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Embolia , Humanos , Resultado del Tratamiento , Embolia/etiología , Embolia/diagnóstico por imagen , Embolia/terapia , Masculino , Cianoacrilatos/administración & dosificación , Cianoacrilatos/efectos adversos , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/efectos adversos , Anciano , Femenino , Adhesivos Tisulares , Persona de Mediana EdadRESUMEN
BACKGROUND: Anastomotic leakage (AL) is the most frequent life-threating complication following colorectal surgery. Several attempts have been made to prevent AL. This prospective, randomized, multicentre trial aimed to evaluate the safety and efficacy of nebulised modified cyanoacrylate in preventing AL after rectal surgery. METHODS: Patients submitted to colorectal surgery for carcinoma of the high-medium rectum across five high-volume centres between June 2021 and January 2023 entered the study and were randomized into group A (anastomotic reinforcement with cyanoacrylate) and group B (no reinforcement) and followed up for 30 days. Anastomotic reinforcement was performed via nebulisation of 1 mL of a modified cyanoacrylate glue. Preoperative features and intraoperative and postoperative results were recorded and compared. The study was registered at ClinicalTrials.gov (ID number NCT03941938). RESULTS: Out of 152 patients, 133 (control group, n = 72; cyanoacrylate group, n = 61) completed the follow-up. ALs were detected in nine patients (12.5%) in the control group (four grade B and five grade C) and in four patients (6.6%), in the cyanoacrylate group (three grade B and one grade C); however, despite this trend, the differences were not statistically significant (p = 0.36). However, Clavien-Dindo complications grade > 2 were significantly higher in the control group (12.5% vs. 3.3%, p = 0.04). No adverse effects related to the glue application were reported. CONCLUSION: The role of modified cyanoacrylate application in AL prevention remains unclear. However its use to seal colorectal anastomoses is safe and could help to reduce severe postoperative complications.
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Anastomosis Quirúrgica , Fuga Anastomótica , Cianoacrilatos , Recto , Humanos , Fuga Anastomótica/prevención & control , Fuga Anastomótica/etiología , Femenino , Masculino , Estudios Prospectivos , Anciano , Persona de Mediana Edad , Cianoacrilatos/administración & dosificación , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Recto/cirugía , Adhesivos Tisulares/uso terapéutico , Técnicas de Sutura , Neoplasias del Recto/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Patients with cirrhosis commonly undergo endoscopic cyanoacrylate injection for gastric and esophageal variceal bleeding. However, postoperative infections can increase the risk of rebleeding and mortality. AIM: This study aimed to determine the risk of postoperative infections and its associated factors following cyanoacrylate injection treatment in these patients. METHODS: A retrospective analysis was conducted on 57 patients treated with ligation (ligation group), 66 patients treated with cyanoacrylate injection (injection group), and 91 patients treated with conservative treatment (control group) at the Nanchong Central Hospital. RESULTS: The rate of postoperative infection was similar among the cyanoacrylate, ligation, and conservative treatment groups, with no significant statistical difference observed ( P â =â 0.97). Multivariate analysis identified postoperative Child-Pugh score and renal insufficiency as two independent risk factors for postoperative infection. The rebleeding rate in the injection group was significantly lower than in the other groups ( P â =â 0.01). Mortality was significantly higher in the control group compared with the ligation and injection groups ( P â =â 0.01). CONCLUSION: Cyanoacrylate combined with lauromacrogol injection did not significantly increase the risk of infection compared with ligation and conservative treatments, and it was more effective in reducing the risk of rebleeding. This method is safe, effective, and holds clinical value for broader application.
