Treatment of Venous Leg Ulcers by Cyanoacrylate Glue: a Prospective Study of Safety and Feasibility

Epicutaneous-Caval Catheters (ECCs) and/or neonatal Peripherally Inserted Central Catheters (n-PICCs) are commonly used in neonatal care, but securing these catheters remains a challenge. Recent studies have suggested that cyanoacrylate glue might offer a safer, more reliable alternative to traditional suture fixation. This study aimed to evaluate the efficacy and safety of cyanoacrylate glue as an adjunct to standard catheter securement methods in reducing complications such as dislodgement, catheter-related bloodstream infections (CRBSI), and hemorrhage. A systematic review of randomized clinical trials was conducted according to PRISMA 2020 guidelines. Databases including MEDLINE/PubMed, CENTRAL, and Embase were searched for studies involving neonatal central venous catheters secured with cyanoacrylate glue. Trials in English, Spanish, or Portuguese were considered, excluding studies with arterial or umbilical catheters, animal studies, and incomplete trials. Twelve studies involving 3076 central venous catheters were included. Results showed that cyanoacrylate glue significantly reduced catheter-related complications, including dislodgement, infection, and thrombosis, compared to traditional securement methods. Cyanoacrylate glue appears to be an effective and safe alternative for securing neonatal central venous catheters. Further research is needed to standardize its use in clinical practice.

Abstract Background Non-cirrhotic portal hypertension (NCPH) represents a diagnostic and therapeutic challenge, particularly when secondary to myeloproliferative neoplasms. In such cases, portal vein thrombosis (PVT) is a common complication, limiting decompressive procedures such as transjugular intrahepatic portosystemic shunt (TIPS). We present a case of life threatening upper gastrointestinal bleeding (UGIB) in a woman with primary myelofibrosis (PMF) and diffuse splanchnic vein thrombosis, where splenectomy provided sustained relief after failure of conventional therapy. Aims To report a rare case of upper gastrointestinal bleeding secondary to NCPH in the setting of PVT associated with PMF, highlighting the role of splenectomy as a definitive intervention leading to durable clinical improvement. Methods Case report. Results A healthy 30-year-old woman presented with UGIB due to large esophageal and gastric varices (GOV2). She was managed with endoscopic band ligation and cyanoacrylate injection. CT showed splenomegaly, ascites, and cavernous transformation of the portal vein without evidence of cirrhosis. Liver function was preserved, secondary workup was negative, and biopsy showed extramedullary hematopoiesis, consistent with NCPH. Thrombocytosis prompted further hematologic investigations, which confirmed JAK2 V617F–PMF. Follow-up CT showed progressive splanchnic thrombosis and acute splenic infarction. Therapeutic anticoagulation was initiated. Two TIPS procedures were attempted; the second achieved stent placement but thrombosed early due to the patient’s underlying prothrombotic state. Ruxolitinib was started for disease control and splenomegaly. Given her complex anatomy and disease extent, she wasn’t a candidate for surgical shunting or liver transplant. Subsequent CT revealed TIPS occlusion with persistent varices. To reduce bleeding risk, she underwent EUS-guided variceal embolization using coils and cyanoacrylate glue. The second embolization session was complicated by fever and abdominal pain due to splenic infarction resulting from non-target embolization of cyanoacrylate glue into splenic vessels. Given failure of endovascular therapy, she underwent open splenectomy. Histopathology confirmed extensive necrosis without malignancy. She was discharged on Ruxolitinib, anticoagulation and vaccinations. At five-month follow-up, EGD revealed marked improvement in portal hypertensive gastropathy with only post-treatment scarring of prior varices. She remained clinically stable and was referred for bone marrow transplant evaluation. Conclusions Management of variceal bleeding in NCPH due to PMF-associated extensive splanchnic thrombosis presents significant therapeutic challenges. When decompressive strategies such as TIPS or endoscopic embolization are contraindicated or unsuccessful, splenectomy may serve as a definitive intervention. Funding Agencies None

Cyanoacrylate glue migration after endoscopic ultrasound-guided embolization of periduodenal varices presenting as obstructive jaundice.

