proved to be a worthy alternative for open surgery, other even less invasive techniques were being introduced by the late nineties of the last century. Percutaneous thermo-ablation techniques are still being used today and seem more effective than non-thermal techniques. However, thermal techniques require anaesthesia and potentially may cause inadvertent damage to surrounding tissues such as nerves. Cyanoacrylate adhesive has a proven record, but not for the treatment of chronic venous disease of the leg. Innovation has led to the development of the VenaSeal® Sapheon Closure System which has been designed to use a modified cyanoacrylate glue as a new therapy for truncal vein incompetence. This paper explores the feasibility of ultrasound guided cyanoacrylate adhesive perforator embolization (CAPE). Results show a 76% occlusion rate of incompetent perforating veins without serious complications leading to the conclusion that further investigation with a dedicated delivery device in a larger patient population is warranted.
Collapse
Affiliation(s)
- Irwin M Toonder
- Maastricht University Medical Centre, Department of Vascular Surgery, the Netherlands
| | - Yee Lai Lam
- Maastricht University Medical Centre, Department of Vascular Surgery, the Netherlands
| | - James Lawson
- Maastricht University Medical Centre, Department of Dermatology, the Netherlands
| | - Cees HA Wittens
- Maastricht University Medical Centre, Department of Vascular Surgery, the Netherlands
- Universitätsklinikum Aachen, Dept of Vascular Surgery, Germany
| |
Collapse
|
20
|
Abstract
Tumescent anesthesia refers to the percutaneous administration of large volume anesthetic to cause the target tissue to become swollen or firm. The use of tumescent anesthesia is essential for the treatment of refluxing truncal veins using endothermal technologies. In order to obviate the use of tumescent anesthesia as an adjunct to treatment, one has to evaluate the technologies that do not employ thermal energy as the modality for treatment. These technologies include foam sclerotherapy, mechanicochemical ablation (MOCA), and the use of glue (Sapheon™ closure system). The following review juxtaposes the literature supporting the use of tumescent-based techniques to the literature supporting the use of tumescent-less techniques
Collapse
|
21
|
Ostler AE, Holdstock JM, Harrison CC, Whiteley MS. Arterial false aneurysm in the groin following endovenous laser ablation. Phlebology 2013; 30:220-2. [DOI: 10.1177/0268355513512826] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endovenous laser ablation is a minimally invasive catheter-based procedure for the treatment of varicose veins. The procedure involves injecting tumescent anaesthesia around the catheterised truncal vein, before thermal ablation by the laser. We report a case of a false aneurysm arising from a branch of the inferior epigastric artery, following endovenous laser ablation. The false aneurysm was thought to be caused by injury to the artery by the needle used to inject the tumescent anaesthesia. Although a rare complication, newer tumescentless techniques such as mechanicochemical ablation and cyanoacrylate glue would prevent such a complication.
Collapse
Affiliation(s)
| | | | | | - Mark S Whiteley
- The Whiteley Clinic, Surrey, UK
- Faculty of Health and Biomedical Sciences, University of Surrey, Surrey, UK
| |
Collapse
|