Adverse events and complications following cyanoacrylate adhesive closure of varicose veins

• Shirinbek O.
• Mnatsakanyan G.V.
• Odinokova S.N.

Abstract

Background. Cyanoacrylate adhesive closure is currently considered to be an alternative to thermal ablation of varicose veins. It emerged as a natural step towards minimally invasive surgical treatment of incompetent saphenous veins.

Objective. The purpose of this study was to assess the safety of cyanoacrylate adhesive closure in treatment of patients with varicose veins based on two-year experience.

Patients and methods. Between July 2019 and July 2021, cyanoacrylate adhesive closure was performed in a total of 457 patients (634 limbs and 725 venous trunks). The inclusion criteria were as follows: CEAP clinical classes C2–C6, junctional and truncal valve incompetence with reflux >0.5 sec, saphenous vein diameter > 6 mm, presence of varicosities. Cyanoacrylate adhesive closure was carried out according to the standard VenaSeal protocol. In 76.2% of cases, the procedure was performed selectively without tributary treatment. Duplex ultrasound follow-up examinations were carried out on POD 3, as well as at 1, 3, 6 and 12 months following the procedure.

Results. Partial recanalization occurred in 4 (0.8%) cases between 6 and 15 months post-procedure. Glue migration and propagation into the deep vein was detected in 7 (1.5%) patients and asymptomatic sural vein thrombosis was found in 2 (0.4%) cases. Phlebitis-like skin reaction developed in 50 (11%) cases, superficial thrombophlebitis – in 20 (4.3%) patients. In 6 (1.3%) cases, the procedure was complicated by soft tissue foreign body granuloma. There were no cases of either pulmonary embolism or peripheral neuropathy.

Conclusion. The procedure of cyanoacrylate adhesive closure proved highly effective and safe in treating patients with superficial venous insufficiency and was associated with minimal incidence of adverse events during the two-year follow-up. Further studies are needed to assess the long-term safety of the method.

Keywords:cyanoacrylate adhesive closure; cyanoacrylate embolization; glue ablation; varicose veins; non-thermal non-tumescent methods

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