{Reference Type}: Journal Article
{Title}: Single-Center Clinical Experience of Cyanoacrylate Embolization Method for Incompetent Perforating Veins in Treating CEAP-6 Patients.
{Author}: Türkmen U;
{Journal}: J Vasc Surg Venous Lymphat Disord
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jul 1
暂无{DOI}: 10.1016/j.jvsv.2024.101939
{Abstract}: <B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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).<BR><B>CONCLUSIONS: </B>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.