CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S16
DOI: 10.1055/s-0041-1730688

Treatment of Incompetent Perforators in Recurrent Venous Insufficiency with Adhesive Embolization and Sclerotherapy

Krishna Prasad Bellam Premnath
Queen's Hospital, London, UK
Binu Joy
Rajagiri Hospital, Kochi, India
Ajith Toms
Rajagiri Hospital, Kochi, India
Teena Sleeba
Rajagiri Hospital, Kochi, India
› Author Affiliations

Background: Recurrent lower limb venous insufficiency is often a challenge in clinical practice and is most commonly due to incompetent perforators. Many of these patients do not have adequate symptom relief with compression and require some form of treatment for incompetent perforator interruption. The various treatment methods have been tried with different efficiencies. To evaluate the feasibility, efficiency, and safety of an outpatient combined cyanoacrylate adhesion–sodium tetradecyl sulfate sclerotherapy for the treatment of patients with symptoms of persistent or recurrent lower limb venous insufficiency secondary to incompetent perforators. Methods: Eighty-three limbs of 69 patients with symptoms of persistent or recurrent lower limb venous insufficiency secondary to incompetent perforators were treated with cyanoacrylate embolization of incompetent perforators and sclerotherapy of dilated collateral veins (surface branch varicose veins). Technical success, procedural pain, perforator occlusion, venous occlusion, clinical improvement, and ulcer healing were assessed. The follow-up was done 3- and 6-month postprocedure. Results: The procedure could be successfully performed in all patients. One hundred and ninety-one perforators were treated in total. Perforator and varicose veins occlusion rate was 100%. Deep venous extension of cyanoacrylate occurred in 4 (4.8%) patients, with no adverse clinical outcome. Venous clinical severity score improved from a baseline of 8.18 ± 3.60–4.30 ± 2.48 on 3-month follow-up and 2.42 ± 1.52 on 6-month follow-up (P < 0.0001). All ulcers showed complete healing within 3 months. Significant prolonged thrombophlebitis occurred in 38.5% of limbs. Conclusion: Combined cyanoacrylate adhesion and setrol sclerotherapy is technically easy, has a lot of advantages including being an outpatient procedure and highly efficacious but with a guarded safety profile.

Publication History

Article published online:
11 May 2021

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