The utility of endovenous cyanoacrylate glue ablation for incompetent saphenous veins in the setting of venous leg ulcers

• Published in: Journal of vascular surgery. Venous and lymphatic disorders (New York, NY) Vol. 8; no. 6; pp. 1041 - 1048
• Main Authors: Chan, Sally Shin Jie, Yap, Charyl Jia Qi, Tan, Seck Guan, Choke, Edward Tieng Chek, Chong, Tze Tec, Tang, Tjun Yip
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2020
• Subjects: Ablation Techniques - adverse effects; Aged; Chronic Disease; Compression Bandages; Cyanoacrylate glue; Cyanoacrylates - adverse effects; Cyanoacrylates - therapeutic use; Endovenous; Female; Humans; Male; Middle Aged; Pain, Postoperative - etiology; Prospective Studies; Saphenous Vein - diagnostic imaging; Saphenous Vein - surgery; Singapore; Stockings, Compression; Time Factors; Treatment Outcome; Varicose Ulcer - diagnostic imaging; Varicose Ulcer - surgery; Varicose veins; VenaSeal closure system; Venous Insufficiency - diagnostic imaging; Venous Insufficiency - surgery; Venous leg ulcer; Wound Healing; Singapore; Endovenous; Venous leg ulcer; Cyanoacrylate glue; VenaSeal closure system; Varicose veins
• ISSN: 2213-333X; 2213-3348
• DOI: 10.1016/j.jvsv.2020.01.013

Patients with venous leg ulcers (VLUs) represent the worse spectrum of chronic venous insufficiency (CVI). The Early Venous Reflux Ablation (EVRA) landmark trial published in 2018 demonstrated that early endovenous intervention results in faster healing of VLUs. We describe our post-EVRA experience using endovenous cyanoacrylate glue ablation (ECGA) to treat superficial venous reflux on an early basis and assess its efficacy and safety in the setting of VLUs.
There were 37 patients (39 legs, 43 truncal veins) with 43 discrete venous ulcers who underwent ECGA for CVI symptoms and VLUs. They received compression therapy and regular dressings for the VLUs postoperatively and were reviewed at 1 week, 3 months, 6 months, and 12 months after the procedure. Postoperative healing time for VLUs and complications were recorded along with the patient's satisfaction and postprocedure pain scores.
The venous ulcers were all <30 cm2 before ECGA. The mean time for VLU healing from operation was 73.6 ± 21.9 days, and the primary occlusion rate of the CVI at both 1 week and 3 months was 100%. No major adverse events were observed except for one case of deep venous thrombosis. There was significant improvement in the revised Venous Clinical Severity Score postoperatively from 11 ± 1.63 (baseline) to 5.6 ± 1.37 (P < .001) at 3-month follow-up (on a scale of 0 to 27, with the severity of symptoms at a maximal 27). The visual analog scale scores for pain were low postoperatively, decreasing from a preoperative score of 6.84 ± 1.42 to 2.72 ± 1.59 (P < .001) at the 3-month follow-up (on a scale of 1-10, with 10 being the most severe pain). The median time to return to normal activities was 7 days (interquartile range, 5-7 days).
ECGA together with compression therapy for VLUs is both safe and effective in this population of Asian patients. ECGA for patients with VLUs has excellent patient acceptability, minimal morbidity, and low recanalization rates at 12 months. Larger extensive studies and longer follow-up periods are required to validate the preliminary outcomes of this paper, and if it is proven to significantly improve ulcer healing rates, this will change the way we approach chronic venous ulceration.