First Experience of Using Russian Sulfacrylate Glue Clinical and Morphologic Study (In Vivo)

Abstract

Russian adhesive sulfacrylate was synthesized in 2000, in contrast to foreign analogues it is based on ethyl ether of α-cyanoacrylic acid, not butyl. Two additional plasticizers were added to the glue, which reduced the brittleness of the compound. In 2010 it was approved for use in clinical practice in Russia. From May 2019 till July 2020 an endovasal catheter obliteration of the main trunks of the great saphenous vein (GSV) and small saphenous vein (SSV) was performed using the sulfacrylate glue in 48 patients with varicose disease (C2-C4). The diameter of the target vein varied from 9 to 13 mm. The dose of VenoGlue depends on the diameter of the target vein. For vein diameter 0.8-1.0, 0.1 mL glue is used for every 5 cm treated. For vein diameter greater than 1.0 cm, 0.2 mL is used for every 5 cm treated. We evaluated pain, thrombophlebitis, and local and general allergic reactions. Ultrasound control was carried out at days 3 and 60, as well as month 6. Immediately after the intervention and on the first day, the possible spread of the glue in the proximal and distal direction of the GSV and SSV was monitored. A histologic study of morphologic changes (in vivo) was performed with the consent of patients to conduct the study. We studied the parts of GSV (n = 11) and SSV (n = 4) taken from 15 patients within the period from 7 to 180 days after procedure. Pain after 48 hours was observed in 10 patients (21%) with visual analogue scale scores ranging from 0.86 to 2.2. In six cases (12%), the visual analogue scale scores were a 4 of 5. A postprocedural phlebitic reaction took place in 25% only a self-limited inflammatory response over the treated vein, and no cases with classic superficial venous thrombosis. There were no cases of glue extension into deep veins and no allergic reactions in the patients. In six patients when the glue reached the subcutaneous fat there were signs of aseptic inflammation. During the histologic examination starting from day 7, there was a gradually relieving aseptic inflammation in the vein wall. Within 180 days, the lumen of all veins was completely obliterated by mature connective tissue, in the absence of glue particles, which was indicative of its complete biodegradation. The anatomical success rate was 100% after 3 and 6 months of follow-up, respectively. Cyanoacrylate adhesive embolization of incompetent truncal veins using the Russian glue cyanoacrylate is a safe and effective procedure. The high adhesive ability of the glue contributes to the absence of extension into the deep system. The glue is biodegradable and was not detected in the vein after 12 months. The Russian glue is a low-cost treatment which can easily be performed as an office-based procedure.