Abstract：
OBJECTIVE: The most severe form of chronic venous insufficiency includes venous leg ulcers in CEAP-6 stage. The aim of this study is to evaluate the relationship between incompetent perforator veins occluding with cyanoacrylate and closure of perforator veins and healing of venous leg ulcers in patients at CEAP-6 stage.
METHODS: A total of 187 patients who underwent cyanoacrylate application to incompetent perforator veins due to venous leg ulcers from 2018 to 2021 were retrospectively reviewed. Twelve months post-procedure, patients were evaluated for perforator vein closure, ulcer diameter, and Venous Clinical Severity Scale. Receiver Operating Characteristic analysis was used to estimate the probability of postoperative non-occlusion of the perforating vein based on the preoperative ulcers\' diameters and the perforating veins\' mean diameters. Univariate and Multivariate Binary Logistic Regression analyses were conducted to identify the risk factors associated with incomplete closure of the perforating vein.
RESULTS: At the 12 months, 87.1% of patients experienced incompetent perforator veins closure, leading to complete healing of venous leg ulcers. Preoperative ulcer diameter significantly decreased from 7.20±3.48 cm2 to 0.28±0.77 cm2 post-procedure (P<0.001). On average, 3.5±1.01 perforating veins were treated, with a diameter of 4.09±0.41 mm. No postoperative paresthesia or deep vein thrombosis occurred. Preoperative Venous Clinical Severity Scale scores decreased significantly from 17.85±3.06 to 8.03±3.53 postoperatively (P<0.001). Patients with non-occluded perforating veins had larger preoperative ulcer diameters (13.77±1.78 cm2) compared to those with occluded perforating veins (6.24±2.47 cm2) (P<0.001). The mean perforating vein diameter was also larger in non-occluded perforating veins patients (4.45±0.41 mm) than in occluded perforating veins patients (4.04±0.38 mm) (P<0.001). The sensitivity, specificity, and accuracy of the preoperative ulcer diameter cut-off point of 11,25 cm2 for the possibility of postoperative non-occlusion of perforating veins were 100%. In contrast, those for the preoperative mean perforating vein diameter cut-off point of 4.15 mm were determined as 66.7%, 79.1%, and 77.5%, respectively. Diabetes mellitus presence increased the likelihood of incompetent perforator veins remaining open by 3.4 times (95% CI:1.11-10.44) (P = 0.032), while a 1 mm larger mean perforating vein diameter increased this likelihood by 9.36 times (95% CI: 3.47-25.29) (P<0.001).
CONCLUSIONS: This study demonstrates that occlusion of incompetent perforator veins with cyanoacrylate is effective, safe, and associated with low complication rates in CEAP-6 patients. The findings support that cyanoacrylate occlusion of perforator veins may be a valuable option in the treatment of venous leg ulcers.
METHODS: A total of 187 patients who underwent cyanoacrylate application to incompetent perforator veins due to venous leg ulcers from 2018 to 2021 were retrospectively reviewed. Twelve months post-procedure, patients were evaluated for perforator vein closure, ulcer diameter, and Venous Clinical Severity Scale. Receiver Operating Characteristic analysis was used to estimate the probability of postoperative non-occlusion of the perforating vein based on the preoperative ulcers\' diameters and the perforating veins\' mean diameters. Univariate and Multivariate Binary Logistic Regression analyses were conducted to identify the risk factors associated with incomplete closure of the perforating vein.
RESULTS: At the 12 months, 87.1% of patients experienced incompetent perforator veins closure, leading to complete healing of venous leg ulcers. Preoperative ulcer diameter significantly decreased from 7.20±3.48 cm2 to 0.28±0.77 cm2 post-procedure (P<0.001). On average, 3.5±1.01 perforating veins were treated, with a diameter of 4.09±0.41 mm. No postoperative paresthesia or deep vein thrombosis occurred. Preoperative Venous Clinical Severity Scale scores decreased significantly from 17.85±3.06 to 8.03±3.53 postoperatively (P<0.001). Patients with non-occluded perforating veins had larger preoperative ulcer diameters (13.77±1.78 cm2) compared to those with occluded perforating veins (6.24±2.47 cm2) (P<0.001). The mean perforating vein diameter was also larger in non-occluded perforating veins patients (4.45±0.41 mm) than in occluded perforating veins patients (4.04±0.38 mm) (P<0.001). The sensitivity, specificity, and accuracy of the preoperative ulcer diameter cut-off point of 11,25 cm2 for the possibility of postoperative non-occlusion of perforating veins were 100%. In contrast, those for the preoperative mean perforating vein diameter cut-off point of 4.15 mm were determined as 66.7%, 79.1%, and 77.5%, respectively. Diabetes mellitus presence increased the likelihood of incompetent perforator veins remaining open by 3.4 times (95% CI:1.11-10.44) (P = 0.032), while a 1 mm larger mean perforating vein diameter increased this likelihood by 9.36 times (95% CI: 3.47-25.29) (P<0.001).