Gastric varices present a unique therapeutic challenge for endoscopists. While the use of direct endoscopic cyanoacrylate glue injection is superior to band ligation, it carries a risk of systemic adverse events. This led to the development of endoscopic ultrasound (EUS)-guided therapy. EUS enables accurate measurement and targeting of vessels, allowing for the precise intravascular delivery of cyanoacrylate and/or coils. Doppler imaging can be used to confirm obliteration in real time. In this review, we highlight recent literature on varying embolization techniques and detail the technical considerations required for a successful EUS-guided approach.

This case report presents an emergency surgical technique for managing a traumatic sealed corneal perforation in a young adult male, utilizing a sterile polydrape patch and cyanoacrylate glue. The objective was to showcase a straightforward, low-cost solution that can be especially useful in situations where donor corneal tissue is not readily available, such as in resource-limited environments or urgent care scenarios. A 22-year-old male sustained an ocular injury at his workplace following an accident involving a hand saw machine. He arrived with complaints of sudden visual decline, ocular pain, redness, and excessive tearing in his left eye. On clinical examination, a 4 mm × 3 mm sealed corneal perforation with pseudocornea was identified in the inferior quadrant, accompanied by a shallow anterior chamber and hypotony. Given the emergency and lack of access to corneal graft material, a temporary globe-sealing procedure was undertaken. A section of sterile surgical polydrape was punched into a 4 mm circular patch and carefully positioned over the perforation site. It was secured using N-butyl-cyanoacrylate glue, followed by the application of a bandage contact lens to enhance patient comfort and protect the surgical site. The patient's recovery was uneventful. At the 1-month review, the cornea had healed with a leucomatous scar at the perforation site. The anterior chamber was well maintained, and there were no signs of infection or persistent inflammation. In emergency settings or regions with limited access to donor corneas, the combination of a sterile polydrape patch and cyanoacrylate adhesive provides an effective and accessible method to restore globe integrity. This approach not only stabilizes the eye but also creates a critical window for healing or referral for definitive surgical management. It is a valuable interim solution, particularly in rural or under-resourced healthcare environments.

Gastric variceal bleeding in cirrhosis remains a challenging clinical problem with variations in management strategies. This randomized controlled trial compared aggressive versus conservative cyanoacrylate therapy for gastric varices in patients with cirrhosis presenting with their first variceal bleed.Patients with cirrhosis and large gastric varices (GOV1, GOV2, IGV1) and a first episode of variceal bleeding were randomized to receive aggressive endotherapy (Group A) or conservative endotherapy (Group B). In Group A, all visible gastric varices were obliterated using cyanoacrylate glue; in Group B, only varices with stigmata of recent hemorrhage or high-risk features were treated. The primary outcome was variceal rebleeding at 1 year. Secondary outcomes included all-cause mortality, variceal obliteration time, and adverse events.145 patients were analyzed (Group A 72; Group B 73). At 1 year, the cumulative incidence of rebleeding was comparable between groups (18.2% vs. 15.0%). All-cause mortality at 1 year was also similar (22.2% vs. 32.9%), with a hazard ratio of 0.63 (95%CI 0.33-1.18; P = 0.15), suggesting a nonsignificant 37% reduction in mortality risk with aggressive endotherapy. Time to obliteration of GOV1 varices was shorter in Group A, with a median (range) of 4 (4-20) vs. 8 (4-116) weeks in Group B. Similarly, the number of endoscopic sessions required for GOV1 obliteration was fewer in Group A (1 [1-4] vs. 2 [1-5] sessions). Adverse event rates were comparable across both groups.Aggressive endotherapy resulted in rebleeding and mortality rates similar to those of conservative therapy.

