asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2022-006asurgery-347Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYЦианоакрилатная клеевая облитерация в европейских и американских клинических рекомендациях 2022 годаCyanoacrylate adhesive closure in the European and American 2022 clinical practice guidelineshttps://orcid.org/0000-0003-2116-2247ШиринбекО.ShirinbekO.

Ширинбек Олими, д.м.н., врач-хирург, заместитель главного врача по хирургии, заведующий кафедрой хирургии, 127299, Москва, ул. Космонавта Волкова, д. 9/2;

руководитель центра, 125130, Москва, Старопетровский проезд, д. 7а, стр. 22

Olimi Shirinbek, Dr. Sci. (Med.), Surgeon, Deputy Chief Physician for Surgery, 9/2, Cosmonaut Volkov St., Moscow, 127299;

Head of the Centre, 7a, Bldg. 22, Staropetrovskiy Lane, Moscow, 125130

olims@mail.ruЦентр медицинского и корпоративного обучения; Центр флебологии «СМ-Клиника»РоссияCentre for Medical and Corporate Training; “SM-Clinic” Phlebology CenterRussian Federation2023180520232013843Copyright © Ширинбек О., 20232023Ширинбек О.Shirinbek O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/347

Нетермические нетумесцентные (НТНТ) методы устранения вертикального рефлюкса при хронических заболеваниях вен (ХЗВ) нижних конечностей за последнее десятилетие приобретают все большую популярность. Основными НТНТ-методами являются механохимическая облитерация и цианоакрилатная клеевая облитерация (ЦКО). Преимуществами нетермической облитерации варикозных вен являются отсутствие необходимости в тумесцентной анестезии, низкий уровень периоперационной боли и экхимозов, высокий уровень комфорта и удовлетворенности пациентов, а также уникальное для ЦКО достоинство – отсутствие необходимости в послеоперационной компрессии. Клеевая облитерация является одним из наиболее перспективных нетермических эндовенозных методов лечения, в основе которого лежит закрытие просвета магистральной подкожной вены с помощью цианоакрилатного адгезива и, как следствие, устранение патологического вено-венозного рефлюкса. Целью настоящего обзора явилась оценка обновленных европейских и американских клинических рекомендаций по диагностике и лечению ХЗВ нижних конечностей в отношении цианоакрилатной облитерации. Накопленные за последнее десятилетие доказательства свидетельствуют о высокой эффективности и безопасности клеевой облитерации и ее преимуществах по таким показателям, как уровень послеоперационных болей и экхимозов, риск развития нежелательных явлений, частота окклюзии в отдаленном периоде, длительность вмешательства, а также сроки реабилитации и качество жизни пациентов. В этой связи в обновленных зарубежных клинических рекомендациях 2022 г., наряду с золотым стандартом лечения – методами термической облитерации, значительное место занимает нетермическая облитерация в целом и клеевая в частности. Так, согласно рекомендациям Европейского общества сосудистых хирургов при выборе нетермического метода облитерации большой подкожной вены предпочтение следует отдавать клеевой облитерации. Американские профессиональные сообщества в равной степени рекомендуют термическую и нетермическую облитерацию большой подкожной вены при наличии симптоматического аксиального рефлюкса, при этом главное значение имеет наличие опыта лечащего врача и предпочтения пациента. 

Over the last decade non-thermal non-tumescent (NTNT) methods of truncal reflux elimination in chronic venous disease (CVD) are becoming increasingly popular. The main NTNT modalities are mechanochemical ablation and cyanoacrylate adhesive closure (CAC). The advantages of non-thermal ablation are avoidance of tumescent anesthesia, low periprocedural pain and bruising, high patient comfort and satisfaction rates. CAC method has an additional benefit of avoiding the postprocedural compression. CAC is one of promising non-thermal ablation procedures, that leads to truncal vein occlusion and reflux elimination via endovenous delivery of n-butyl-2-cyanoacrylate. This review is aimed at assessment of the updated European and American clinical practice guidelines on CVD management, particularly the role of CAC. Current evidence shows high efficacy and safety of the CAC, its advantages regarding the periprocedural pain and ecchymoses, risk of adverse events, closure rates in the long-term, procedure and recovery time and patients’ quality of life. Therefore, along the current gold standard of varicose vein treatment – thermal ablation, the updated 2022 European and American clinical practice guidelines have significantly emphasized the role of NTNT modalities in general and CAC in particular. Specifically, the European Society for Vascular Surgeons guidelines recommend CAC for patients with great saphenous vein (GSV) incompetence when the NTNT technique is preferred. American guidelines recommend both thermal and non-thermal ablation for the patients with symptomatic axial reflux of the GSV, depending on the available expertise of the treating physician and the preference of the patient.