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Cianoacrilatos , Várices Esofágicas y Gástricas , Hemorragia Gastrointestinal , Recurrencia , Humanos , Várices Esofágicas y Gástricas/etiología , Várices Esofágicas y Gástricas/terapia , Masculino , Femenino , Estudios Retrospectivos , Cianoacrilatos/efectos adversos , Cianoacrilatos/administración & dosificación , Cianoacrilatos/uso terapéutico , Persona de Mediana Edad , Factores de Riesgo , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Ligadura , Anciano , Resultado del Tratamiento , Polietilenglicoles/administración & dosificación , Polietilenglicoles/uso terapéutico , Polietilenglicoles/efectos adversos , Adulto , Infección de la Herida Quirúrgica/etiología , Cirrosis Hepática/complicacionesRESUMEN
Cyanoacrylate adhesive closure (CAC) systems are widely used to treat varicose veins. In terms of efficacy and safety, these nonthermal, non-tumescent methods are noninferior to endovenous thermal ablation techniques. However, no published studies have compared products that use CAC systems. VenaSeal® (Medtronic, Santa Rosa, CA, USA) and VenaBlock® (Invamed) are the most commonly used CAC-based products worldwide. This study aimed to focus on the efficacy of these two commonly used products, with little emphasis on safety. Published full-text articles on the VenaBlock® and VenaSeal® systems were searched. Data for each product were evaluated by comparing them with each other in terms of effectiveness. In total, 1882 extremities from 11 studies using VenaBlock® and 524 extremities from eight studies using VenaSeal® were included and compared. Both devices were effective, and their cumulative recanalization-free survival rates were similar (P=0.188) at the 6-, 12-, 24-, 36-, and 60-month follow-ups. Both products improved the venous clinical severity score (VCSS) and quality of life (QoL) scores. VenaBlock® and VenaSeal® are effective in terms of cumulative recanalization-free survival rates, and no significant difference was found between the two groups (P=0.188). Both significantly improve the VCSS and QoL scores. CAC is feasible for the treatment of varicose veins.
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Cianoacrilatos , Procedimientos Endovasculares , Insuficiencia Venosa , Humanos , Cianoacrilatos/efectos adversos , Cianoacrilatos/uso terapéutico , Cianoacrilatos/administración & dosificación , Insuficiencia Venosa/terapia , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Enfermedad Crónica , Resultado del Tratamiento , Extremidad Inferior/irrigación sanguínea , Estudios de Factibilidad , Masculino , Femenino , Várices/terapia , Persona de Mediana Edad , Calidad de Vida , Adhesivos Tisulares/uso terapéutico , AdultoRESUMEN
INTRODUCTION: Fast gut cutaneous sutures have become more prominent due to their low tissue reactivity, rapid absorption, and elimination of suture removal visits. It is not known how fast gut sutures compare to other closure modalities. METHODS: A comprehensive literature review was conducted to identify randomized controlled trials comparing fast gut sutures to alternative closure methods during dermatologic surgery. Data collected included patient and physician assessed cosmetic outcome as well as standardized complication rates. RESULTS: Six studies were included in final analysis and reported on 208 patients. Fast gut sutures were associated with lower physician opinions of final scar when compared to polypropylene sutures (SMD 0.438; 95% CI 0.082 to 0.794). No differences existed between physician opinion of fast gut sutures and cyanoacrylate tissue adhesive (SMD - 0.024; 95% CI - 0.605 to 0.556). Complications with fast gut suture placement were rare, and included infection, dehiscence, and hematomas. Fast gut sutures were less likely to experience wound dehiscence than tissue adhesive (p = 0.01). CONCLUSION: If no contraindications to polypropylene sutures exist, they may provide superior cosmetic outcomes compared to fast gut sutures. Further research is required to better quantify cosmetic outcomes and optimal use of fast gut sutures.
