Clinical Efficacy and Safety of Using N-Butyl Cyanoacrylate in the Treatment of Perforator Vein Insufficiency

Abstract

Objectives: Venous insufficiency has traditionally been managed through various techniques, including surgical interventions and thermal ablation. A novel technique for venous insufficiency is non-thermal ablation using a vein sealing system, involving the endovenous delivery of N-butyl cyanoacrylate (NBCA) tissue adhesive to the vein. Despite advances in treatment options, the management of isolated perforator incompetence remains a challenge due to its role in the pathophysiology of chronic venous insufficiency (CVI). This single-center retrospective study aimed to evaluate the efficacy of the non-thermal, non-tumescent embolization method using NBCA for managing perforator incompetence. Materials and Methods: We retrospectively analyzed 98 consecutive patients diagnosed with perforator vein insufficiency, treated with NBCA. The study protocol included physical examinations, Doppler ultrasonography, venous clinical severity scoring, CEAP (Clinical-Etiology-Anatomy- Pathophysiology) classification, and quality of life assessments before and after the procedure. The primary goal was to compare clinical, functional, and duplex parameters in managing varicose vein diseases with isolated primary perforator incompetence using duplex-guided NBCA treatment. Analyses were performed using SPSS software. Categorical variables were reported as frequencies, and continuous variables as means ± standard deviations or medians with interquartile ranges. Chi-square or Fisher’s exact tests were used for categorical data, and the Mann-Whitney U test for continuous variables. A p value less than 0.05 was considered statistically significant. Results: Ninety-eight obliteration procedures were completed. The study evaluated occlusion rate, procedural pain, phlebitis, ecchymosis, and paresthesia. The occlusion rate at 6 months was 96.9%, with a significant reduction in pain and other symptoms of CVI. The incidence of complications was low. Phlebitis was observed in 3.4% of cases, ecchymosis in 2.8%, and transient paresthesia in 1.7%. There were no reports of serious adverse events, such as deep vein thrombosis or systemic allergic reactions. Conclusion: The interruption of perforators effectively reduces the symptoms of CVI and promotes rapid ulcer healing. This non-tumescent, nonthermal embolization method can be safely applied with high success rates. The results of this study suggest that NBCA is a viable option for treating perforator incompetence.

Keywords

• N-butyl cyanoacrylate
• perforator vein incompetence
• venous ulcer

Perforatör Ven Yetmezliğinin Tedavisinde N-Butil Siyanoakrilat Kullanımının Klinik Etkinliği ve Güvenliği

Abstract

Gereç ve Yöntem: NBCA ile tedavi edilen, perforatör ven yetmezliği tanısı alan 98 ardışık hasta retrospektif olarak analiz edilmiştir. Çalışma protokolü, işlem öncesi ve sonrası fizik muayene, doppler ultrasonografi, venöz klinik şiddet skorlaması, CEAP (Klinik-Etiyoloji-Anatomi- Patofizyoloji) sınıflandırması ve yaşam kalitesi değerlendirmelerini içermektedir. Birincil amaç, Doppler ultrasonografi kılavuzluğunda NBCA tedavisi kullanılarak izole primer perforatör ven yetmezliği olan damar hastalıklarının tedavisinde klinik, fonksiyonel ve Doppler ultrasonografi parametreleri karşılaştırmaktır. Analizler SPSS yazılımı kullanılarak yapılmış olup, kategorik değişkenler frekanslar olarak ve sürekli değişkenler ortalama ± standart sapmalar veya çeyrekler arası aralıklara sahip medyanlar olarak rapor edilmiştir. Kategorik veriler için ki-kare veya Fisher’s exact testleri, sürekli değişkenler için Mann-Whitney U testi kullanılmıştır. 0,05’ten küçük bir p değeri istatistiksel olarak anlamlı kabul edilmiştir. Bulgular: Doksan sekiz obliterasyon işlemi tamamlanmıştır. Çalışmada obliterasyon oranı, işlem esnasında ve sonrasında ağrı, flebit, ekimoz ve parestezi değerlendirilmiştir. Altıncı ayda obliterasyon oranı %96,9 olup, ağrıda ve diğer kronik venöz yetmezlik semptomlarında önemli bir azalma olmuştur. Komplikasyon görülme sıklığı düşüktür. Olguların %3,4’ünde flebit, %2,8’inde ekimoz ve %1,7’sinde geçici parestezi gözlenmiştir. Derin ven trombozu veya sistemik alerjik reaksiyonlar gibi ciddi yan etkiler bildirilmemiştir. Sonuç: Perforatör venlerin obliterasyonu ile kesintiye uğratılması, kronik venöz yetmezlik semptomlarını etkili bir şekilde azaltmakta ve ülserin hızlı iyileşmesini desteklemektedir. Tümesan kullanılmayan, termal olmayan bu embolizasyon yöntemi, yüksek başarı oranlarıyla güvenle uygulanabilmektedir. Bu çalışmanın sonuçları, NBCA’nın perforatör ven yetmezliğinin tedavisinde uygun bir seçenek olduğunu göstermekt

Keywords

• N-butil siyanoakrilat
• perforatör ven yetmezliği
• venöz ülser

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