ABSTRACT
Naoki Sakakibara, MD PhD
Executive advisor
Edogawa Hospital Vein Center
Edogawa Ward, Tokyo, Japan
Cyanoacrylate adhesive closure (CAC) is a safe and effective modality, while the standard procedure is time-consuming. Recently, the manufacturer advised the simultaneous three-segment adhesion with a single manual compression in order to reduce the total procedure time. Therefore, more segment adhesion at once is advantageous for a speedy procedure. The objective of this study is to evaluate the outcome of CAC with more than four segments in a single manual compression (“consecutive adhesion”) compared with the standard procedure.
Methods:
A multiple center, retrospective, and observational study was conducted with a chart review. In a total of 780 legs, the consecutive adhesion with the registered cyanoacrylate product was performed in 53 legs for GSV reflux. Patients who underwent CAC with a treated length of more than 20 cm were exclusively included in this study. The consecutive procedure adhered to more than four segments simultaneously in a single manual compression. After droplets were delivered in the first three segments with proximal compression, the physician compressed the delivered segment with his left hand. During that time, the assistant continued to drawback the delivery catheter for the remaining segments, and the physician delivered the other droplets at the 3 cm interval. After giving the last droplet, the physician compressed the whole treated area with both hands for two and a half minutes. The patient observation period was up to six months.
Results:
The consecutive adhesion group included 53 legs in 51 patients, and the standard procedure group included 69 legs in 67 patients. The average age was 64 (SD 14) years old; 65 patients (52% of the total number of patients) were females. In a total of 123 legs, a mean truncal vein diameter was 6.7 (SD2.0) mm; the median CEAP C class was 3 (SD 1.1); the mean VCSS was 3.8 (SD2.6). The mean procedure time was 27 (SD12) minutes, and an average cyanoacrylate volume was 1.4 (SD 0.6) mL, while the mean treated vein length was 36 (SD 9) cm. A shorter procedure time (p < 0.001) and a larger maximum vein diameter (p=0.006) were observed in the consecutive adhesion (Table 1). Anatomical and clinical success was obtained in all patients, and EGIT and glue extension were not observed. There was phlebitis in 4 patients (consecutive 1, standard 3), but no hypersensitivity.
Conclusions:
The consecutive adhesion was safe and effective as well as the standard procedure. The procedure time was reduced by 41 % and the outcome was equivalent to the standard procedure even with a larger maximum vein diameter. This result is promising, however further study is still necessary.