RESUMO
Endovenous thermal methods are superseding surgical stripping for treating chronic superficial venous disease but require tumescent anesthesia and can cause heat-related nerve injuries. Endovenous cyanoacrylate ablation is a more recent technique that does not share these drawbacks. A retrospective observational study of consecutive adults managed with endovenous cyanoacrylate was conducted in 2018-2021 at a single university center. The follow-up was 18 months. We identified factors associated with target vein closure at 18 months and measured changes in quality of life using the generic 36-item Short-Form (SF-36) tool and the venous disease-specific VEINES-QOL/Sym questionnaire. Adverse events were collected. In the 55 study patients with 67 treated veins, the closure rate at 18 months was 94% (95% CI, 85-98%). Target vein diameter ≥9.5 mm had 81% sensitivity and 75% specificity for predicting recanalization. Quality-of-life scores improved significantly (p < 0.001 for both surveys). The only adverse event was a type IV allergic reaction to cyanoacrylate that was resolved with corticosteroid and histamine-antagonist therapy. Endovenous cyanoacrylate ablation was highly effective and is safe in experienced hands. Studies are warranted to determine whether changes in the protocol increase the closure rate in patients with target veins ≥9.5 mm in diameter.
RESUMO
The management of stable coronary artery disease has evolved in recent years and is now based on the latest recommendations of the European Society of Cardiology. Drug prescription takes into account two strategic approaches: on the one hand, pharmacological treatments that improve the prognosis and on the other hand treatments to improve symptoms and/or ischemia. Improving the prognosis involves reducing as well as stabilizing coronary plaque thanks to 3 therapeutic classes: aspirin, statins and renin-angiotensin system blockers (ACE inhibitors or ARBs). In parallel, a fast-acting nitrovasodilator associated with a beta-blocker or a heart-slowing calcium-channel blocker makes it possible to reduce the angina. In addition, pharmacological modifications and regular reassessments are fundamental aspects of CAD management.