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Procedimientos Quirúrgicos Dermatologicos , Técnicas de Sutura , Suturas , Humanos , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Técnicas de Sutura/efectos adversos , Adhesivos Tisulares/efectos adversos , Polipropilenos , Cicatriz/etiología , Cicatriz/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Cianoacrilatos/administración & dosificación , Cicatrización de HeridasAsunto(s)
Cianoacrilatos , Endosonografía , Várices Esofágicas y Gástricas , Humanos , Persona de Mediana Edad , Cianoacrilatos/administración & dosificación , Endosonografía/métodos , Várices Esofágicas y Gástricas/terapia , Várices Esofágicas y Gástricas/etiología , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Adhesivos Tisulares/administración & dosificación , Ultrasonografía IntervencionalRESUMEN
BACKGROUND: Rebleeding is a significant complication of endoscopic injection of cyanoacrylate in gastric varices in cirrhotic patients. AIM: This systematic review and meta-analysis aimed to evaluate the efficiency of endoscopic cyanoacrylate injection and summarized the risk factors for rebleeding. METHODS: Databases were searched for articles published between January 2012 and December 2022. Studies evaluating the efficiency of endoscopic injection of cyanoacrylate glue for gastric varices and the risk factors for rebleeding were included. RESULTS: The final analysis included data from 24 studies. The hemostatic rates ranged from 65 to 100%. The pooled rate of gastric varices recurrence was 34% [95% CI 21-46, I2 = 61.4%], early rebleeding rate was 16% [95% CI 11-20, I2 = 37.4%], late rebleeding rate was 39% [95% CI 36-42, I2 = 90.9%], mild and moderate adverse events rate were 28% [95% CI 24-31, I2 = 91.6%], 3% [95% CI - 2 to 8, I2 = 15.3%], rebleeding-related mortality rate was 6% [95% CI 2-10, I2 = 0%], all-cause mortality rate was 17% [95% CI 12-22, I2 = 63.6%]. Independent risk factors for gastric variceal rebleeding included portal venous thrombosis, ascites, cyanoacrylate volume, fever/systemic inflammatory response syndrome, red Wale sign, previous history of variceal bleeding, active bleeding and paragastric veins. The use of proton pump inhibitors could be a protective factor. CONCLUSIONS: Endoscopic cyanoacrylate glue injection is an effective and safe treatment for gastric varices. Cirrhotic patients with the above risk factors may benefit from treatment aimed at reducing portal hypertension, antibiotic prophylaxis, and anticoagulation if they meet the indications.
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Cianoacrilatos , Várices Esofágicas y Gástricas , Hemorragia Gastrointestinal , Recurrencia , Humanos , Várices Esofágicas y Gástricas/terapia , Várices Esofágicas y Gástricas/etiología , Cianoacrilatos/administración & dosificación , Cianoacrilatos/efectos adversos , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Factores de Riesgo , Adhesivos Tisulares/administración & dosificación , Cirrosis Hepática/complicaciones , Hemostasis Endoscópica/métodosRESUMEN
Acute gastric variceal bleeding is a life-threatening condition that could be effectively treated with endoscopic cyanoacrylate injection diluted with lipiodol. The mixture acts as a tissue adhesive that polymerizes when in contact with blood in a gastric varix. This work reports a patient that presented to the emergency department with upper gastrointestinal bleeding due to acute variceal bleeding, who developed systemic embolization following cyanoacrylate injection therapy. This complication culminated in cerebral, splenic and renal infarctions with a fatal outcome. Systemic embolization is a very rare, but the most severe complication associated with endoscopic cyanoacrylate injection and should be considered in patients undergoing this treatment.
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Cianoacrilatos , Várices Esofágicas y Gástricas , Hemorragia Gastrointestinal , Adhesivos Tisulares , Humanos , Cianoacrilatos/uso terapéutico , Cianoacrilatos/administración & dosificación , Cianoacrilatos/efectos adversos , Embolia/etiología , Embolia/terapia , Embolización Terapéutica/métodos , Várices Esofágicas y Gástricas/terapia , Várices Esofágicas y Gástricas/etiología , Resultado Fatal , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/etiología , Adhesivos Tisulares/uso terapéutico , Adhesivos Tisulares/administración & dosificaciónRESUMEN
This review provides an overview of the treatment options available for gastric varices (GV) with a focus on endoscopic methods. Various minimally invasive techniques, including endoscopic band ligation, endoscopic cyanoacrylate injection, and transjugular intrahepatic portosystemic shunt, can be applied to the treatment of GV. Endoscopic cyanoacrylate injection is now recognized as a first-line treatment for GV. Endoscopic ultrasound-guided cyanoacrylate injection combined with coils has shown good security and effectiveness. Thrombin injection therapy is a promising treatment, with a similar hemostasis rate to cyanoacrylate injection but with fewer serious complications. With the deepening understanding of the hemodynamics of the GV system, various treatment methods and their combination are gradually evaluated to provide patients with safer and more effective treatment options.