CONCLUSIONS: This study demonstrates that occlusion of incompetent perforator veins with cyanoacrylate is effective, safe, and associated with low complication rates in CEAP-6 patients. The findings support that cyanoacrylate occlusion of perforator veins may be a valuable option in the treatment of venous leg ulcers.
摘要：
目的：慢性静脉功能不全的最严重形式包括CEAP-6期下肢静脉性溃疡。这项研究的目的是评估CEAP-6期患者用氰基丙烯酸酯阻塞的无能穿支静脉与穿支静脉闭合与下肢静脉溃疡愈合之间的关系。
方法：回顾性分析了2018年至2021年因下肢静脉性溃疡而对功能不全的穿支静脉应用氰基丙烯酸酯的187例患者。术后12个月,对患者进行了穿支静脉闭合评估，溃疡直径,和静脉临床严重程度量表。根据术前溃疡直径和穿通静脉平均直径，使用接收器操作特征分析来估计术后穿通静脉未闭塞的可能性。进行单变量和多变量二元Logistic回归分析以确定与穿支静脉不完全闭合相关的危险因素。
结果：在12个月时，87.1％的患者经历了无能的穿支静脉闭合，导致腿部静脉溃疡完全愈合。术前溃疡直径从术后的7.20±3.48cm2降至0.28±0.77cm2（P<0.001）。平均而言,处理3.5±1.01支静脉，直径为4.09±0.41mm。术后无感觉异常及深静脉血栓发生。术前静脉临床严重程度量表评分从术后的17.85±3.06显著下降至术后的8.03±3.53(P<0.001)。非闭塞穿支静脉患者术前溃疡直径(13.77±1.78cm2)大于闭塞穿支静脉患者(6.24±2.47cm2)(P<0.001)。非闭塞穿支静脉患者的平均穿支静脉直径(4.45±0.41mm)也大于闭塞穿支静脉患者的平均穿支静脉直径(4.04±0.38mm)(P<0.001)。敏感性,特异性，术前溃疡直径切点11,25cm2对术后未闭塞的可能性的准确性为100％。相比之下,术前平均穿支静脉直径为4.15mm的切点被确定为66.7%，79.1%,77.5%,分别。糖尿病的存在使功能不全的穿支静脉保持开放的可能性增加3.4倍（95％CI：1.11-10.44）（P=0.032），而增大1mm的平均穿支静脉直径则增加了9.36倍（95％CI：3.47-25.29）（P<0.001）。
结论：这项研究表明，用氰基丙烯酸酯闭塞功能不全的穿支静脉是有效的，安全,并与CEAP-6患者的低并发症发生率相关。研究结果支持氰基丙烯酸酯闭塞穿支静脉可能是治疗腿部静脉性溃疡的有价值的选择。
方法：回顾性分析了2018年至2021年因下肢静脉性溃疡而对功能不全的穿支静脉应用氰基丙烯酸酯的187例患者。术后12个月,对患者进行了穿支静脉闭合评估，溃疡直径,和静脉临床严重程度量表。根据术前溃疡直径和穿通静脉平均直径，使用接收器操作特征分析来估计术后穿通静脉未闭塞的可能性。进行单变量和多变量二元Logistic回归分析以确定与穿支静脉不完全闭合相关的危险因素。
结果：在12个月时，87.1％的患者经历了无能的穿支静脉闭合，导致腿部静脉溃疡完全愈合。术前溃疡直径从术后的7.20±3.48cm2降至0.28±0.77cm2（P<0.001）。平均而言,处理3.5±1.01支静脉，直径为4.09±0.41mm。术后无感觉异常及深静脉血栓发生。术前静脉临床严重程度量表评分从术后的17.85±3.06显著下降至术后的8.03±3.53(P<0.001)。非闭塞穿支静脉患者术前溃疡直径(13.77±1.78cm2)大于闭塞穿支静脉患者(6.24±2.47cm2)(P<0.001)。非闭塞穿支静脉患者的平均穿支静脉直径(4.45±0.41mm)也大于闭塞穿支静脉患者的平均穿支静脉直径(4.04±0.38mm)(P<0.001)。敏感性,特异性，术前溃疡直径切点11,25cm2对术后未闭塞的可能性的准确性为100％。相比之下,术前平均穿支静脉直径为4.15mm的切点被确定为66.7%，79.1%,77.5%,分别。糖尿病的存在使功能不全的穿支静脉保持开放的可能性增加3.4倍（95％CI：1.11-10.44）（P=0.032），而增大1mm的平均穿支静脉直径则增加了9.36倍（95％CI：3.47-25.29）（P<0.001）。
结论：这项研究表明，用氰基丙烯酸酯闭塞功能不全的穿支静脉是有效的，安全,并与CEAP-6患者的低并发症发生率相关。研究结果支持氰基丙烯酸酯闭塞穿支静脉可能是治疗腿部静脉性溃疡的有价值的选择。
