Abstract

Objectives: Venous insufficiency has traditionally been managed through various techniques, including surgical interventions and thermal ablation. A novel technique for venous insufficiency is non-thermal ablation using a vein sealing system, involving the endovenous delivery of N-butyl cyanoacrylate (NBCA) tissue adhesive to the vein. Despite advances in treatment options, the management of isolated perforator incompetence remains a challenge due to its role in the pathophysiology of chronic venous insufficiency (CVI). This single-center retrospective study aimed to evaluate the efficacy of the non-thermal, non-tumescent embolization method using NBCA for managing perforator incompetence.

Materials and Methods: We retrospectively analyzed 98 consecutive patients diagnosed with perforator vein insufficiency, treated with NBCA. The study protocol included physical examinations, Doppler ultrasonography, venous clinical severity scoring, CEAP (Clinical-Etiology-Anatomy- Pathophysiology) classification, and quality of life assessments before and after the procedure. The primary goal was to compare clinical, functional, and duplex parameters in managing varicose vein diseases with isolated primary perforator incompetence using duplex-guided NBCA treatment. Analyses were performed using SPSS software. Categorical variables were reported as frequencies, and continuous variables as means ± standard deviations or medians with interquartile ranges. Chi-square or Fisher’s exact tests were used for categorical data, and the Mann-Whitney U test for continuous variables. A p value less than 0.05 was considered statistically significant.

Results: Ninety-eight obliteration procedures were completed. The study evaluated occlusion rate, procedural pain, phlebitis, ecchymosis, and paresthesia. The occlusion rate at 6 months was 96.9%, with a significant reduction in pain and other symptoms of CVI. The incidence of complications was low. Phlebitis was observed in 3.4% of cases, ecchymosis in 2.8%, and transient paresthesia in 1.7%. There were no reports of serious adverse events, such as deep vein thrombosis or systemic allergic reactions.

Conclusion: The interruption of perforators effectively reduces the symptoms of CVI and promotes rapid ulcer healing. This non-tumescent, non-thermal embolization method can be safely applied with high success rates. The results of this study suggest that NBCA is a viable option for treating perforator incompetence.