Efficacy of Radiofrequency Ablation System for Cyanoacrylate Closure Recanalization Cases

Objective: Recently cyanoacrylate closure (CAC) is common practice to treat the saphenous vein trunk.  But strategy for CAC recanalization cases is unknown. In our experience, CAC recanalization occurred in 8.5%. Sclerotherapy and stab avulsion are safe and reliable method certainly, so it may be the first option. However, there are many unsuccessful cases. We report the experience of CAC recanalization cases using radiofrequency ablation system.

Methods:

CAC recanalization after CAC treatment occurred in 22 cases (8.5%) in our clinic, and the pattern was variable and complex. 20 case was segmental recanalization and 2 case was recanalization to the full length of the bilateral GSV. At first, we performed sclerotherapy in 20 cases, but sclerotherapy was ineffective in 4 cases. Next, we performed laser and RF Multiple Direct Puncture Ablation (MDPA). In each case, a catheter was inserted directly into the blood vessel by the percutaneous puncture method using an angiocath needle without sheath system under ultrasound observation.

Results:

For the first recanalization cases of CAC, we inserted laser catheter and ablated CAC site directly. Then we observed CAC deformation at ultrasound. Therefore, we ablated only the no glue portion. Next, we performed preliminary experiments using processed meat as an alternative. At first, blood was applied to cyanoacrylate, next we ablated that by laser slim fiber and RF. Laser showed very hard deformation and charring, while RF showed only mild and soft deformation. This result suggests the risk of damage to the prismatic glass and perivenous tissue due to laser cauterization, and RF seems to be safe. Based on this result,  we performed RF MDPA for recanalization cases. There was no CAC deformation during RF cauterization and the postoperative course was favorable.

Conclusions:

For CAC recanalization cases, laser MDPA may not be suitable because of CAC deformation. RF MDPA may be effective and safe strategy for CAC recanalization. We need more case accumulation for further investigation.