Case Selection and Initial Results of Cyanoacrylate Glue Closure for Varicose Veins over 2-year Period

<p>Case selection and initial results of cyanoacrylate closure (CAC) at one facility for saphenous veins of lower extremity varicose veins which has been generally covered by health insurance in Japan since 2020, are presented. Until December 2021, there were 206 consecutive cases (male 82, female 124, 70±12 years old), 277 limbs (CEAP classification, C2 171, C3 17, C4a 79, C4b 1, C5 3, C6 6), and 283 veins (GSV 238, SSV 45). For case selection, the characteristics of CAC and other treatments as well as the characteristics of each patient's lesion, were explained, and patients who wanted bilateral simultaneous treatment and those who needed treatment down to the middle calf were mainly treated; 283 of 549 (51.5%) saphenous veins treated during the same period were treated with CAC, and 93.3% of the patients visited the clinic up to 6 months after surgery. The condition of 17 of the 19 patients who did not visit the clinic was confirmed by telephone. Average treatment length was 40±13 cm in the GSV and 20±7 cm in the SSV. Mean diameter was 4.8±1.1 cm in the GSV (mean of the area parallel to the skin on the upper and lower 1/3 of the thigh) and 4.7±1.3 cm in the SSV (uniform area parallel to the skin on the upper 1/3 of the calf). Simultaneous treatments were varicectomy in 214/277 limbs (77%), form sclerotherapy (FS) of varices in 15/277 limbs (5%), severing of incompetent perforating veins (IPVs) in 5/277 limbs (2%), and FS of IPVs in 1/277 limbs (0.4%). The occlusion rate was 95.8% (GSV 96.2%, SSV 93.3%). Twelve recanalizations (GSV 9, SSV 3) were all partial, and four of them were re-treated. Grade 2 or higher deep venous junction thrombosis was observed in 2.1%. Foreign-derived inflammatory complications in 7.9%, of which 10 limbs were untreated and the remaining 12 limbs were treated and relieved by 5 weeks postoperatively. CAC is considered to be particularly useful in cases where the advantages of using a small amount of local anesthesia and not causing neuropathy can be of benefit.</p>