Modification of protocol with one extra drop of endovascular cyanoacrylate improved closure rates in incompetent great saphenous veins.

Introduction: Great saphenous vein diameter (GSV) of >8 mm was predictor of recanalization following Venaseal cyanoacrylate treatment. The aim of this study was to report our modified protocol with a single extra-drop for treatment for GSV>8 mm, and comparative duplex results in closure rates.

Methods: Patients in our single-centre registry treated with Venaseal were followed up by serial duplex examinations at week 1 and month(s)- 1, 6, 12, 18, 24, and then annually. The primary endpoint was successful obliteration of the GSV, secondary endpoints were closure distance from Saphenofemoral junction (SFJ), presence of endovenous glue-induced thrombosis (EGIT) or deep vein thrombosis.

Results: A total of 243 legs in 123 consecutive patients with duplex-proven SFJ/GSV incompetence were included in this study between September 2014 and October 2020. The median duplex follow-up period of this cohort of patients was 24 (range 0.2-58) months. Comparing closure rates in GSV diameter ≥8 mm treated with normal protocol, the 'extra-drop protocol' significantly improved closure rates ( = .034). However, the closure rates of ≥8 mm GSV treated with 'extra-drop protocol' was still not as good as GSV <8 mm ( < .001). There were no statistically significant differences in the stump distance between the three groups and no difference in the occurrence of EGIT. There were no deep vein thrombosis.

Conclusion: Our experience showed that VenaSeal cyanoacrylate worked best in GSV<8 mm diameter. Even in GSV diameter of ≥8 mm which has a higher recanalization rate on follow-up duplex, our modified extra-drop protocol significantly improved the closure rates, and did not predispose to development of EGIT.