Karel Novotný1, Míla Roček2, Radek Pádr2, Radim Pavlík2, Michal Polovinčák2, Theodor Adla2, Petra Zimolová3, Jana Choi-Širůčková3, Martin Weis4, Simon Jirát5, Vilém Rohn1. 1. 1 Department of Cardiology, 2nd Faculty of Medicine, Charles University, Prague and Motol University Hospital, Prague, Czech Republic. 2. 2 Department of Radiology, 2nd Faculty of Medicine, Charles University, Prague and Motol University Hospital, Prague, Czech Republic. 3. 3 Cardiology Clinic of the 2nd Faculty of Medicine, Charles University, Prague and Motol University Hospital, Prague, Czech Republic. 4. 4 Ambulant angiography, Prague, Czech Republic. 5. 5 Angiology Zbraslav, Prague, Czech Republic.
Abstract
BACKGROUND: Treating great and small saphenous vein trunk insufficiency with cyanoacrylate glue is the least taxing treatment method of all available techniques. Due to long-term unavailability of commercial kits with n-butyl-2-cyanoacrylate (histoacryl) in the Czech Republic, we used a modified technique. PATIENTS AND METHODS: Fifty-six limbs in 49 patients suffering from great saphenous vein or small saphenous vein insufficiency in combination with symptomatic chronic venous insufficiency and complicating comorbidities were treated with a modified endovascular cyanoacrylate glue application technique. RESULTS: The immediate success rate of the treatment was 98 %. In follow-up intervals of six weeks, six months, one year, and two years, the anatomical success rates of embolization (recanalization of no more than 5 cm of the junction) were 98, 96, 94, and 94 %, respectively. At identical intervals the venous insufficiency was scored according to the Aberdeen Varicose Vein Questionnaire and the American Venous Clinical Severity Score. In both cases, improvement was demonstrated over the two-year follow-up, with a 0.5 % significance level. Specific clinical signs of venous insufficiency were also evaluated, such as pain, oedema, clearance of varicose veins, and healing of venous ulceration. One severe complication - a pulmonary embolism - was reported, without consequences. CONCLUSIONS: We demonstrated that treating insufficient saphenous veins with modified histoacryl application brought a relief from symptoms of venous insufficiency and that the efficiency of this technique is comparable to commonly used methods.
BACKGROUND: Treating great and small saphenous vein trunk insufficiency with cyanoacrylate glue is the least taxing treatment method of all available techniques. Due to long-term unavailability of commercial kits with n-butyl-2-cyanoacrylate (histoacryl) in the Czech Republic, we used a modified technique. PATIENTS AND METHODS: Fifty-six limbs in 49 patients suffering from great saphenous vein or small saphenous vein insufficiency in combination with symptomatic chronic venous insufficiency and complicating comorbidities were treated with a modified endovascular cyanoacrylate glue application technique. RESULTS: The immediate success rate of the treatment was 98 %. In follow-up intervals of six weeks, six months, one year, and two years, the anatomical success rates of embolization (recanalization of no more than 5 cm of the junction) were 98, 96, 94, and 94 %, respectively. At identical intervals the venous insufficiency was scored according to the Aberdeen Varicose Vein Questionnaire and the American Venous Clinical Severity Score. In both cases, improvement was demonstrated over the two-year follow-up, with a 0.5 % significance level. Specific clinical signs of venous insufficiency were also evaluated, such as pain, oedema, clearance of varicose veins, and healing of venous ulceration. One severe complication - a pulmonary embolism - was reported, without consequences. CONCLUSIONS: We demonstrated that treating insufficient saphenous veins with modified histoacryl application brought a relief from symptoms of venous insufficiency and that the efficiency of this technique is comparable to commonly used methods.