Endovenous Glue-Induced Thrombosis: Incidence, Risk Factors and Prevention

Non-thermal non-tumescent methods have been recently used in the treatment of varicose veins of the lower extremities. In particular, we talk about cyanoacrylate adhesive obliteration. However, this approach can result complications, including glue-induced thrombosis. Objective. To evaluate the incidence, risk factors and preventive measures for glue-induced thrombosis following cyanoacrylate adhesive obliteration of varicose veins of the lower extremities. Material and methods. We retrospectively analyzed electronic medical records of patients with varicose veins of the lower extremities after cyanoacrylate adhesive obliteration. The inclusion criteria were C2—C6 varicose veins with reflux >0.5 s, saphenous vein diameter ≥ 6 mm. Cyanoacrylate adhesive obliteration was performed according to the protocol recommended by the manufacturer. Examination and ultrasound of lower limb veins were performed after 3 and 7 days, 1 and 3 months, 1, 3 and 5 years. Complications and adverse events, therapeutic measures and effectiveness of treatment were analyzed. Results. Medical records of 1.794 patients (2.531 lower extremities and 2.729 venous trunks) were analyzed. There were 1.179 women (65.7%) and 615 men (34.3%). Mean age of patients was 61.1±15 years. Distribution of patients by CEAP classes was as follows: C2 — 31.7%; C3 — 44.1%; C4 — 17.3%; C5 — 1.7%; C6 — 5.2%. A total of 2.729 cyanoacrylate adhesive obliteration procedures were performed. After 3 days, ultrasound verified vein occlusion in 100% of patients. The target vein occlusion rate was 95% after 1 year, 92.8% after 3 years, and 92.3% after 5 years. The long-term 5-year results were assessed in 39 patients. Glue migration with its propagation into the deep vein and glue-induced thrombosis occurred in 44 (2.5%) patients (1.6% of all interventions). Glue-induced thrombosis class I («glue crossectomy») was detected in 35 (1.9%) patients, class II in 8 (0.4%), and class III in 1 (0.05%) case. Mean thrombus retraction time for class II and III was 3—6 months. Possible risk factors of glue-induced thrombosis were intraoperative technical errors (proximal disposition of the delivery catheter at the junction area, insufficient compression of the junction area with ultrasound probe) and target vein diameter < 6 mm. Conclusion. Glue-induced thrombosis is a rare complication with favorable asymptomatic course and no need for anticoagulation in the vast majority of patients.