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Várices Esofágicas y Gástricas , Hemostasis Endoscópica , Humanos , Várices Esofágicas y Gástricas/terapia , Hemostasis Endoscópica/métodos , Ligadura/métodos , Derivación Portosistémica Intrahepática Transyugular/métodos , Cianoacrilatos/administración & dosificación , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/etiología , Masculino , Resultado del Tratamiento , Femenino , EndosonografíaRESUMEN
BACKGROUND: To compare radiofrequency ablation (RFA) and cyanoacrylate closure (CAC) for large-diameter great saphenous vein (GSV) insufficiency between diameters of 12 and 16 mm. METHODS: This study is a single-center retrospective study. Subjects who underwent endovenous treatment with RFA (Group A) or CAC (Group B) for GSV insufficiency between June 2015 and June 2021 who were followed up for at least 2 years were included in the study. Subjects who had a 12-mm to 16-mm target vessel diameter and subjects with grade 3 and grade 4 reflux were included. Subjects' demographic data (age, sex), body mass indices, clinical, etiological, anatomic, pathophysiologic classification, GSV diameter, reflux grade, target vessel length, preoperative venous clinical severity score (VCSS), procedural time, postoperative first-day pain scores, postoperative 14th-day patient satisfaction scale, and postoperative complications were noted. In follow-up, subjects were evaluated with duplex ultrasonography and VCSS at 1, 6, 12, and 24 months. RESULTS: In total, 142 subjects were included (n = 71 for both groups). The mean GSV diameter was 13.21 ± 1.00 for Group A and 13.51 ± 0.97 for Group B. The groups did not differ in terms of age, sex, body mass index, clinical, etiological, anatomic, pathophysiologic classification, GSV diameter, reflux grade, target GSV length, preoperative VCSS, complications, postoperative 24-hr pain status or postoperative 14-day patient satisfaction scale (P > 0.05 for all comparisons). The procedure time was significantly shorter in Group B (34.68 ± 4.22 min for Group A vs. 22.59 ± 4.5 min for Group B, P = 0.001). In the 1-month and 6-month Duplex ultrasonography of the subjects, partial closure and patency rates in Group B were significantly higher than those in Group A (P = 0.003 and P = 0.025, respectively). At the 12-month and 24-month evaluation, closure rates did not show a statistically significant difference between the groups (P = 0.056 and P = 0.090, respectively). Preoperative and 1-month VCSS measurements did not show a statistically significant difference between groups (P > 0.05 for all comparisons). The 6-month, 12-month, and 24-month VCSS measurements of Group A were significantly higher than those in Group B. (P = 0.043, P = 0.009 and P = 0.002, respectively). CONCLUSIONS: Both RFA and CAC were found to be effective in the treatment of large-diameter GSV incompetency. The complication rates were similar between the 2 techniques. CAC had a shorter procedure time. Although the closure rates in the early postoperative period were better in the RFA group, long-term follow-up demonstrated similar patency rates. The functional results in the long-term follow-up were better in the RFA group.
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Cianoacrilatos , Vena Safena , Insuficiencia Venosa , Humanos , Vena Safena/diagnóstico por imagen , Vena Safena/fisiopatología , Vena Safena/cirugía , Estudios Retrospectivos , Femenino , Masculino , Insuficiencia Venosa/diagnóstico por imagen , Insuficiencia Venosa/cirugía , Insuficiencia Venosa/fisiopatología , Insuficiencia Venosa/terapia , Persona de Mediana Edad , Resultado del Tratamiento , Cianoacrilatos/efectos adversos , Cianoacrilatos/administración & dosificación , Factores de Tiempo , Adulto , Anciano , Ablación por Radiofrecuencia/efectos adversos , Procedimientos Endovasculares/efectos adversos , Adhesivos Tisulares/uso terapéutico , Adhesivos Tisulares/efectos adversosRESUMEN
OBJECTIVE: The current Instructions for Use (IFU) of cyanoacrylate closure (CAC) is to start initial injection with the catheter tip positioned 5 cm distal to the sapheno-femoral junction (SFJ) to prevent endovenous glue-induced thrombosis (EGIT). However, this defensive design is responsible for the relatively long stump length. Although clinical studies on the long-term recurrence rate are still lacking, the long stump length can predict a higher long-term recurrence rate compared to other surgical methods. The author developed a novel surgical technique that can overcome the weakness of CAC, and the initial outcomes of this technique are described in this article. METHODS: This study retrospectively reviewed 25 great saphenous vein (GSV) in 20 patients who underwent CAC for incompetent GSV at our hospital. The procedure from puncturing the GSV to insertion of the catheter is the same as the conventional method. Place the catheter tip 2-3 cm below the SFJ before cyanoacrylate injection. After confirming the position of the SFJ with the longitudinal view of the ultrasound, press the GSV directly above the SFJ transversely with the second to fifth fingertips of the left hand. Then, the ultrasound probe is placed against the distal part of the fingertips, and CA injection is performed while GSV is monitored in real time. RESULTS: The mean stump length immediately after surgery was 19.3 (± 7.8) mm, with a range of .0-38.4 mm. The mean stump length after 1 week was 12.3 (± 7.4) mm and the range was .1-35.4 mm. The mean stump length after 1 month was 15.4 (± 10.1) mm, and the range was .0-35.4 mm. There was no case with EGIT or recanalization. CONCLUSIONS: The author confirmed the possibility of safely reducing stump length with this novel surgical technique, and expect that this method can help overcome the weakness of CAC.