цианоакрилатная облитерацияклеевая облитерацияцианоакрилатная эмболизацияварикозная болезнь нижних конечностейнетермические нетумесцентные методыcyanoacrylate adhesive closureglue ablationvaricose veinschronic venous diseasenon-thermal non-tumescentReferencesBootun R., Lane T.R., Davies A.H. The advent of non-thermal, non-tumescent techniques for treatment of varicose veins. Phlebology. 2016;31(1):5–14. https://doi.org/10.1177/0268355515593186.Bootun R., Lane T.R., Davies A.H. The advent of non-thermal, non-tumescent techniques for treatment of varicose veins. Phlebology. 2016;31(1):5–14. https://doi.org/10.1177/0268355515593186.Whiteley M.S. Glue, steam and Clarivein-Best practice techniques and evidence. Phlebology. 2015;30(2 Suppl.):24–28. https://doi.org/10.1177/0268355515591447.Whiteley M.S. Glue, steam and Clarivein-Best practice techniques and evidence. Phlebology. 2015;30(2 Suppl.):24–28. https://doi.org/10.1177/0268355515591447.Whiteley M.S. Current Best Practice in the Management of Varicose Veins. Clin Cosmet Investig Dermatol. 2022;15:567–583. https://doi.org/10.2147/CCID.S294990.Whiteley M.S. Current Best Practice in the Management of Varicose Veins. Clin Cosmet Investig Dermatol. 2022;15:567–583. https://doi.org/10.2147/CCID.S294990.van Eekeren R.R., Boersma D., Elias S., Holewijn S., Werson D.A., de Vries J.P., Reijnen M.M. Endovenous mechanochemical ablation of great saphenous vein incompetence using the ClariVein device: a safety study. J Endovasc Ther. 2011;18(3):328–334. https://doi.org/10.1583/11-3394.1.van Eekeren R.R., Boersma D., Elias S., Holewijn S., Werson D.A., de Vries J.P., Reijnen M.M. Endovenous mechanochemical ablation of great saphenous vein incompetence using the ClariVein device: a safety study. J Endovasc Ther. 2011;18(3):328–334. https://doi.org/10.1583/11-3394.1.Witte M.E., Reijnen M.M., de Vries J.P., Zeebregts C.J. Mechanochemical Endovenous Occlusion of Varicose Veins Using the ClariVein® Device. Surg Technol Int. 2015;26:219–225. Available at: https://pubmed.ncbi.nlm.nih.gov/26055013.Witte M.E., Reijnen M.M., de Vries J.P., Zeebregts C.J. Mechanochemical Endovenous Occlusion of Varicose Veins Using the ClariVein® Device. Surg Technol Int. 2015;26:219–225. Available at: https://pubmed.ncbi.nlm.nih.gov/26055013.Almeida J.I., Javier J.J., Mackay E., Bautista C., Proebstle T.M. First human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. J Vasc Surg Venous Lymphat Disord. 2013;1(2):174–180. https://doi.org/10.1016/j.jvsv.2012.09.010.Almeida J.I., Javier J.J., Mackay E., Bautista C., Proebstle T.M. First human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. J Vasc Surg Venous Lymphat Disord. 2013;1(2):174–180. https://doi.org/10.1016/j.jvsv.2012.09.010.Almeida J.I., Javier J.J., Mackay E.G., Bautista C., Cher D.J., Proebstle T.M. Thirty-sixth-month follow-up of first-in-human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. J Vasc Surg Venous Lymphat Disord. 2017;5(5):658–666. https://doi.org/10.1016/j.jvsv.2017.03.016.Almeida J.I., Javier J.J., Mackay E.G., Bautista C., Cher D.J., Proebstle T.M. Thirty-sixth-month follow-up of first-in-human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. J Vasc Surg Venous Lymphat Disord. 