The Coronavirus Disease 2019 (COVID-19) pandemic has significantly impacted intravenous therapy practices, particularly in critically ill patients. Vascular access strategies were adapted to evolving clinical needs, infection control priorities, and resource limitations, with a focus on safety, efficacy, and technological advancements. This scoping review aimed to explore how the COVID-19 pandemic affected vascular access practices and catheter-related complications, with the objective of mapping innovations, identifying emerging trends, and summarizing preventive and therapeutic strategies. The review followed PRISMA-ScR guidelines and was registered in PROSPERO (CRD420251027530). A systematic search was conducted in PubMed®, EMBASE®, EBSCO-CINAHL®, and CENTRAL for English-language studies published between January 2020 and May 2025 addressing catheter-related complications in COVID-19 patients, including catheter-related bloodstream infections (CRBSI), central line-associated bloodstream infections (CLABSI), catheter-related thrombosis (CRT), and accidental catheter removal. Among 521 screened articles, 58 met the inclusion criteria. Most studies reported higher rates of CRBSI, CLABSI, CRT, and accidental removal in COVID-19 patients, especially in critical care settings. Arterial catheters were also associated with elevated risks of thrombosis and infection during the pandemic. Mid-thigh femoral access sites emerged as practical alternatives to reduce central line use and healthcare personnel exposure. Technological advances, including power-injectable catheters, ultrasound-guided insertion, intracavitary ECG for tip confirmation, and securement tools such as cyanoacrylate glue and subcutaneous anchor systems, improved safety and reduced mechanical and infectious complications. Chlorhexidine-based antisepsis, antimicrobial-impregnated devices, and disinfectant caps effectively decreased CRBSI and CLABSI rates. In older, comorbid patients-now representing the majority of COVID-19 hospitalizations-nutritional and anticoagulant therapy must be carefully balanced to minimize bleeding and thrombotic risks. In conclusion, the pandemic catalyzed significant innovation and adaptation in vascular access practices. Integrating portable technologies, infection prevention strategies, and alternative access routes has enhanced patient care and established new standards for managing intravenous therapy in high-risk, resource-constrained settings.

Middle meningeal artery embolization for chronic subdural hematoma using PVA 45-150 particles versus n-BCA glue: a pragmatic study with analysis of estimated cost.

Sulfur Hexafluoride (SF6) Injection to Dry a Leaking Sclerotomy before Cyanoacrylate Glue Closure.

Cirrhosis with unexplained upper gastrointestinal bleeding (CUUGB) remains a persistent diagnostic and therapeutic challenge in the management of patients with cirrhosis. It is worth investigating whether EUS-guided cyanoacrylate injection (EUS-CYA) provides greater efficacy in the diagnosis and treatment of CUUGB compared to cyanoacrylate injection under direct endoscopy (DEI-CYA). This study enrolled116 patients with CUUGBand employed asingle-blind, prospective, parallel-group randomized designto assign participants into two arms: theDEI-CYA group (n = 58)and theEUS-CYA group (n = 58). Both groups of patients were followed up at 1, 3, and 6months postoperatively. In cases of rebleeding during this period, endoscopy was promptly repeated. The primary outcome was the comparison of rebleeding rates between the two groups of patients with CUUGB. Secondary outcomes included technical success rate, rate of vascular obliteration, Occurrence of complications during follow-up, and liver function status. Among the 116 enrolled patients, direct endoscopy revealed47 cases (40.51%)with gastric fundalred-color signs (RCS) and 27 cases (23.30%)with punctate erosions. Post-treatment, theEUS-CYA groupdemonstrated a significantly higherGV obliteration rate (82.76% vs. 65.52%, p = 0.035)and a lowerlong-term rebleeding rate (22.41% vs. 60.34%, p < 0.01) compared to the DEI-CYA group. Thecumulative incidence of rebleedingwas lower in theEUS-CYA group(p = 0.003). Liver function improved following EUS-CYA, with significant increases inalbumin (p = 0.038)and prothrombin time (PT, p = 0.009), whereas DEI-CYA improved only PT (p = 0.002). Multivariate analysis identifieddiabetes mellitusas an independent predictor of rebleeding (OR = 0.19; 95% CI: 0.06-0.65;p = 0.008). Notably,DEI-CYAwas associated withsignificantly higher odds of rebleedingcompared toEUS-CYA(OR = 0.23; 95% CI: 0.10-0.56;p = 0.001). Compared with DEI-CYA, EUS-CYA demonstrates a significantly higher detection rate of bleeding etiology, superior vascular obliteration rates, and a lower incidence of rebleeding in patients with CUUGB. Chinese Clinical Trial Registry (ChiCTR) website ( https://www.chictr.org.cn/ ), Number ChiCTR2200058888.