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Cianoacrilatos , Vena Safena , Insuficiencia Venosa , Humanos , Vena Safena/diagnóstico por imagen , Vena Safena/cirugía , Estudios Retrospectivos , Femenino , Resultado del Tratamiento , Masculino , Persona de Mediana Edad , Cianoacrilatos/administración & dosificación , Cianoacrilatos/efectos adversos , Anciano , Insuficiencia Venosa/diagnóstico por imagen , Insuficiencia Venosa/cirugía , Insuficiencia Venosa/terapia , Factores de Tiempo , Adulto , Adhesivos Tisulares/administración & dosificación , Várices/cirugía , Várices/diagnóstico por imagen , Várices/terapia , PuncionesRESUMEN
BACKGROUND: Despite recent advances in ostomy care, the incidence of stoma and peristomal skin complications including peristomal moisture-associated skin damage (MASD) remains as high as 80% of patients living with ostomies. We evaluated a cyanoacrylate liquid skin protectant (CLSP) for the treatment and healing of peristomal MASD in patients with an ileostomy, ileal conduit, or colostomy. CASES: Five patients (24-85 years old) with peristomal MASD related to an ileostomy (n = 2), ileal conduit (n = 2), or colostomy (n = 1) were evaluated in this case study. All were treated with a CLSP in an attempt to reduce peristomal MASD caused by effluent leakage, which resulted in painful denudation of the peristomal skin. All patients received 1 to 2 applications of the CLSP prior to replacement of the pouching system. Prior to CLSP application, patients underwent assessment focusing on the causes of ostomy pouching system undermining and leakage. Interventions to prevent recurrent undermining and leakage, usually focused on modifications of the pouching system, were completed when indicated. CONCLUSIONS: For these 5 patients, complete resolution of peristomal MASD was observed at 2 to 8 days following CLSP treatment. More severe peristomal MASD cases required 7 to 8 days for complete resolution while less severe peristomal MASD resolved within 2 to 3 days. Patients showed less frequent pouching system changes, healing of peristomal skin, and reduced peristomal MASD associated with the CLSP treatment and addressing underlying etiology. On a pain scale of 0 to 10, patients reported less pain with an average of more than 7 out of 10 prior to the CLSP treatment and less than 4 out of 10 after treatment.
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Cianoacrilatos , Estomía , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Adulto Joven , Colostomía/efectos adversos , Ileostomía/efectos adversos , Ileostomía/métodos , Estomía/efectos adversos , Dolor , Piel , Cuidados de la Piel , Cianoacrilatos/administración & dosificaciónRESUMEN
INTRODUCTION: Cyanoacrylate embolization (CAE) is a novel non-thermal non-tumescent venous ablation technique that has shown promising results in treating saphenous vein insufficiency. We aimed to assess the efficacy and safety profile of CAE in comparison to endovenous laser ablation (EVLA) in treating saphenous vein insufficiency. MATERIAL AND METHODS: We conducted a systematic review and meta-analysis in accordance with the PRISMA Statement. A systematic search was performed through online databases including PubMed, ScienceDirect, and Cochrane to find relevant studies. Manual searching was also performed from the references of the selected studies. Specific keywords that we used were "(cyanoacrylate) AND (laser OR laser ablation OR laser therapy) AND (vein OR venous OR saphenous vein OR venous insufficiency OR varicose vein)". Outcomes of interest were efficacy, safety, and intervention time. Efficacy was determined by venous closure rate 1 year post-intervention and Venous Clinical Severity Score (VCSS) 1 year post-intervention. Safety was determined by rates of periprocedural pain, skin pigmentation, nerve damage, phlebitis, deep vein thrombosis (DVT) and ecchymosis. Data extraction and quality assessment of included studies were performed by 2 reviewers, and statistical analysis was conducted using RevMan 5.4.0 software. RESULTS: Five relevant articles (2 randomized-controlled trials and 3 cohort studies) were selected for this study, consisting a total of 1432 venous ablation procedures (710 CAE and 722 EVLA). From the efficacy point of view, venous closure rates and VCSS did not differ significantly between CAE group and EVLA group. From the safety point of view, pooled data showed that CAE group was associated with less periprocedural pain score (P < 0.001), lower skin pigmentation rates (0.60% vs. 4.46%; P = 0.008), and lower nerve damage rates (0% vs. 3.94%; P = 0.007). Rates of phlebitis, deep vein thrombosis, and ecchymosis did not differ significantly between the 2 groups. In addition, intervention time was significantly faster in CAE group compared to EVLA group (P < 0.001). CONCLUSION: Cyanoacrylate embolization yields similar efficacy compared to EVLA. However, CAE is associated with less periprocedural pain, lower occurrence rates of skin pigmentation and nerve damage, and faster intervention time.
