The American Venous Forum has formulated evidence-based clinical practice guidelines to provide recommendations on the care of patients with upper extremity deep vein thrombosis. All recommendations follow a systematic review of workup and therapy options for patients with upper extremity deep vein thrombosis. Potential limitations of these guidelines are due to the lack of evidence on some specific sub-areas such as risk stratification and long-term outcomes.
Objective: The aim of this study was to evaluate mid-term durability, clinical outcomes, and patient-reported outcomes after cyanoacrylate closure (CAC) of superficial truncal veins in routine practice, with limb- and vein-level analyses.
Methods: This was a single-center, retrospective cohort study of adults previously treated with CAC of the great saphenous vein, small saphenous vein, anterior saphenous vein, or posterior accessory saphenous vein, with standardized follow-up assessments. Eligible patients were invited for standardized follow-up including duplex ultrasound, CEAP class, revised Venous Clinical Severity Score, EuroQol 5-dimension survey, and Aberdeen Varicose Vein Questionnaire. The primary endpoint was complete closure of the primary target vein on duplex ultrasound, defined as no ≥5-cm contiguous patency within the treated segment. Secondary endpoints included vein-level patency, new clinically significant varicose veins, adverse events, and satisfaction with symptoms and cosmetic appearance. Analyses accounted for clustering of veins/limbs within patients using generalized estimating equations.
Results: The study enrolled 89 patients (76.4% female; median age, 53 years) representing 110 limbs and 156 treated veins. The median time from treatment to follow-up was 3.7 years. Primary target vein complete closure at the limb level was 97.3% (107/110; 95% confidence interval [CI], 91.9%-99.1%). At follow-up, patency in any treated vein was present in 10.9% of limbs and 7.7% of veins. At follow-up, revised Venous Clinical Severity Score decreased from 6 (interquartile range, 4-8) to 1 (interquartile range, 0-2) (mean change, -4.5 ± 2.5; P < .001) and Aberdeen Varicose Vein Questionnaire scores improved among the subset with paired data (mean change, -7.7 ± 8.9; P < .001). New clinically significant varicose veins were present in 19.1% of limbs (95% CI, 12.7%-27.8%), often involving the anterior saphenous vein. Higher baseline body mass index was associated with vein-level patency on univariable analysis (median 33 vs 24 kg/m2; P < .001) and remained an independent predictor in exploratory multivariable models. Patient satisfaction per limb was 97% (completely/somewhat satisfied) but was significantly lower when any treated vein remained patent (completely satisfied 41.7%; P < .001). Limb-level adverse events occurred in 20.0% (95% CI, 12.9%-29.7%), with localized tenderness/phlebitis most commonly encountered; no deep venous events were observed.
Conclusions: Complete closure rates of all treated veins with CAC remain high at a median of 3.7 years post treatment with sustained clinical and patient-reported outcome improvements. Incomplete closure and recurrent varicose veins correlate with worse symptoms, visual appearance and patient satisfaction.
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