Systematic review and meta-analysis of endovenous cyanoacrylate adhesive ablation for incompetent saphenous veins

• Published in: Journal of vascular surgery. Venous and lymphatic disorders (New York, NY) NY), 2020-03, Vol.8 (2), p.287-296
• Main Authors: García-Carpintero, Esther, Carmona, Montserrat, Chalco-Orrego, Juan Pablo, González-Enríquez, Jesús, Imaz-Iglesia, Iñaki
• Format: Article
• Language: English
• Subjects: Cyanoacrylate ablation; Great saphenous; Meta-analysis; Nontumescent endovenous ablation; Varicose veins
• ISSN: 2213-333X; 2213-3348
• DOI: 10.1016/j.jvsv.2019.09.010

The objective of this study was to assess the effectiveness, safety, and quality of care afforded by cyanoacrylate ablation (CA) vs existing options in treating great saphenous vein incompetence. We conducted a systematic review; used the Grading of Recommendations Assessment, Development, and Evaluation framework; assessed the quality of randomized clinical trials using the Cochrane risk of bias tool; and performed a meta-analysis on the available comparative measurements. Three comparative studies, two randomized controlled trials and one observational study comprising 1057 participants, were included for effectiveness assessment purposes. The safety assessment also included 10 case series. Available evidence allowed comparison of CA with radiofrequency ablation (RFA) and endovenous laser ablation (EVLA) but not with other treatments. The comparative effectiveness analysis showed that whereas all three treatments reduced disease severity, none was significantly better than any other in terms of effectiveness. In terms of safety, however, CA devices gave rise to fewer adverse events and less severity at 12 months of follow-up than did EVLA or RFA. Other important advantages of CA over EVLA or RFA were linked to quality of care; patients reported less pain during intervention with CA than with RFA or EVLA devices and registered shorter intervention and recovery times. Furthermore, tumescent anesthesia and compression bandages were not necessary, making this technique more comfortable for the patients than endothermal techniques. Compared with EVLA and RFA, CA treatments yield comparable effectiveness outcomes and lead to less frequent and fewer mild adverse events, without difference in major adverse events. Furthermore, CA devices have advantages in terms of quality of care indicators, such as pain during intervention, treatment and recovery times, lower use of anesthesia, and zero use of compression bandages after treatment.