Introduction/Purpose Rhabdomyosarcomas are rare, highly vascular tumors characterized by an extensive arterial supply. Preoperative embolization is commonly employed in the management of hypervascular lesions to minimize blood loss and enhance surgical safety. The conventional method involves superselective catheterization of the feeding vessels, followed by embolization. However, this intervention can be challenging in lesions with numerous small feeders that are too small to catheterize, or in those with high risk feeders such as branches from the ophthalmic artery. We present a case of alveolar rhabdomyosarcoma with incapacitating nasopharyngeal hemorrhage in which standard endovascular embolization was insufficient, and successful hemorrhage control was ultimately achieved through direct endonasal tumor puncture for embolization using n‐butyl cyanoacrylate (n‐BCA) glue (TruFill, Johnson &amp; Johnson Medtech, New Brunswick, NJ, USA). Materials/Methods Single case study Results A 21‐year‐old male with a known history of alveolar rhabdomyosarcoma was transferred from an outside hospital for evaluation and management of significant nasopharyngeal hemorrhage requiring intubation and multiple transfusions. CTA of the head and neck demonstrated a large, destructive mass centered in the left nasal cavity, consistent with his known malignancy, with invasion into the left orbit and anterior cranial fossa. Initial management by Interventional Neuroradiology included particle embolization (Embosphere 300‐500 µm, Merit Medical, South Jordan, UT, USA) and coil embolization of the left supraorbital artery, distal left internal maxillary artery, and the left zygomatico‐orbital artery. Although the patient did not require further transfusions, the patient continued to experience hemoptysis, particularly with movement. Ongoing management included repeat nasopharyngeal packing by ENT. He was taken back for embolization two days later, which included direct tumor puncture with injection of n‐BCA glue and particle embolization of the left ascending pharyngeal artery, resulting in decreased tumor vascularity. However, bleeding persisted, prompting a follow‐up angiogram and subsequent embolization of the right internal maxillary artery, along with an additional direct tumor puncture embolization, with a more extensive D5W flush leading to better tumor penetration, and complete and durable cessation of hemorrhage and eventual extubation. Conclusion N‐butyl cyanoacrylate glue is a fast‐acting liquid embolic material used in the treatment of a variety of vascular malformations and lesions of the head and neck. Investigations surrounding the use of n‐BCA injections as a new alternative embolic agent began in the 1980's. This case highlights the utility of direct tumor embolization as an effective salvage technique in the management of life‐threatening hemorrhage from hypervascular lesions. In this patient, initial endovascular embolization via the left supraorbital, distal internal maxillary, and zygomatico‐orbital arteries failed to achieve lasting hemostasis, likely due to the presence of numerous small, feeding branches and multiple collateral pathways. Subsequent direct tumor puncture with n‐BCA glue resulted in significant reduction of tumor vascularity. Direct tumor embolization is a valuable adjunctive technique in the management of hypervascular tumors when traditional endovascular approaches are limited or insufficient.

Abstract Background Fistula-in-ano is one of the most common anorectal diseases with prevalence in men greater than women, with a rate of 12.3 cases per 100,000 and 5.6 cases per 100,000 respectively. A fistula-in-ano is an epithelial lined tract connecting the anal canal to the perianal skin most commonly due to the development of anorectal abscess. Aim of the Work to evaluate the efficacy and safety of the use of cyanoacrylate glue in the management of high trans-sphencteric perianal fistula regarding remission of symptoms, recurrence rate and effect on continence. Patients and Methods This non-comparative retrospective study was conducted at the General Surgery Department of Ain Shams University Hospitals, with approval obtained from the Ethical Committee, and the study period spanned from June 2023 to October 2024. Results This study evaluated cyanoacrylate glue for treating high trans-sphincteric perianal fistulae in 40 patients (mean age: 47.1 years, 57.5% male). Comorbidities like hypertension (42.5%) and diabetes (25%) were common. The procedure was time-efficient (51.6 minutes) with favorable short-term outcomes: reduced pain (mean score: 2.7), minimal incontinence (Wexner score: 0.15), and low infection rates (2.5%). However, recurrence was high at six months (57.5%), despite preserved continence. While effective for symptom management and sphincter preservation, the high recurrence rate highlights a need for improved long-term efficacy. Future research should optimize techniques to balance minimal invasiveness with durable outcomes, addressing the challenges of this complex condition. Conclusion Cyanoacrylate glue for the management of high trans-sphincteric perianal fistulae demonstrated promising short-term outcomes, including significant pain reduction, low rates of postoperative infection, and complete preservation of continence without any cases of incontinence over a six-month follow-up period. However, the procedure was associated with a relatively high recurrence rate of 57.5%, highlighting a limitation in its long-term efficacy.

