Improving Access to Treatment for Veterans with Chronic Venous Disease Utilizing Non-Thermal Non-Tumescent Venous Ablation with Cyanoacrylate Glue
Esther Bae, DO, Lalithapriya Jayakumar, MD, Taylor Watkins, MD, Lori Pounds, MD.
UTHSCSA, San Antonio, TX, USA.
OBJECTIVES: The treatment of superficial chronic venous disease has evolved over the last fifty years, transitioning from “stripping” of the great saphenous vein to minimally invasive techniques of endothermal ablation. These modalities have been transformative, their decreased morbidity and ease of administration allowing them to maintain popularity over the last two decades. The next generation of venous treatments is even less invasive, with the elimination of tumescent solution previously needed to provide anesthesia or to protect surrounding structures from the heat generated during ablation. Cyanoacrylate glue (VenaSeal TM) is a FDA approved treatment that yields equivalent results to thermal based procedures. At the Veterans Health Administration Hospital in San Antonio, Texas, cyanoacrylate glue has allowed the transition of treatment from the operating room, with conscious sedation, to a vascular laboratory utilizing only local anesthesia.
METHODS: Through an IRB-approved protocol, we retrospectively collected data on patients at the South Texas Veterans Health Administration Hospital in San Antonio who were treated with cyanoacrylate glue over 15 months. Age, sex, BMI, CEAP class, and treatment location (OR vs clinic) were documented. Duplex ultrasounds were performed after the procedure, and outcomes recorded at one month.
RESULTS: A total of six females and twenty males were treated. Average age was 61 (37-81), and average BMI 32 (25-52). Venous disease ranged from C2 to C6. The first seventeen patients over seven months were treated in OR, and the rest in clinic. Nearly all patients experienced lasting ablation with negligible side effects, the most common being mild skin irritation. One incidence of extension was anticoagulated to resolution in one week. One patient experienced skin irritation that required resection of portions of the ablated tract several months later, with resolution of symptoms. The vast majority remained asymptomatic and free of complications. All nine patients who underwent ablations in clinic tolerated them to completion.
CONCLUSIONS: Non-thermal non-tumescent venous ablation with cyanoacrylate glue is an alternative to thermal ablation that abolishes the discomfort of tumescent solution and the need for conscious sedation. It is safe and effective, and treatment in office setting offers greater flexibility in scheduling for the Veteran as well as cost savings for the facility. In addition, it allows for increases in operating room utilization for procedures that require more advanced anesthesia.
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