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Cianoacrilatos/administración & dosificación , Embolización Terapéutica , Terapia por Láser , Vena Safena/cirugía , Insuficiencia Venosa/terapia , Embolización Terapéutica/efectos adversos , Humanos , Terapia por Láser/efectos adversos , Tempo Operativo , Complicaciones Posoperatorias/etiología , Índice de Severidad de la Enfermedad , Pigmentación de la Piel , Insuficiencia Venosa/cirugíaRESUMEN
OBJECTIVE: Low-grade primary superficial venous reflux (C0-C3 EpAsPr [Ep (primary), As (superficial), and Pr (reflux)]) is a common feature of chronic venous disease. However, the procedural efficacy focusing on symptom characteristics and improvement patterns in this population has not been fully explored. METHODS: From 2018 to 2019, 325 limbs from 279 patients with C0-C3 EpAsPr (including 66.1% with C0-C1) who had undergone cyanoacrylate ablation (CA) with ultrasound-guided foam sclerotherapy (UGFS) or endovenous laser ablation (EVLA) with UGFS were included in the present study. Venous symptoms were classified into five categories: leg heaviness, calf cramping, itching sensation, pain, and numbness. A retrospective propensity score-matched analysis of data collected using a prospectively designed case report form was performed to identify the improvement magnitude of each symptom. As secondary outcomes, the postoperative changes in symptom severity (0-5 points), venous reflux-originated severity score, venous clinical severity score (VCSS), and 14-item chronic venous insufficiency quality of life questionnaire (CIVIQ-14) were evaluated in a 3-month postoperative data analysis. RESULTS: After adjusting the data, 174 limbs (CA with UGFS, n = 87; EVLA with UGFS, n = 87) were matched. The symptoms with the greatest improvement after treatment were night cramping (94.7%) and itching (93.8%), followed by heaviness (85.2%), numbness (77.8%), and pain (60.9%). All symptom improvement scores after each endovenous procedure showed similar patterns in both groups. The advantages of CA with UGFS over EVLA with UGFS were a shorter procedure time (20.1 ± 10.6 minutes vs 28.4 ± 10.9 minutes; P = .001) and lower perioperative visual analog for pain scores (2.99 ± 2.34 vs 3.74 ± 2.49; P = .03). Compared with the preoperative values, the venous reflux originated severity score, VCSS, CIVIQ-14 score, and symptom severity score were significantly improved in both groups (P < .001 for all). Improvements in all five symptoms (P = .085 to P = 1.0), VCSS (P = .435), CIVIQ-14 score (P = .788), and satisfaction score (P = .392) at 3 months postoperatively were comparable between the two groups. In the CA group, 2 cases of endovenous glue-induced thrombosis and 24 cases (27.6%) of type IV hypersensitivity reactions occurred. CONCLUSIONS: Minimally invasive endovenous surgery with CA and EVLA provides significant symptom improvement for patients with low-grade CEAP classes.