PurposeVarious materials and techniques have been explored to prevent anastomotic leakage (AL). Polyglycolic acid (PGA) sheets and cyanoacrylate (CA) glue have been investigated for their potential in wound healing and fistula closure. This study aims to assess the feasibility of PGA-CA complex (PCC) to prevent AL by developing a major leakage model in rats.MethodsAfter the creation of the major leakage model in the jejunum of rat, the leakage site was treated with each material individually and in combination. Rats were categorized into the control, CA, PGA, and PCC groups.ResultsA total of 40 rats were included, with one animal from the CA and PGA groups having expired. Gross intra-abdominal conditions showed no significant difference between the groups. Median intraluminal bursting pressure was 120.0 (range, 102.5–138.0) in the CA group and 138.0 (range, 127.0–147.0) in the PCC group (P = 0.286). Pathologic evaluation revealed fibroblast activation was significantly different in the PCC group (P = 0.025).ConclusionNo significant differences were observed in the macroscopic intra-abdominal findings or intraluminal bursting pressure between the groups. The only difference in PCC group was enhanced fibroblast activation at moderate levels compare to the control group. Further research is warranted to optimize material combinations and validate efficacy in larger preclinical and clinical settings.

Arteriovenous malformations (AVMs) are uncommon congenital vascular anomalies characterized by direct, high-flow connections between arteries and veins. Forehead AVMs present unique challenges due to their aesthetic considerations, risk of complications, and proximity to critical neurovascular structures. A 26-year-old male presented with a pulsatile forehead swelling present since birth, which gradually increased in size. Doppler ultrasound and magnetic resonance imaging (MRI) revealed a forehead AVM fed by branches from the superficial temporal and ophthalmic arteries, without evidence of intracranial extension. Presurgical embolization using cyanoacrylate glue achieved 90% occlusion. However, the procedure was complicated by glue migration into the cavernous sinuses, resulting in headache and dizziness. The patient was initially managed with low-molecular-weight heparin and close clinical observation. Definitive surgical resection was performed successfully 1 month later. The wound healed without complications, and no recurrence was observed during 6 months of follow-up. This case highlights the importance of a multidisciplinary approach in managing AVMs and emphasizes the need to balance embolization risks with therapeutic benefits to achieve optimal outcomes.

Background: There is a possible association between the usage of topical steroids on the face and the density of Demodex mites. This study was undertaken with the aim to study the density of Demodex mites in patients with topical steroid-damaged faces. Methods: This cohort study included 232 patients with TSDF (group A) and 40 patients with no facial dermatological lesions and conditions and with no history of use of topical steroids (group B). The sample from the skin was collected using the skin surface biopsy (SSB) technique with cyanoacrylic glue and skin tape stripping (STS) method. Results: There was a significantly greater density of Demodex mites amongst group A subjects compared to group B subjects [18.5% vs 5.0%] (p value &lt;.05). There was no statistically significant association between the duration and potency of TC use and the density of Demodex mites (p value &gt;0.05). Clinical features were also not found to have a significant association with the potency of TC used. Conclusions: Infestation of facial skin with Demodex mites is significantly associated with the use of topical steroids on the face. There was no statistically significant association between the duration and potency of TC use and the density of Demodex mites.

