Ablation of the great saphenous vein with nontumescent n-butyl cyanoacrylate versus endovenous laser therapy.

ABSTRACT

OBJECTIVE: The endovenous application of n-butyl cyanoacrylate (NBCA) is a new nontumescent ablation technique for the treatment of venous insufficiency. The aim of this study was to retrospectively compare an NBCA-based ablation method with endovenous laser ablation (EVLA) for the management of incompetent great saphenous veins. METHODS: Between May 2013 and August 2014, there were 339 patients with incompetent varicose veins who were treated with either the endovenous application of NBCA (VariClose Vein Sealing System [VVSS]; Biolas, Ankara, Turkey) or EVLA. The preprocedural, intraprocedural, postprocedural, and follow-up data of the patients were collected and retrospectively compared. RESULTS: The mean age was 45.09 ± 12 years in the VVSS group and 47.08 ± 11 years in the EVLA group (P = .113). The average ablated vein length was 31.97 ± 6.83 cm in the VVSS group and 31.65 ± 6.25 cm in the EVLA group (P = .97). The average tumescent anesthesia use was 300 mL (range, 60-600 mL) in the EVLA group. The average procedure time was 7 minutes (range, 4-11 minutes) in the VVSS group and 18 minutes (range, 14-25 minutes) in the EVLA group (P < .01). On the basis of ultrasound examinations performed at the end of the procedure, all procedures in both groups were successful, and the target vein segments were fully occluded. The 12-month total occlusion rates in the VVSS and EVLA groups were 98.6% and 97.3%, respectively (P = .65). In both the VVSS and EVLA groups, the Venous Clinical Severity Score declined significantly with no difference between groups. There were fewer adverse events after VVSS treatment compared with EVLA treatment (pigmentation, P ≤ .002; phlebitis, P ≤ .015). There was no need for tumescent anesthesia in the VVSS group. CONCLUSIONS: The NBCA-based vein sealing system is a fast and effective treatment option for the management of incompetent saphenous veins that does not involve tumescent anesthesia, compression stockings, paresthesia, burn marks, or pigmentation. Further large-scale studies with long-term outcomes are required to identify the optimal treatment modalities for patients with saphenous vein insufficiency.