Nuttawut Sermsathanasawadi
Current Position
Associate Professor Dr.
Division of Vascular Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University
Venous Reflux Session

Topic: Complications of cyanoacrylate closure of varicose vein treatment


Cyanoacrylate closure (CAC) is a nonthermal, nontumescent ablation technique in which cyanoacrylate functions as a medical adhesive to close the vein. A hypersensitivity reaction (HSR) is defined as a red, itchy dermal reaction that is sometimes painless, but that can also be associated with pain and/or localized swelling. Most HSR symptoms were mild, could be treated with NSAIDs and antihistamine, and were resolved within 1 week. The risk factors for HSR were suprafascial saphenous vein with a depth <1 cm from the skin, and saphenous vein diameter of > 8 mm. Cyanoacrylate granuloma (CAG) is defined as cyanoacrylate extravasation with chronic foreign body reaction after CAC. CAG occurred in 2.9%. Patients with CAG presented with granuloma and abscess at the puncture site at 3-5 months after CAC. Treatment of CAG is an incision, drainage, and removal of the glue foreign body. One of the hypothesize potential mechanisms is residual polymerized cyanoacrylate inadvertently deposited in the subcutaneous tissue during withdrawal of the delivery catheter from the vein or deposition of cyanoacrylate at the access site. Recapture of the white delivery catheter should be performed by advancing the blue sheath forward over the white delivery catheter while the white delivery catheter is still inside the vein. Thrombus extension after cyanoacrylate closure (TEACAC), that is defined as a newly developed thrombus that proximally extends into the deep vein from the adhesive occlusion site in the treated saphenous vein. In contrast to the immediate presentation of endovenous glue-induced thrombosis (EGIT), TEACAC is found within days after CAC. The incidence of TEACAC is 4.9%. No patient or procedural predictive factors for TEACAC were identified. Treatment of TEACAC class 1-3 following endovenous heat-induced thrombosis guidelines seems to be both safe and effective.