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Cianoacrilatos/administración & dosificación , Procedimientos Endovasculares , Terapia por Láser , Escleroterapia , Insuficiencia Venosa/terapia , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Cianoacrilatos/efectos adversos , Procedimientos Endovasculares/efectos adversos , Femenino , Humanos , Terapia por Láser/efectos adversos , Masculino , Persona de Mediana Edad , Calidad de Vida , Recuperación de la Función , Estudios Retrospectivos , Escleroterapia/efectos adversos , Encuestas y Cuestionarios , Evaluación de Síntomas , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Intervencional , Insuficiencia Venosa/complicaciones , Insuficiencia Venosa/diagnóstico por imagen , Insuficiencia Venosa/fisiopatología , Adulto JovenRESUMEN
OBJECTIVE: A common pattern of recurrence after cyanoacrylate treatment of incompetent saphenous veins has been associated with reflux from the residual stump. The purpose of this study was to analyze the starting point of cyanoacrylate glue injection from the junction to decrease the stump length. METHODS: A retrospective review was performed using prospectively collected data of patients with cyanoacrylate closure (CAC). Preoperatively, the diameter of the saphenous vein was measured. CAC was performed according to the manufacturer's instructions. After the procedure, clinical outcomes including pain, Venous Clinical Severity Score, and quality of life using the Aberdeen Varicose Vein Questionnaire were evaluated. Postoperative duplex scanning was performed to evaluate the occlusion rate of the target vein, stump length, and presence of endovenous glue-induced thrombosis. The stump length was analyzed according to the preoperative venous diameter to determine the proper point of glue injection to decrease the stump length. RESULTS: During the study period, CAC was performed in 408 patients. The mean age was 56.2 ± 11.5 years (range, 19-84 years). A total of 279 patients (68.4%) were women. Occlusion of the target vein was achieved in all patients. After the procedure, pain, Venous Clinical Severity Score, and quality of life were improved (P < .001). Endovenous glue-induced thrombosis developed in 5.8% of patients. There was a 1.53-fold linear increase in the stump length for every 1-mm increment of the preoperative venous diameter. In 20 patients with a venous diameter ≥5 mm, glue injection was performed safely 4 cm distal to the junction to decrease the stump length. CONCLUSIONS: The stump length linearly increased with an increase in the saphenous vein diameter. If the diameter of the saphenous vein is more than 5 mm, cyanoacrylate glue may be injected 4 cm distal to the junction to decrease the stump length.
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Cianoacrilatos/administración & dosificación , Procedimientos Endovasculares , Vena Safena , Insuficiencia Venosa/terapia , Adulto , Anciano , Anciano de 80 o más Años , Cianoacrilatos/efectos adversos , Bases de Datos Factuales , Procedimientos Endovasculares/efectos adversos , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Vena Safena/diagnóstico por imagen , Vena Safena/fisiopatología , Resultado del Tratamiento , Insuficiencia Venosa/diagnóstico por imagen , Insuficiencia Venosa/fisiopatología , Adulto JovenRESUMEN
OBJECTIVE: The treatment of varicose veins has shifted from conventional surgical stripping (SS) to minimally invasive endovenous modalities. Cyanoacrylate closure (CAC) with the VenaSeal system (Medtronic, Dublin, Ireland) has increased in popularity owing to its nonthermal and nontumescent technique. The purpose of the present study was to compare the clinical outcomes of CAC and SS for the treatment of incompetent great saphenous veins. METHODS: An open-label, multicenter, prospective, randomized controlled trial was conducted. The subjects were randomized to either the CAC or SS procedure. The primary endpoint of the present study was to evaluate complete closure of the target vein at 3 months. Target vein occlusion was assessed on the third day and 1, 3, 6, and 12 months postoperatively using duplex ultrasound. The pain and ecchymosis grades were also assessed. Additionally, the clinical outcomes, such as the venous clinical severity score and Aberdeen Varicose Vein Questionnaire score, were assessed. RESULTS: Three-month follow-up data were obtained for all 126 enrolled and randomized subjects (63 with CAC and 63 with SS). At 3 months, complete target vein closure was observed in both groups. The postoperative pain score was significantly better in the CAC group than in the SS group (0.3 ± 0.6 in the CAC group and 1.1 ± 1.5 in the SS group; P < .001). In addition, the mean ecchymosis grade was 0.3 ± 0.5 in the CAC group and 1.1 ± 1.1 in the SS group (P < .001). The venous clinical severity score and quality of life had improved equally in both groups. The adverse events after both procedures were mostly minor complications (9 events in CAC group and 20 events in SS group). Major complications occurred in one patient who had undergone the SS procedure. CONCLUSIONS: The CAC and SS procedures were both associated with complete occlusion of the target vein at 3 months. The postoperative pain and ecchymosis grades were significantly lower in the CAC group. Other differences between the two groups included the frequency and nature of the complications. The results showed that CAC has high success with few complications.
