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 215
When the distribution of CEAP classification was analysed,
42 (41.2%) patients were found to be C3 grade, 37 (36.3%)
were C4a, and 23 (22.5%) were C4b. All patients were treated
successfully. Pre-operative white blood cell count (WBC) was
6.82 ± 1.67× 109 cells/μl, while after the intervention it was 6.57 ±
1.49 × 109 cells/μl; the difference was not statistically significant
(p = 0.68). The neutrophil count before the intervention was 4.09
± 1.33 × 109 cells/μl, and post intervention it was 4.09 ± 1.33×
109 cells/μl, with no statistically significant difference (p = 0.833).
The eosinophil count was 0.64 ± 1.51 × 109 cells/μl prior to the
procedure, and after the procedure it was 0.76 ± 1.65 × 10 9 cells/
μl. The difference was statistically significant, demonstrating a
negative correlation (p = 0.01) (Table 2).
Pre-intervention sedimentation rate and CRP values were
18.92 ± 9.77 mm/h and 1.71 ± 1.54 mg/dl, respectively, and
postoperative values were 19.78 ± 15.90 mm/h and 1.73 ±
1.59 mg/dl, respectively. The differences were not statistically
significant (psedim = 0.480, pCRP = 0.714). The change in values pre-
and post intervention are presented in detail in Table 2.
The change in values by gender are summarised in Table 3.
Differences in pre- and postoperative WBC and eosinophil count,
sedimentation rate and CRP were not statistically significant in
women. On the other hand, although the change in WBC count
and CRP value was not statistically significantly different in
males, the difference in the eosinophil count was statistically
significant, with a negative correlation (p = 0.002). The difference
in sedimentation rate was also statistically significant and
demonstrated a positive correlation (p = 0.005) (Table 3). In
other words, postoperative sedimentation rate decreased in men
and the change was 2.66 ± 4.76 mm/h, which was statistically
significantly different (p < 0.05) (Table 3). When the difference in
the rheumatoid factor was evaluated pre- and postintervention,
no statistically significant changes were found in either gender (p
< 0.05) (Table 3).
Discussion
The field of use of cyanoacrylate (CA) in medical treatment
has gradually increased since its discovery.13,14 It has been used
in ophthalmological operations, cosmetic procedures, dental
applications and acute bleeding, with the aim of stopping the
bleeding and attaching the tissues. Also, endoscopic injection
of CA has been widely and safely used in order to cease gastric
variceal bleeding. 9 Recently it has been administered via the
endovenous route for the treatment of varicose veins and
superficial venous insufficiency without the need for tumescent
anaesthesia11 or thermal energy, with increasing evidence proving
that it could be an appropriate agent for the treatment of
peripheral varicose veins.10,15
The mechanism of effect of NBCA is simple; it stimulates
polymerisation when it comes into contact with blood and
plasma, hence causing an obstruction of the vein in which it
is administered. This occurs in three steps: the initiation phase
lasts approximately 10 seconds and the tensile force increases
rapidly; the second phase lasts for approximately one minute and
creates a steady tensile force; the last phase is completion of the
polymerisation and a strong tensile force is obtained.16
Almeida et al. closed the truncal vein of pigs using CA
and after a follow-up period of 60 days, found no thrombus
obstructing the lumen of the vein on sonography or histology.
Instead he observed a chronic foreign body reaction against
NBCA.15 When the tissues were examined, they observed an
inflammatory reaction and the formation of giant cell foreign
bodies, followed by the development of intraluminal fibrosis. 15
Endovenous NBCA application has been well tolerated in
Table 3. Pre- and postoperative changes in whole blood and
serological parameters by gender
Parameter
Pre-operative
value
Postoperative
value t-value p-value
WBC (× 103 cells/μl)
Female 6.87 ± 1.55 6.65 ± 1.53 1.375 0.173
Male 6.68 ± 1.96 6.37 ± 1.41 1.262 0.217
Neutrophils (× 103 cells/μl)
Female 3.99 ± 1.30 3.99 ± 1.30 –0.985 0.328
Male 4.35 ± 1.39 4.34 ± 1.38 1.116 0.273
Eosinophils (× 103 cells/μl)
Female 0.51 ± 1.03 0.51 ± 0.98 0.000
Male 0.96 ± 2.28 1.37 ± 2.57 –3.479 1.000
Basophils (× 103 cells/μl) 0.002*
Female 0.06 ± 0.16 0.04 ± 0.07 1.199 0.235
Male 0.33 ± 0.74 0.09 ± 0.22 1.740 0.093
Haemoglobin (g/dl)
Female 13.17 ± 0.93 13.05 ± 0.89 1.000 0.324
Male 15.26 ± 1.51 15.76 ± 1.32 –2.584 0.022*
Haematocrit (%)
Female 40.64 ± 2.77 39.78 ± 2.76 1.837 0.075
Male 45.29 ± 4.08 49.16 ± 9.74 –1.650 0.121
Thrombocytes (103 cells/μl)
Female 260.80 ± 61.55 239.31 ± 88.02 1.551 0.129
Male 186.11 ± 33.16 193.72 ± 38.98 –2.061 0.055
Sedimentation rate (mm/h)
Female 22.08 ± 9.42 24.41 ± 16.79 –1.407 0.164
Male 11.33 ± 5.54 8.66 ± 3.07 3.065 0.005*
CRP (mg/dl)
Female 1.24 ± 1.25 1.30 ± 1.26 –1.540 0.128
Male 2.84 ± 1.62 2.75 ± 1.85 0.526 0.603
Rheumatoid factor (IU/ml)
Female 6.80 ± 5.83 6.41 ± 5.63 0.853 0.396
Male 7.11 ± 4.79 7.24 ± 2.50 –0.205 0.839
WBC: white blood cells; CRP: C-reactive protein.
Table 2. Pre- and postoperative changes in whole blood
and serological parameters of patients
Parameter
Pre-operative
value
Postoperative
value
Amount of
change t-value p-value
WBC
(× 10 3 cells/μl)
6.82 ± 1.67 6.57 ± 1.49 0.24 ± 1.33 1.846 0.068
Neutrophils
(× 10 3 cells/μl)
4.09 ± 1.33 4.09 ± 1.33 –0.00 ± 0.02 0.211 0.833
Eosinophils
(× 10 3 cells/μl)
0.64 ± 1.51 0.76 ± 1.65 –0.11 ± 0.46 –2.624 0.010*
Basophils
(× 10 3 cells/μl)
0.14 ± 0.43 0.06 ± 0.13 0.08 ± 0.42 1.966 0.052
Haemoglobin
(g/dl)
13.79 ± 1.47 13.84 ± 1.61 –0.05 ± 0.80 –0.503 0.617
Haematocrit
(%)
42.00 ± 3.82 42.54 ± 7.11 –0.53 ± 5.78 –0.656 0.515
Platelets
(× 10 3 cells/μl)
238.01 ± 64.33 225.40 ± 78.97 12.61 ± 75.39 1.285 0.204
Sedimentation
(mm/h)
18.92 ± 9.77 19.78 ± 15.90 –0.86 ± 12.29 –0.709 0.480
CRP (mg/dl) 1.71 ± 1.54 1.73 ± 1.59 –0.21 ± 0.59 –0.634 0.714
Rheumatoid
factor (IU/ml)
6.89 ± 5.52 6.65 ± 4.92 0.23 ± 3.80 0.634 0.527
WBC: white blood cells; CRP: C-reactive protein. *p < 0.05 statistically significant.