title: Nonthermal, Nontumescent Endovenous Treatment of Varicose Veins.
abstract: BACKGROUND
  Endothermal treatment of the great saphenous vein has become the first line of treatment for superficial venous reflux. A new technique for venous insufficiency is non-thermal ablation with vein sealing system which comprises the endovenous delivery of cyanoacrylate tissue adhesive to the vein causing fibrosis.
  
  
  METHODS
  This is a single-center prospective study of treatment of great saphenous vein incompetence in 62 patients with vein sealing system (Biolas VariClose®FG Group, Turkey). All cases were implemented under local anesthesia. Tumescent anesthesia was not required. Patients were not given any nonsteroidal anti-inflammatory drug postoperatively; advised to wear elastic bandages for 1 day; and compression stockings were not offered.
  
  
  RESULTS
  Treatment success was defined as complete occlusion of treated vein or recanalized segment shorter than 5 cm. Subtotal recanalization was defined as great saphenous vein flow containing 5-10 cm segment of treated vein. A recanalized great saphenous vein or treatment failure was defined as an open part of the treated vein segment more than 10 cm in length. At 1 week and 1 month control, duplex scans showed total occlusion for all patients (100%), total occlusion for 58 patients (93.5%), and subtotal occlusion for 4 patients (6.5%) at third month. At the end of 6 months, total occlusion 56 patients (90.3%) and subtotal occlusion for 2 patients (3.2%). For 4 (6.5%) patients, no occlusion was observed, and the diameter was >11 mm. Embolization of great saphenous vein with cyanoacrylate has been performed since the beginning of this decade. Combined chemical and physical mechanism of action results in permanent vein closure. In a recently published study, a 24-month occlusion rate of 92% was demonstrated. The most commonly reported complications of cyanoacrylate use for the treatment of varicose vein disease, so far, include ecchymosis and phlebitis. Almeida et al. reported that phlebitis is the most frequent side effect at a rate of 16%. In our study, phlebitis rate was not as high as reported. It may be caused due to shorter time of follow-up in the hospital.
  
  
  CONCLUSIONS
  Endovenous ablation of incompetent great saphenous vein with cyanoacrylate-based glue is feasible. Operation time is short, and tumescent anesthesia is unnecessary as postprocedure compression stockings. Lack of significant side effects and an yearly success rate of 100% are benefits of the system.
authors.affiliation: Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Ali İhsan
authors.initials: Aİ
authors.lastname: Tekin
authors.affiliation: Erzincan University, Mengücek Gazi Training and Research Hospital, Erzincan, Turkey. Electronic address: osnutuncer@gmail.com.
authors.forename: Osman Nuri
authors.initials: ON
authors.lastname: Tuncer
authors.affiliation: Siyami Ersek Chest and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey.
authors.forename: Mehmet Erdem
authors.initials: ME
authors.lastname: Memetoğlu
authors.affiliation: Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
authors.forename: Ümit
authors.initials: Ü
authors.lastname: Arslan
authors.affiliation: Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Öztekin
authors.affiliation: Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Bayram
authors.initials: B
authors.lastname: Yağmur
authors.affiliation: Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Mahmut
authors.initials: M
authors.lastname: Biçer
authors.affiliation: Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Rıfat
authors.initials: R
authors.lastname: Özmen
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D058128:Compression Bandages; D003487:Cyanoacrylates / Q000008:administration & dosage* / Q000009:adverse effects; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D011446:Prospective Studies; D012501:Saphenous Vein / Q000000981:diagnostic imaging; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000175:diagnosis / Q000601:surgery*; D062666:Vascular Access Devices
chemical_list: D003487:Cyanoacrylates