Varicose veins of the lower limbs are a common clinical condition caused by CVI (Chronic Venous Insufficiency). EVLA (Endovenous Laser Ablation) is a widely practiced, minimally invasive treatment modality for managing superficial venous insufficiency and varicosities. Although complications are infrequent, some device-related issues warrant attention due to their potential consequences. We report a rare case of intravascular fragmentation of the laser fiber tip during EVLA. A 62-year-old male with a 30-year history of bilateral varicose veins presented with left lower limb pain and pigmentation. Clinical examination and venous Doppler revealed SFJ (Saphenofemoral Junction) incompetence and multiple perforator insufficiencies. EVLA of the left GSV (Great Saphenous Vein) was performed. During the procedure, loss of resistance during fiber retraction prompted inspection, which revealed that the laser fiber tip had broken intravascularly. The fragment was localized radiologically and surgically retrieved via targeted wound exploration. The patient had an uneventful postoperative recovery. Intravascular fragmentation of the laser fiber tip is a rare but recognized device-related complication of EVLA. Adherence to procedural protocols, including fiber inspection before and after ablation, careful energy settings, and continuous intraoperative monitoring, is essential for prevention. This case underscores the importance of prompt recognition and appropriate management to prevent further complications. Varicose veins of the lower limbs are a prevalent vascular disorder resulting from CVI. This condition arises due to valvular incompetence within the superficial venous system, leading to venous reflux, increased venous pressure, and subsequent vein dilation. It significantly impacts patients’ quality of life by causing symptoms such as pain, heaviness, leg swelling, skin changes, and ulceration, in addition to posing socioeconomic burdens due to reduced productivity and healthcare costs.[1,2] Historically, the mainstay of treatment for superficial venous insufficiency was surgical—specifically, high ligation and stripping of the great saphenous vein. In recent years, however, the management landscape has shifted toward minimally invasive endovenous techniques, including EVLA, RFA (Radio-Frequency Ablation), foam sclerotherapy, and cyanoacrylate glue closure. These techniques offer high efficacy, lower morbidity, shorter recovery time, and improved cosmetic outcomes.[3] Among these, EVLA has emerged as one of the most commonly performed procedures due to its high vein closure rates and low recurrence and complication profiles. Although EVLA is typically considered safe, there are some rare instances where complications may arise. These include bruising, thrombophlebitis, DVT, skin burns, nerve injury, pigmentation, and more rarely, device-related issues such as laser fiber tip fragmentation.[4,5] The case presented in this report is significant because it illustrates a rare but important device-related complication: intravascular fragmentation of the laser fiber tip during EVLA. This type of complication, if not promptly recognized and appropriately managed, can lead to serious outcomes such as thrombosis, embolism, or infection. The case underscores the need for strict procedural protocols, intraoperative vigilance, and post-procedural fiber inspection to ensure patient safety and optimal outcomes. By documenting this event, the case adds to the limited existing literature on fiber tip fragmentation during EVLA and serves as a practical reminder for vascular surgeons and interventional radiologists to remain alert to this preventable complication during what is otherwise a safe and routine procedure.

Intravenous catheters (IVCs) are a common medical device, used in 70% of hospital patients. Due to their high failure ratio (35%-50%) and complications, we aimed to perform a systematic review and meta-analysis to assess the efficacy of Cyanoacrylate Glue (CG) use in preventing IV complications at the Emergency Department. This study was registered in PROSPERO on February 5, 2025, with registry number CRD42025642588 and received no financial support. A systematic search at PubMed, Embase, and Cochrane databases was performed and only Randomized Controlled Trials about CG use for securing IVCs were included. Primary outcomes showed no statistical significance between the groups across all four outcomes at maximum follow-up. However, in a subgroup analysis including only adult patients, CG group presented lower IVCs dislodgement and failure events. Further studies in pediatric patients are needed.

Conventional Sutures versus Cyanoacrylate Glue in Mesh Fixation in Open Inguinal Hernioplasty

Objective. To evaluate the short-term outcomes of original cyanoacrylate glue ablation technique for incompetent perforating veins. Material and methods. A prospective cohort study enrolled 209 patients (253 limbs) with recurrent varicose veins. All of them underwent cyanoacrylate glue ablation of incompetent veins. The follow-up was 6 months. Incidence of perforating vein ablation (no blood flow according to ultrasound data) was assessed. No migration of cyanoacrylate glue into deep venous system was a safety criterion. Results. In each patient, 1—4 perforating veins were obliterated (331 veins in total). Diameter of perforating veins varied from 2.5 to 7.4 mm (mean 4.2 mm). About 0.4 ml of cyanoacrylate glue was used per a procedure. Total occlusion of perforating veins was achieved in 245 lower extremities after 24 hours. Blood flow through the perforating was partially preserved in 5 lower extremities. Excellent technical results were achieved 2 months after procedure in 241 (95%) lower extremities, after 6 months — in 238 (94%) extremities. Glue migration into deep veins occurred in 3 cases. Conclusions. In most cases, original technique of cyanoacrylate obliteration of perforating veins provides excellent technical results with minimal risk of complications.