title: Roll-in phase analysis of clinical study of cyanoacrylate closure for incompetent great saphenous veins.
abstract: Cyanoacrylate closure (CAC) was shown in the recently published VenaSeal Sapheon Closure System vs Radiofrequency Ablation for Incompetent Great Saphenous Veins (VeClose) randomized clinical study to be an effective and noninferior option (in terms of both safety and effectiveness) to radiofrequency ablation (RFA) in the treatment of incompetent great saphenous veins. The objectives of this analysis were to report the efficacy and safety outcomes of the VeClose roll-in (training) group treated with CAC by physicians who had received device use training but had no prior treatment experience with the technique and to compare the outcomes with those from the randomized RFA and CAC groups.
  
  
  
  The first two subjects at each participating site (n = 20) were roll-in cases (ie, not randomized but instead treated with CAC) to ensure the physician's familiarity with the procedure. Subsequent eligible subjects were randomized to either CAC or RFA. After treatment, all subjects returned for assessment on day 3 and months 1, 3, 6, and 12. The study's primary end point was complete closure of the target vein at month 3. Secondary analyses included patient-reported intraprocedural pain and investigator-rated ecchymosis at day 3. Additional assessments included procedure time, quality of life surveys, and adverse events.
  
  
  
  Mean procedure time was longer in the roll-in group (31 minutes) compared with the randomized groups (24 minutes for CAC and 19 minutes for RFA; P < .0001). Procedure time decreased in both the CAC and RFA groups over time, plateauing at about 22 minutes for CAC and 15 minutes for RFA. In the roll-in group, the 3-month complete occlusion rate was 100%. Reported intraprocedural pain ratings were similar between the roll-in and randomized groups. Other clinical assessments, including quality of life improvement and adverse events, were similar between the roll-in and randomized groups. Increasing procedure number did not affect clinical outcomes.
  
  
  
  The results from the VeClose study roll-in group demonstrate that despite the physician's lack of prior experience, initial treatment with CAC leads to comparable efficacy and safety results to RFA and is associated with a relatively short learning period.
authors.affiliation: OhioHealth, Riverside Methodist Hospital, Columbus, Ohio. Electronic address: raghu.kolluri@ohiohealth.com.
authors.forename: Raghu
authors.initials: R
authors.lastname: Kolluri
authors.affiliation: The Lake Washington Vascular, Bellevue, Wash.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Gibson
authors.affiliation: Wild Iris Consulting LLC, Palo Alto, Calif.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cher
authors.affiliation: Medtronic, EndoVenous Division, Plymouth, Minn.
authors.forename: Monte
authors.initials: M
authors.lastname: Madsen
authors.affiliation: The Maryland Laser, Skin, and Vein Institute, Hunt Valley, Md.
authors.forename: Robert
authors.initials: R
authors.lastname: Weiss
authors.affiliation: The Morrison Vein Institute, Scottsdale, Ariz.
authors.forename: Nick
authors.initials: N
authors.lastname: Morrison
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation; D003487:Cyanoacrylates / Q000627:therapeutic use*; D004438:Ecchymosis / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012501:Saphenous Vein / Q000601:surgery*; D035703:Therapies, Investigational / Q000295:instrumentation; D016896:Treatment Outcome; D014648:Varicose Veins / Q000601:surgery*
chemical_list: D003487:Cyanoacrylates