Cyanoacrylate adhesive closure for varicose veins: An Indian expert consensus using a modified Delphi method

Cyanoacrylate adhesive closure (CAC) is a non-thermal, nontumescent option for treating saphenous reflux. This study aimed to develop a formal, evidence-based expert consensus on the use of CAC for the management of varicose veins in India. A modified Delphi consensus process was conducted. A panel of 12 experienced Indian interventional radiologists was convened. Consensus was defined as ≥80% agreement, achieved through anonymized voting and iterative discussions. All 12 panelists (100% participation) achieved a unanimous consensus (100% agreement) with the finalization of 29 consensus statements across eight domains. The consensus delineated the role of CAC across the clinical-etiological-anatomical-pathophysiological classes C2-C6 and in saphenous veins with diameters of 4-20 mm. The consensus provides a standardized procedural algorithm detailing specific steps for adhesive delivery, catheter recapture (recapturing the delivery catheter into the blue introducer sheath while intravascular before removal), and compression. CAC is recommended as an outpatient, non-tumescent day procedure using a 7F short introducer sheath; consequently, it is associated with reduced intra-procedural discomfort and reduced post-treatment bruising compared with thermal ablation. Key recommendations include: postprocedural compression stockings are not mandatory, early ambulation is encouraged, and structured follow-up is advised. The consensus also differentiates phlebitis (pain/erythema, absence of itching) from hypersensitivity (itching) to guide management, advises careful patient selection for shallow veins and operator judgment for large-diameter vessels, suggests considering prophylactic NSAID or antihistamine on a case-by-case basis, and recommends avoiding CAC in patients at high risk for immune-mediated reactions.