Universitas Indonesia Hospital, Depok, West Java, Indonesia.
Universitas Indonesia Hospital, Depok, West Java, Indonesia.
Ann Vasc Surg. 2022 Mar;80:313-324. doi: 10.1016/j.avsg.2021.09.041. Epub 2021 Nov 12.
Cyanoacrylate embolization (CAE) is a novel non-thermal non-tumescent venous ablation technique that has shown promising results in treating saphenous vein insufficiency. We aimed to assess the efficacy and safety profile of CAE in comparison to endovenous laser ablation (EVLA) in treating saphenous vein insufficiency.
We conducted a systematic review and meta-analysis in accordance with the PRISMA Statement. A systematic search was performed through online databases including PubMed, ScienceDirect, and Cochrane to find relevant studies. Manual searching was also performed from the references of the selected studies. Specific keywords that we used were "(cyanoacrylate) AND (laser OR laser ablation OR laser therapy) AND (vein OR venous OR saphenous vein OR venous insufficiency OR varicose vein)". Outcomes of interest were efficacy, safety, and intervention time. Efficacy was determined by venous closure rate 1 year post-intervention and Venous Clinical Severity Score (VCSS) 1 year post-intervention. Safety was determined by rates of periprocedural pain, skin pigmentation, nerve damage, phlebitis, deep vein thrombosis (DVT) and ecchymosis. Data extraction and quality assessment of included studies were performed by 2 reviewers, and statistical analysis was conducted using RevMan 5.4.0 software.
Five relevant articles (2 randomized-controlled trials and 3 cohort studies) were selected for this study, consisting a total of 1432 venous ablation procedures (710 CAE and 722 EVLA). From the efficacy point of view, venous closure rates and VCSS did not differ significantly between CAE group and EVLA group. From the safety point of view, pooled data showed that CAE group was associated with less periprocedural pain score (P < 0.001), lower skin pigmentation rates (0.60% vs. 4.46%; P = 0.008), and lower nerve damage rates (0% vs. 3.94%; P = 0.007). Rates of phlebitis, deep vein thrombosis, and ecchymosis did not differ significantly between the 2 groups. In addition, intervention time was significantly faster in CAE group compared to EVLA group (P < 0.001).
Cyanoacrylate embolization yields similar efficacy compared to EVLA. However, CAE is associated with less periprocedural pain, lower occurrence rates of skin pigmentation and nerve damage, and faster intervention time.
氰基丙烯酸酯栓塞（CAE）是一种新型的非热非肿胀静脉消融技术，在治疗大隐静脉功能不全方面显示出良好的效果。我们旨在评估 CAE 与静脉内激光消融（EVLA）治疗大隐静脉功能不全的疗效和安全性。
我们按照 PRISMA 声明进行了系统评价和荟萃分析。通过在线数据库（包括 PubMed、ScienceDirect 和 Cochrane）进行系统搜索，以查找相关研究。还从选定研究的参考文献中进行了手动搜索。我们使用的特定关键词是“(氰基丙烯酸酯) AND (激光 OR 激光消融 OR 激光治疗) AND (静脉 OR 静脉 OR 大隐静脉 OR 静脉功能不全 OR 静脉曲张)”。感兴趣的结果是疗效、安全性和干预时间。疗效通过术后 1 年的静脉闭塞率和术后 1 年的静脉临床严重程度评分（VCSS）来确定。安全性通过围手术期疼痛、皮肤色素沉着、神经损伤、静脉炎、深静脉血栓形成（DVT）和瘀斑的发生率来确定。由 2 名评审员进行纳入研究的数据提取和质量评估，使用 RevMan 5.4.0 软件进行统计分析。
选择了 5 篇相关文章（2 项随机对照试验和 3 项队列研究）进行本研究，共包括 1432 例静脉消融术（710 例 CAE 和 722 例 EVLA）。从疗效的角度来看，CAE 组和 EVLA 组的静脉闭塞率和 VCSS 无显著差异。从安全性的角度来看，汇总数据显示，CAE 组围手术期疼痛评分较低（P<0.001），皮肤色素沉着率较低（0.60%比 4.46%；P=0.008），神经损伤率较低（0%比 3.94%；P=0.007）。静脉炎、深静脉血栓形成和瘀斑的发生率在两组间无显著差异。此外，CAE 组的干预时间明显短于 EVLA 组（P<0.001）。
氰基丙烯酸酯栓塞与 EVLA 的疗效相当。然而，CAE 与围手术期疼痛较少、皮肤色素沉着和神经损伤发生率较低以及干预时间较快有关。
