Abstract
Background:
Varicose vein disease is characterized by dilated and tortuous lower extremity veins and affects approximately 37.25% of Indian population. Endovenous ablation is the first-line treatment approved for superficial venous reflux. A new technology recently available is a nontumescent and nonthermal method (VenaSeal) wherein aliquots of cyanoacrylate glue are delivered throughout the length of vein resulting in venous obliteration. The aim of this study was to evaluate the clinical outcomes of endovenous glue ablation for treatment of superficial venous reflux in patients with symptomatic varicose vein disease.
Materials and Methods:
This was a single-center retrospective observational study of 175 patients with 6, 12, and 18 months follow-up. The treatment success was measured in terms of vein occlusion rate on Duplex scan and clinical outcomes in terms of improvement in revised Venous Clinical Severity Score (VCSS).
Results:
A total of 176 limbs were treated over a study period of 1 year 5 months with 6-, 12-, and 18-month follow-up. The most common CEAP classification was C2 seen in 83/176 (47.2%) limbs. Incompetent great saphenous vein (GSV) was ablated in 170, incompetent short saphenous vein (SSV) in 5 and accessory GSV in 1 patient. The preprocedure GSV diameter (supine position) was 5.7±1.8 mm and the length of ablated vein was 32.9±7 cm. The technical success was 100% with no device related complications. The vein closure rate was 100% at 6 months and 99.4% at 12 and 18 months. The preprocedural VCSS score was 5.8±2.2. There was statistically significant improvement in VCSS score at 6 months (2.1±1.2; p<0.001) with sustained improvement at 12 months (1.7±0.99; p<0.001) and 18 months (1.4±0.67; p<0.001). The most common side effect was thrombophlebitis seen in 13/176 (7.4%) limbs. There was no serious adverse event and paraesthesia was not seen.
Conclusion:
This study has demonstrated high efficacy and safety of endovenous glue ablation in terms of truncal closure, technical and clinical success in symptomatic patients with chronic venous insufficiency in Indian population. However, complications like thrombophlebitis and hypersensitivity reactions are reported with cyanoacrylate ablation.
Clinical Impact
It will authenticate the safety and efficacy of glue based ablation for the treatment of lower limb varicose veins. Cyanoacrolate glue based non thermal Ablation of lower limb Varicose Veins has better efficacy, fewer side effects and practically painless compared to thermal Ablation.
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