VESS08. Incidence, Classification, and Risk Factors of Endovenous Glue-Induced Thrombosis After Cyanoacrylate Closure of Varicose Vein

Abstract

Cyanoacrylate closure (CAC) is a safe and effective modality for the treatment of incompetent saphenous vein. The glue extension into the deep vein, so-called endovenous glue-induced thrombosis (EGIT) may be a worrisome complication. However, the incidence, classification, and risk factors of EGIT have not been elucidated. We report the incidence after CAC for an incompetent saphenous vein. A retrospective review was performed from prospectively collected data of CAC patients (Table I). Preoperatively, the diameter, reflux time, and peak reflux velocity of saphenous veins were measured. CAC was performed following the instructions for use. Postoperative follow-up was done at 1 week, 3 months, 6months, and 1 year after procedure. Postoperative duplex scanning was performed to evaluate the presence of glue extension into the deep vein. We classified it as four grades. The risk factor for the development of EGIT was analyzed (Table II). The paired t-test, independent t-test, Fisher’s exact test and one-way analysis of variance were used for statistical analysis. A P value of less than .05 was considered statistically significant. During the study period, CAC was performed in 191 patients. The mean age was 56.1 ± 11.7 years with a range of 19 to 84 years. The 126 patients were female. EGIT developed in 11 patients (5.8%). EGIT grades I and II developed in seven (63.6%) and four (36.4%) patients, respectively. All patients with EGIT did not use an anticoagulant. After the procedure, pain, venous clinical severity score, and quality of lift score were improved with statistical significance (P < .001). On the analysis of risk factor for the development of EGIT, a preoperative saphenous vein diameter of less than 5 mm was the only risk factor (P < .001). EGIT is not uncommon complication. A small diameter of saphenous vein less than 5 mm is a risk factor for the development of EGIT. The clinical course of EGIT was benign.Table IPatient demographics (N = 191)DemographicsAge, years56.1 ± 11.7 (19-84)Sex Male65 (34.0) Female126 (66.0)Indication for treatment Discomfort168 (88.0) Heaviness152 (79.6) Night cramping129 (67.5) Pain23 (12.0) Itching10 (5.2) Swelling5 (2.6)Limbs286 Right47 (24.6) Left49 (25.7) Bilateral95 (49.7)Truncal veins332 179 (41.4) 287 (45.5) 321 (11.0) 44 (2.1)Anesthesia Local190 (99.5) General1 (0.5)Operation time, minutes67.7 ± 29.8EGIT11 (5.8)Gradea 17 (63.6) 24 (36.4) 30 (0) 40 (0)Truncal vein (GSV : SSV)7 (63.6) : 4 (36.4) : 0 (0) : 0 (0)Pain scoreb Immediate after procedure1.6 ± 1.0 Postoperative 7 days0.8 ± 1.1Venous clinical severity scorec Immediate after procedure (n = 145)4.25 ± 2.35 Postoperative 7 days (n = 167)1.25 ± 1.31 Postoperative 90 days (n = 96)0.95 ± 1.34Quality of lift scored Immediate after procedure (n = 145)11.51 ± 8.24 Postoperative 7 days (n = 167)7.89 ± 5.50 Postoperative 90 days2.65 ± 4.01EGIT, Endovenous glue-induced thrombosis; GSV, great saphenous vein; SSV, small saphenous vein.Values are mean ± standard deviation (range) or number (%).aGrade was classified with the occupied area of common femoral or popliteal vein of glue extension.bPain score was measured with via visual analog scale (P < .001 by paired t-test).cThe venous clinical severity score was improved after procedure (P < .001 by one-way analysis of variance).dQuality of lift score was calculated with Aberdeen Varicose Veins Questionnaire (P < .001 by one way analysis of variance). Open table in a new tab Table IIRisk factors of endovenous glue-induced thrombosis (EGIT)Risk factorsNo EGITEGITP valueNo. (%)180 (94.2)11 (5.8)Age, years, mean ± SD55.9 ± 11.923.7 ± 4.9.573aBMI, mean ± SD25.1 ± 4.856.1 ± 11.7.456aSex, no. (%).189b Male59 (90.8)6 (9.2) Female121 (96.0)5 (4.0)Side, no. (%).577b Right43 (91.5)4 (8.5) Left47 (95.9)2 (4.1) Bilateral90 (94.7)5 (5.3)Treated vein, no. (%).860b GSV99 (95.2)5 (4.8) SSV30 (90.9)3 (9.1) Both51 (94.4)3 (5.6)Comorbidity, no. (%) Hypertension (yes:no)22:1582:9.632b Diabetes (yes:no)15:1650:111.00b Hypercholesterolemia (yes:no)7:1731:10.384b Smoking (yes:no)4:1761:10.259b Cancer (yes:no)1:1790:111.00b Previous DVT (yes:no)1:1791:10.112bPresence of symptom (yes:no)178:211:01.00bVein diameter <5 mm (yes:no)10:1708:3<.001bBMI, Body mass index; DVT, deep vein thrombosis; GSV, great saphenous vein; SD, standard deviation; SSV, small saphenous vein.aIndependent t-test.bFisher’s exact test. Open table in a new tab