Cardiovascular Journal of Africa: Vol 29 No 4 (July/August 2018)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018 AFRICA 213
Does the use of N-butyl-2 cyanoacrylate in the treatment
of lower extremity superficial varicose veins cause acute
systemic inflammation and allergic reactions?
Özge Korkmaz, Sabahattin Göksel, Müslim Gül, Hasan Başçil, Yavuz Yildir, Öcal Berkan
Abstract
Introduction: In this study we used N-butyl-2 cyanoacrylate
(NBCA), including dimethyl sulfoxide (DMSO), via the
endovenous route, for mechanochemical ablation in the treat-
ment of superficial venous insufficiency, in an attempt to
establish whether an early systemic inflammatory response
and an allergic reaction occurred in the patients.
Methods: A total of 102 patients were treated with endovenous
medical ablation in two centres between October 2015 and
February 2016. This study was a two-centre, retrospective,
non-randomised investigational study. Ablation treatment
with endovenous NBCA was used in patients with C3 to C4b
grade superficial venous insufficiency, according to the CEAP
(clinical, aetiology, anatomy and pathophysiology) clinical
classification, with sapheno-femoral junctional insufficiency
and a reflux of 0.5 seconds and longer on duplex ultra-
sonography. Pre-operative whole blood count, erythrocyte
sedimentation rate (ESR), C-reactive protein (CRP) level and
blood chemistry were studied in all patients on admission to
the clinic, and repeated in the second hour post-intervention.
Results: All patients were treated successfully. Pre-operative
white blood cell count (WBC) was 6.82 ± 1.67 × 109 cells/μ l,
and post intervention it was 6.57 ± 1.49 × 109 cells/ μl; the differ-
ence was not statistically significant (p = 0.68). The neutrophil
count before the intervention was 4.09 ± 1.33 × 109 cells/μ l,
while afterwards, it was 4.09 ± 1.33 × 109 cells/μl, with no
statistically significant difference (p = 0.833). Pre-intervention
eosinophil count was 0.64 ± 1.51 × 10 9 cells/μl, while it was
0.76 ± 1.65 × 109 cells/μl after the intervention, and the differ-
ence was statistically significant. Pre-intervention ESR and
CRP values were 18.92 ± 9.77 mm/h and 1.71 ± 1.54 mg/dl,
respectively. Postoperative ESR and CRP values were 19.78 ±
15.90 mm/h and 1.73 ± 1.59 mg/dl, respectively, but the differ-
ences were not statistically significant. When the parameters
were analysed by gender, the differences between pre- and
postoperative WBC and eosinophil count, ESR and CRP in
women were not statistically significant. On the other hand,
although the change in WBC count and CRP value were not
statistically significant in males, the differences in eosinophil
count and ESR were statistically significant.
Conclusion: Cyanoacrylate has been used in the endovenous
medical ablation of varicose veins and superficial venous
insufficiency over the last few years without the use of ther-
mal energy and tumescent anaesthesia, which represents
the greatest advantage of this method. In addition, since it
causes no systemic allergic or acute inflammatory reaction, it
appears to be safe to use.
Keywords: N-butyl-2 cyanoacrylate, lower-extremity superficial
varicous vein, acute systemic inflammation, allergic reaction
Submitted 8/11/16, accepted 14/2/18
Cardiovasc J Afr 2018; 29: 213–217
DOI: 10.5830/CVJA-2018-012
Lower extremity venous insufficiency and the secondary
development of varicose veins are important health problems
that are frequently encountered in society. They impair the
quality of life of individuals, and in certain conditions cause
severe complications. The prevalence of venous insufficiency has
been reported to be between 20 and 40% in many studies.1,2
Surgery has been the preferred method of treatment for this
disease for more than 100 years. However, due to postoperative
complications and frequent recurrence, alternative methods of
treatment have been sought. Newly developed endovascular
techniques have gradually replaced open surgery during the last
two decades.
Haematoma, paresthesia, wound site scars, deformities,
and a high rate of recurrence are among the complications
of surgery.3,4 Minimally invasive endovenous thermo-ablation
techniques (radiofrequency and laser), applied in the last decade
in the treatment of superficial venous insufficiency and varicose
veins, have decreased postoperative complications, shortened
the healing process and improved quality of life.5 However, the
necessity of tumescent anaesthesia during these techniques,
and complications in the postoperative period, such as pain,
ecchymosis and paresthesia caused by perforation of the vein
wall, have limited the use of these techniques.6,7
The introduction of cyanoacrylate (CA) in medical
applications dates back to the 1960s. Surgeons used CA in order
to stop bleeding and close wounds during the Vietnam War.8
Also, endoscopic CA injection to stop gastric variceal bleeding
has been safely and widely used.9 Recently, it has been used in the
closure of type I and II endoleaks developing during the repair
Department of Cardiovascular Surgery, Cumhuriyet
University School of Medicine, Sivas, Turkey
Özge Korkmaz, MD,
Sabahattin Göksel, MD
Öcal Berkan
Sivas Numune State Hospital, Sivas, Turkey
Müslim Gül, MD
Hasan Başçil
Department of Medical Biology, Cumhuriyet University,
Sivas, Turkey
Yavuz Yildir