Incidence, classification, and risk factors of endovenous to glue-induced thrombosis after cyanoacrylate closure of the incompetent saphenous vein

Background: The cyanoacrylate closure (CAC) procedure is a safe and effective modality for the treatment of an incompetent saphenous vein. Thrombus extension into the deep vein, known as endovenous glue-induced thrombosis (EGIT), may be a worrisome complication of the procedure. However, the incidence, classification, and risk factors of EGIT have not been elucidated. We report, herein, the incidence, classification, and risk factors of EGIT following the CAC procedure for an incompetent saphenous vein. Methods: A retrospective review was performed of prospectively collected data of CAC patients. Preoperatively, the diameter, reflux time, and peak reflux velocity of the saphenous vein were measured. The CAC procedure was performed as per the instructions for use. Postoperative follow-up was conducted at 1 week, 3 months, 6 months, and 1 year after the procedure. Postoperative duplex scanning was performed to evaluate the occlusion of the target vein and presence of EGIT. Demographic data, risk factors, procedure details, and follow-up data were also obtained. A four-tier classification system and recommended treatment plan were developed based on the EGIT grade. All statistical analyses were performed using SPSS version 22.0 (IBM, Armonk, NY). A P value of <.05 was considered statistically significant. Results: During the study period, the CAC procedure was performed in 191 patients (126 females [66.0%]). The mean age was 56.1 +/- 11.7 years (range, 19-84) years. After the procedure, pain, the Revised Venous Clinical Severity Score, and the Aberdeen Varicose Vein Questionnaire score were significantly improved (P < .001). EGIT developed in 11 patients (5.8%). EGIT of grades I and II developed in seven (63.6%) and four (36.4%) patients, respectively. Duplex follow-up was conducted for all patients with EGIT without anticoagulation. Regarding the analysis of risk factors for the development of EGIT, the preoperative saphenous vein diameter of <5 mm was the only risk factor (P = .040). Conclusions: EGIT is not an uncommon complication of CAC. A small diameter of the saphenous vein (<5 mm) is a risk factor for the development of EGIT. A classification system and treatment protocol for EGIT based on the area of thrombus extension into the deep vein is proposed for managing patients.