Efficiency of the endovenous cyanoacrylate for the treatment of varicose veins using the VenablockTM system: a 24 months follow-up study of 116 patients

Abstract

Objectives: Dilation of superficial veins and valvular insufficiency cause the common condition, varicose veins (VVs) on the lower extremities. The treatment modalities for VVS include endovascular thermal ablation techniques using laser, steam and radiofrequency, surgery, foam sclerotherapy, which has various adverse effects. N-butyl cyanoacrylate (NBCA) is a relatively novel polymerizating agent that is used for the treatment of VVs. The aim of this study is to evaluate and present the 24 months outcomes results of endovenous NBCA treatment in 116 patients with VV. 

Methods: This is a prospective study on 116 patients (71 females, 45 males), treated in a single-center between August 2017 and March 2019. NBCA administration (Venablock®, Invamed, Turkey) was carried out with local anesthesia under ultrasound guidance. All patients were scheduled for follow-up evaluation at 2 weeks, 3, 6, 9, 12, and 24 months. Clinical assessment, VCSS, and ultrasound were performed on patients in the follow-up visits.

Results: The mean follow-up period was 16.27 ± 5.62 months. The preoperative and postoperative VCSS values were 6.93 ± 2.60 and 2.40 ± 1.12, respectively (p < 0.0001). The patients with a greater GSV diameter experienced an unfavorable outcome following the NBCA procedure (p < 0.001). The overall complication rate was 12.9%. The complete occlusion was achieved in 101 (87.0%) patients.

Conclusions: The NBCA administration is a safe treatment method for the VVs, and provides a satisfactory occlusion ratio with improved outcomes. 

Keywords

• cyanoacrylate
• varicose veins
• chronic venous insufficiency
• VenablockTM

References

1. 1. Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health 1999;53:149-53.
2. 2. Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki Ml, et al.The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011;53(5 Suppl):2S-48S.
3. 3. Lee AJ, Evans CJ, Allan PL, Ruckley CV, Fowkes FG. Lifestyle factors and the risk of varicose veins: Edinburgh Vein Study. J Clin Epidemiol 2003;56:171-9.
4. 4. Müller-Bühl U, Leutgeb R, Engeser P, Achankeng EN, Szecsenyi J, Laux G. Varicose veins are a risk factor for deep venous thrombosis in general practice patients. Vasa 2012;41:360-5.
5. 5. Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg 1995;21:635-45.
6. 6. Sarma N. Guidelines and recommendation on surgery for venous incompetence and leg ulcer. Indian Dermatol Online J 2014;5:390-5.
7. 7. Nesbitt C, Bedenis R, Bhattacharya V, Stansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. Cochrane Database Syst Rev 2014;(7):CD005624.
8. 8. Korkmaz Ö, Göksel S, Gül M, Başçil H, Yildir Y, Berkan Ö. Does the use of N-butyl-2 cyanoacrylate in the treatment of lower extremity superficial varicose veins cause acute systemic inflammation and allergic reactions? Cardiovasc J Afr 2018;29:213-7.

9. 9. Eroglu E, Yasim A. A Randomised clinical trial comparing N-Butyl cyanoacrylate, radiofrequency ablation and endovenous laser ablation for the treatment of superficial venous incompetence: two Year follow up results. Eur J Vasc Endovasc Surg 2018;56:553-60.
10. 10. Rutherford RB, Padberg FT Jr, Comerota AJ, Kistner RL, Meissner MH, Moneta GL. Venous severity scoring: an adjunct to venous outcome assessment. J Vasc Surg 2000;31:1307-12.
11. 11. Yavuz T, Acar AN, Aydın H, Ekingen E. A retrospective study of a new n-butyl-2-cyanoacrylate glue ablation catheter incorporated with application guiding light for the treatment of venous insufficiency: twelve-month results. Vascular 2018;26:547-55.
12. 12. Merchant RF, DePalma RG, Kabnick LS. Endovascular obliteration of saphenous reflux: a multicenter study. J Vasc Surg 2002;35:1190-96.
13. 13. Bozoglan O, Mese B, Eroglu E, Ekerbiçer HC, Yasim A. Comparison of endovenous laser and radiofrequency ablation in treating varices in the same patient. J Lasers Med Sci 2017;8:13-16.
14. 14. Anwar MA, Lane TR, Davies AH, Franklin IJ. Complications of radiofrequency ablation of varicose veins. Phlebology 2012;27 Suppl 1:34-9.
15. 15. Bekci T, Tosun A. Mechanochemical ablation of varicose veins with N-Butyl cyanoacrylate: six-month follow-up. Ann Med Res 2019;26:1104-7.
16. 16. Tang TY, Rathnaweera HP, Kam JW, Chong TT, Choke EC, Tan YK. Endovenous cyanoacrylate glue to treat varicose veins and chronic venous insufficiency-Experience gained from our first 100+ truncal venous ablations in a multi-ethnic Asian population using the Medtronic VenaSeal™ Closure System. Phlebology 2019;34:543-51.
17. 17. Kolluri R, Gibson K, Cher D, Madsen M, Weiss R, Morrison N. Roll-in phase analysis of clinical study of cyanoacrylate closure for incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord 2016;4:407-15.
18. 18. Caprini JA, Glase CJ, Anderson CB, Hathaway K. Laboratory markers in the diagnosis of venous thromboembolism. Circulation 2004;109(12 Suppl 1):I4-8.
19. 19. Tang TY, Tiwari A. The VenaSealTM abnormal red skin reaction: looks like but is not phlebitis! Eur J Vasc Endovasc Surg 2018;55:841.
20. 20. Acıpayam M, Eroğlu E, Yasım A, Doğaner A, Azim Okyay R. The same clinical effect, with fewer complications and higher patient comfort, can be achieved with lower doses of N-butyl cyanoacrylate in endovenous ablation therapy: a prospective, randomized study. Turk J Vasc Surg 2020;29:177-83.