Clinical Efficacy Of Cyanoacrylate Embolization Compared With Thermal Ablation For Varicose Veins Of The Lower Extremities

Objective: To compare the clinical efficacy of cyanoacrylate embolization and endovenous thermal ablation techniques for the treatment of varicose veins in the lower extremities.Methods: One hundred and twenty patients treated for varicose veins in the lower extremities in our hospital from August 2020 to January 2022 were collected.The cases were divided into 38 cases in the cyanoacrylate embolization group,46 cases in the radiofrequency ablation group,and 36 cases in the microwave ablation group according to the procedure.General data including age,gender,BMI,clinical-etiology-anatomy-pathophysiology(CEAP)classification were analyzed separately.The rates of saphenous vein trunk closure at 1 week,3,6,and 12 months after surgery,Preoperative and postoperative venous clinical severity score(VCSS),Aberdeen Varicose Vein Questionnaire(AVVQ)were observed at 3,6,and 12 months and 24-hour and 14-day postoperative pain changes,and postoperative complications.Results: There was no statistical difference in the underlying clinical data between the three groups(P(29)0.05).The closure rates at 1 week,3,6,and 12 months postoperatively were100%,94.73%,89.47%,and 86.84% in the CAE group;100%,97.83%,93.48%,and 84.78%in the RFA group;and 100%,94.44%,91.67%,and 83.33% in the EMA group.There was no statistically significant difference in the rate of saphenous vein trunk closure between the three groups of patients at any time point and at the end of follow-up(P(29)0.05).There was no significant difference in pain scores among the three groups at 24 hours postoperatively(P(29)0.05),and the VAS scores at 14 days postoperatively were 2.00(2.00)in the CAE group,4.00(2.00)in the RFA group,and 3.00(1.00)in the EMA group,with statistically significant differences in VAS scores among the three groups,and further two-by-two comparisons revealed that the CAE group was significantly lower than the difference was statistically significant(P＞0.05).The preoperative VCSS scores were 24.45±3.31,23.26±3.12,and24.64±4.47 in the CAE,RFA,and EMA groups,respectively,and at 3 months postoperatively were 21.29±4.05,18.57±3.64,and 20.83±4.55 in the CAE,RFA,and EMA groups,respectively.14.18±4.02,13.11±3.47,13.56±3.78 for the CAE,RFA and EMA groups at 6 months postoperatively,and 4.16±1.55,3.96±2.04,4.28±1.83 for the CAE,RFA and EMA groups at 12 months postoperatively,and the VCSS scores were significantly improved in all three groups compared to the preoperative period.The VCSS scores of the three groups were statistically different at 3 months postoperatively,and a statistically significant difference was found between the RFA group and the CAE group(P＞0.05),and there was no significant difference between the groups at 6 and 12 months postoperatively(P(29)0.05).The preoperative AVVQ scores of the CAE,RFA,and EMA groups were 33.50(10.75),34.50(12.00),and 35.50(10.75),respectively.23.00(7.25),26.50(8.00),and 25.00(7.75)in the CAE,RFA,and EMA groups,at 3 months postoperatively.17.50(5.25),15.50(5.00),and 18.00(8.00)in the CAE,RFA,and EMA groups at 6 months postoperatively.7.50(5.00),8.00(5.25),and 8.00(5.50)at 12 months postoperatively in the CAE,RFA,and EMA groups,respectively.With significant improvement in AVVQ scores in all treatment groups compared to preoperatively,but no significant difference between the treatment groups at any time point(P(29)0.05).No serious complications of deep vein thrombosis occurred in the three groups after the procedure.four patients in the CAE group had phlebitis-like reactions.Skin burns,a common complication of thermal ablation treatment,occurred in 2.17% and 5.56% of the RFA and EMA groups,with no statistically significant difference in comparison(P(29)0.05).There was no significant difference between the three groups in complications such as phlebitis,petechiae,skin pigmentation,sclerosis,and sensory abnormalities(P(29)0.05).Conclusion: 1.CAE,RFA,and EMA treatment all significantly improved patients’ VCSS scores and AVVQ scores,had better saphenous vein trunk closure rates,and achieved good outcomes.2.CAE had similar saphenous vein trunk closure rates,complication rates,and less pain compared to RFA and EMA,and may produce better comfort for patients.3.EMA and RFA treatment There were no significant differences in saphenous vein closure trunk closure rate and VCSS and AVVQ scores compared to varicose veins of the lower extremities,and both had no major complications and fewer complications.Therefore,EMA is a safe and effective ablation technique for the treatment of varicose veins in the lower extremities.