Sclerotherapy and Vein Gluing Combined as a Single-Catheter Procedure for Saphenous Veins

Abstract

Gluing of veins is discussed as being superior to thermo-occlusive methods or sclerotherapy as it may achieve immediate and permanent vein closure without any symptoms during vein regression. Furthermore, no tumescent anesthesia is required. However, approved gluing methods use continuous placement of larger amounts of aggressive and hardly resorbable cyanoacrylate (VenaSeal [Medtronic, Santa Rosa, Calif], VariClose [Biolas Inc, Ankara, Turkey], VenaBlock [Invamed, Ankara, Turkey]). The effect depends on external manual compression. Segmental glue application is preferred by some investigators to save glue and to accelerate the procedure, but this leaves native endothelium and thus a source of relapse. These drawbacks could be overcome by a new modality that combines segmental or point-wise gluing and catheter sclerotherapy (ScleroGlue project). Twenty-four patients (16 women, 8 men; 42-69 years) with great saphenous vein insufficiency and diameters of 8 to 24 mm (mean, 9.4 mm) underwent combined sclerotherapy (Aethoxysklerol 1%, 1+4 with air) and gluing by a double-catheter access including the VariClose gluing system. Besides the great saphenous vein, additional associated targets (refluxive side branches >6 mm in diameter [n = 22] and perforator veins >6 mm in diameter [n = 12]) were included in the treatment plan. First sclerofoam was applied with a polytetrafluoroethylene catheter (PhleboCath, 1.9/2.3 mm in diameter) during withdrawal, and then cyanoacrylate glue was injected during the spasm phase of the target vein while continuously withdrawing the gluing catheter (1.2/1.6 mm in diameter). No manual compression was applied. There were no external compression media (stockings, bandages) used after the treatment. All cases (24/24) showed immediate saphenous occlusion and elimination of reflux. All auxiliary targets (39/39) were successfully reached by microfoam and occluded. The amount of glue used for saphenous veins was 10 to 33 mg (mean, 16.1 mg) per centimeter of vein. Procedural time from first puncture to patient mobilization was 11 to 23 minutes (mean, 15.1). The ScleroGlue combines reliable endothelium denaturation by catheter-delivered sclerofoam with initial and permanent lumen minimization by point-wise gluing, achieved without any external compression and using low quantities of glue. The procedure is fast and requires no anesthesia except for the puncture site. Further studies will be started in December 2016 also including nonacrylate glues.