Asunto(s)
Cianoacrilatos/administración & dosificación , Procedimientos Endovasculares , Vena Safena/cirugía , Várices/terapia , Procedimientos Quirúrgicos Vasculares , Insuficiencia Venosa/terapia , Anciano , Cianoacrilatos/efectos adversos , Equimosis/etiología , Procedimientos Endovasculares/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/etiología , Estudios Prospectivos , Calidad de Vida , Vena Safena/diagnóstico por imagen , Vena Safena/fisiopatología , Seúl , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler Dúplex , Várices/diagnóstico por imagen , Várices/fisiopatología , Procedimientos Quirúrgicos Vasculares/efectos adversos , Insuficiencia Venosa/diagnóstico por imagen , Insuficiencia Venosa/fisiopatologíaRESUMEN
RATIONALE: Surgical treatment remains the most effective option for treating Boerhaave's syndrome. However, in cases of postoperative anastomotic leakage of Boerhaave's syndrome, endoscopic interventions such as over-the-scope clip, stenting, or cyanoacrylate injection have emerged over reoperation. PATIENT CONCERNS: We report the case of a 50-year-old male patient who presented with vomiting and abdominal pain after alcohol consumption. Laparoscopic surgery was performed for primary closure of a laceration at the lower esophagus, and for the closure of a Boerhaave's syndrome, which was detected by abdominal computed tomography. However, postoperative anastomotic leakage was confirmed through esophagography after the operation. In our case, endoscopic treatment with an over-the-scope clip and stenting were not effective for the repair of the anastomotic leakage, but cyanoacrylate injection successfully healed the anastomotic leakage. DIAGNOSES: Boerhaave's syndrome was initially detected by abdominal computed tomography, but postoperative anastomotic leakage after the operation was confirmed with esophagography. INTERVENTIONS: A total of 2.0 cc of N-butyl-2-cyanoacrylate and lipiodol mixture (at 1:1) was injected into the leakage tract through the perforation entrance. OUTCOMES: Complete healing of the anastomotic leakage was confirmed with a follow-up esophagoscopy. LESSONS: N-butyl-2-cyanocrylate injection treatment can be used as a rescue option for postoperative leakage when over-the-scope clips and stenting fail for this indication.
Asunto(s)
Fuga Anastomótica/tratamiento farmacológico , Cianoacrilatos/administración & dosificación , Perforación del Esófago/etiología , Enfermedades del Mediastino/complicaciones , Cianoacrilatos/uso terapéutico , Perforación del Esófago/complicaciones , Perforación del Esófago/cirugía , Humanos , Masculino , Enfermedades del Mediastino/etiología , Enfermedades del Mediastino/cirugía , Persona de Mediana Edad , Rotura EspontáneaRESUMEN
Although the use of topical skin adhesives has increased as an alternative to conventional skin closure methods, studies on the incidence and risk factors of allergic contact dermatitis (ACD) to topical skin adhesives have been limited. The purpose of this study was to investigate the incidence and risk factors of ACD after the use of 2-octyl cyanoacrylate and n-butyl cyanoacrylate topical skin adhesives. We retrospectively reviewed 1145 patients (739 patients with 2-octyl cyanoacrylate and 406 patients with n-butyl cyanoacrylate) who underwent skin closure with topical skin adhesives. Variables suspected to correlate with ACD were retrieved from medical records and analyzed to determine risk factors. The incidence of ACD from the use of 2-octyl cyanoacrylate and n-butyl cyanoacrylate topical skin adhesives was 2.7% and 2.2%, respectively. There was no statistically significant difference in the incidence between the two ingredients. In logistic regression analysis, none of the variables were found to increase the risk of ACD in both 2-octyl cyanoacrylate and n-butyl cyanoacrylate topical skin adhesives. As ACD occurs without risk factors in 2-3% of patients who used 2-octyl cyanoacrylate or n-butyl cyanoacrylate topical skin adhesives, clinicians and patients should be aware of these facts before using topical skin adhesives.