Five-year results of cyanoacrylate adhesive сlosure in the treatment of patients with varicose veins of the lower extremities

• Olimi Shirinbek
• Gevorg V. Mnatsakanyan
• Saniya N. Odinokova

Abstract

Background. Cyanoacrylate adhesive сlosure (САС) of subcutaneous veins is a modern method of treating varicose veins of the lower extremities, demonstrating a number of advantages over traditional surgical and thermal ablation techniques. Unlike endovenous thermal сlosure, tumescent anesthesia is not performed in САС, which significantly reduces pain and impact on perivenous tissues, especially for patients with trophic skin disorders. In addition, postoperative compression is not required, which is contraindicated in the presence of obliterating atherosclerosis of the lower extremities. Given the relative novelty of the methodology, the number of studies with long-term results is limited.

The aim is to evaluate the long-term outcomes of the use of САС in the treatment of patients with IBD.

Material and methods. A retrospective analysis of electronic medical records of patients with IBD has been carried out since the integration of the considered technique into the work of the Phlebology Center of the Multidisciplinary Medical Holding SM-Clinic from 2019 to 2024. The study included patients with varicose-transformed tributaries of the main subcutaneous veins, corresponding to classes C2–C6 according to CEAP, with terminal valve dysfunction with axial reflux (>0.5 s, diameter of the trunk of the subcutaneous vein – 0.6 cm and higher). САС was performed using the VenaSeal Closure System (Medtronic) according to a standard protocol. In the course of the work, demographic and clinical data, key preoperative characteristics (diameter of the target subcutaneous vein, number of venous basins) were evaluated, which were analyzed using descriptive statistics methods. A visual analog scale (VAS) was used to assess the intensity of pain directly during surgery. Postoperative follow-up of patients, including ultrasound duplex scanning, was performed on the 3rd day, then 1, 3, 6 and 12 months after surgery, and thereafter annually. The criterion for the effectiveness of САС was the occlusion of the trunk of the target vein. The safety criterion is the frequency of postoperative adverse events and complications.

Results. Evaluation of long-term results with a follow-up period of 5 years was performed in 39 patients who underwent CT in the second half of 2019. 52 lower extremities and 53 venous basins corresponded to this number of patients. There were 24 women (61.5%) and 15 men (38.5%). The average age of the patients was 58.3±16.2 years. 19 (48.7%) patients were elderly and senile. The distribution of patients according to the CEAP classification: C2 – 21 (53.8%), C3 – 15 (38.5%), C4 – 3 (7.7%).

The average diameter of the large saphenous vein was 10.8±4.1 mm, the small saphenous vein was 6.7±2.3 mm. In 25 (64.1%) patients, CT was performed on the 1^st venous basin, in the remaining 14 (39.5%) – simultaneously on the 2nd venous artery. The average duration of the intervention was 35±25.7 minutes. In 26 patients, САС was performed as an isolated procedure, without intervention on the tributaries and did not require the use of postoperative compression. Simultaneous interventions on tributaries were performed in 13 (33.3%) patients: foam sclerotherapy in 9 (23.1%), miniflebectomy in 4 (10.2%). Intraoperative VAS pain was estimated at less than 3 points in 36 (92.3%) patients. The average VAS score was 2.9±0.7. Immediate technical and anatomical success was achieved in all 39 (100%) patients at the first 2 follow-up examinations (3 days and 1 month after the procedure). In subsequent controls, recanalization was registered in 3 (7.7%) patients. Glue-induced thrombosis was noted in 1 (2.6%) patient. 5 (12.8%) patients had a phlebitic skin reaction (delayed type) that occurred from 1 week to 1 year after surgery. This complication was eliminated by conservative treatment. Tributary thrombophlebitis was recorded in 2 (5.1%) patients. In 1 (2.6%) case, an abscessed soft tissue granuloma was diagnosed at the vein puncture site 5.5 months after the CT scan. Ecchymosis was observed in 4 (10.2%) patients. There were no postoperative neurological complications, pulmonary embolism, or deep vein thrombosis in this group of patients. The incidence of target vein occlusion at 3 months, 6 months, and 3 years after the intervention was 97.5%, 94.9%, and 92.3%, respectively. The last indicator remained until the 5-year observation period.

Conclusion. The САС technique demonstrates a high level of efficacy and safety in the treatment of patients with varicose veins of the lower extremities, with a 92.3% occlusion rate of target veins within 5 years after сlosure.

Keywords: varicose veins of the lower extremities; adhesive сlosure; varicose veins; occlusion of target veins; chronic venous diseases; CEAP classification