Mid Term Results, Complications and Their Treatment After Cyanoacrylate Embolisation of Saphenous Veins

Abstract

Background. The results of cyanoacrylate embolisation (CAE) of the great (GSV) and small (SSV) saphenous trunks in patients with varicose veins (VVs) of the lower limbs were evaluated. Methods. This is an ongoing prospective observational study that started in 2017 at the Hospital Neftyanik, including patients with VVs who underwent CAE of the GSV and/or SSV by VenaSeal technology. Patients are followed with clinical and ultrasound evaluation at one week, three, six, and 12 months after surgery, and then every year. Efficiency criteria are the technical success of the vein occlusion; absence of recanalisation; GSV stump length; vein involution; absence of truncal reflux; absence of reflux at the junction; no need to remove tributaries; no need for re-intervention on the trunk; clinical class by CEAP; and disease severity by VCSS. Safety criteria are the absence of adverse effects (AEs). Results. Between 2017–2019 CAE was performed on 122 limbs of 92 patients: 46 women and 46 men aged from 28 to 69 years (mean age, 45.3 ± 10.3 years) with the CEAP clinical of C2 (47.6%), C3 (35.2%), C4 (16.4%), and C5 (0.8%). The GSV trunk (diameter 4.5–18.0 mm; mean 9.0 ± 2.5) was treated in 82% and the SSV (3.7–13.0 mm; mean, 7.0 ± 2.3) in 18%. Technical success was achieved in all cases. The lengths of the GSV stump varied from 0 to 48 mm (mean, 19.0 ± 9.7). Sclerotherapy for varicose tributaries during the first three months was performed in 55 legs (45.1%). Patients were followed for three months (range one week–18 months). Additional sclerotherapy for varicose tributaries was required for 35 limbs (28.7%). Truncal recanalisation > 5 cm was found in eight limbs (6.6%) 3–12 months after intervention and required second CAE (n = 1), laser ablation (n = 1) or sclerotherapy (n = 4). Other AEs that did not require re-intervention were GSV trunk phlebitis (n = 8; 6.6%) or tributaries (n = 5; 4.1%), allergic reaction (n = 4; 3.3%), cord sensation (n = 5; 4.1%), glue propagation to the junction (n = 2; 1.6%), glue propagation out of the junction (n = 2; 1.6%), altered sensation (n = 4; 3.3%), and puncture site haematoma (n = 1; 0.8%). Conclusion. CAE is an effective method for saphenous vein ablation that is associated with an acceptable incidence of non-severe AEs with a low rate of re-interventions.