2017;5(5):658–666. https://doi.org/10.1016/j.jvsv.2017.03.016.De Maeseneer M.G., Kakkos S.K., Aherne T., Baekgaard N., Black S., Blomgren L. et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184–267. https://doi.org/10.1016/j.ejvs.2021.12.024.De Maeseneer M.G., Kakkos S.K., Aherne T., Baekgaard N., Black S., Blomgren L. et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184–267. https://doi.org/10.1016/j.ejvs.2021.12.024.Wittens C., Davies A.H., Bækgaard N., Broholm R., Cavezzi A., Chastanet S. et al. Editor’s Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678–737. https://doi.org/10.1016/j.ejvs.2015.02.007.Wittens C., Davies A.H., Bækgaard N., Broholm R., Cavezzi A., Chastanet S. et al. Editor’s Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678–737. https://doi.org/10.1016/j.ejvs.2015.02.007.Gloviczki P., Lawrence P.F., Wasan S.M., Meissner M.H., Almeida J., Brown K.R. et al. The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part I. Duplex Scanning and Treatment of Superficial Truncal Reflux: Endorsed by the Society for Vascular Medicine and the International Union of Phlebology. J Vasc Surg Venous Lymphat Disord. 2022:S2213-333X(22)00417-6. https://doi.org/10.1016/j.jvsv.2022.09.004.Gloviczki P., Lawrence P.F., Wasan S.M., Meissner M.H., Almeida J., Brown K.R. et al. The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part I. Duplex Scanning and Treatment of Superficial Truncal Reflux: Endorsed by the Society for Vascular Medicine and the International Union of Phlebology. J Vasc Surg Venous Lymphat Disord. 2022:S2213-333X(22)00417-6. https://doi.org/10.1016/j.jvsv.2022.09.004.Gloviczki P., Comerota A.J., Dalsing M.C., Eklof B.G., Gillespie D.L., Gloviczki M.L. et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5 Suppl.):2S-48S. https://doi.org/10.1016/j.jvs.2011.01.079.Gloviczki P., Comerota A.J., Dalsing M.C., Eklof B.G., Gillespie D.L., Gloviczki M.L. et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5 Suppl.):2S-48S. https://doi.org/10.1016/j.jvs.2011.01.079.Parsi K., Roberts S., Kang M., Benson S., Baker L., Berman I. et al. Cyanoacrylate closure for peripheral veins: Consensus document of the Australasian College of Phlebology. Phlebology. 2020;35(3):153–175. https://doi.org/10.1177/0268355519864755.Parsi K., Roberts S., Kang M., Benson S., Baker L., Berman I. et al. Cyanoacrylate closure for peripheral veins: Consensus document of the Australasian College of Phlebology. Phlebology. 2020;35(3):153–175. https://doi.org/10.1177/0268355519864755.Almeida J.I., Murray S.P., Romero M.E. Saphenous vein histopathology 5.5 years after cyanoacrylate closure. J Vasc Surg Venous Lymphat Disord. 2020;8(2):280–284. https://doi.org/10.1016/j.jvsv.2019.04.014.Almeida J.I., Murray S.P., Romero M.E. Saphenous vein histopathology 5.5 years after cyanoacrylate closure. J Vasc Surg Venous Lymphat Disord. 2020;8(2):280–284. https://doi.org/10.1016/j.jvsv.2019.04.014.Park I. Human Saphenous Vein Histopathology 2 Years After Cyanoacrylate Closure Using the VenaSeal™ System. Ann Vasc Surg. 2021;71:534.e17-534.e21. https://doi.org/10.1016/j.avsg.2020.09.017.Park I. Human Saphenous Vein Histopathology 2 Years After Cyanoacrylate Closure Using the VenaSeal™ System. Ann Vasc Surg. 2021;71:534.e17-534.e21. https://doi.org/10.1016/j.avsg.2020.09.017.Ontario Health (Quality). Nonthermal Endovenous Procedures for Varicose Veins: A Health Technology Assessment. Ont Health Technol Assess Ser. 2021;21(8):1–188. Available at: https://pubmed.ncbi.nlm.nih.gov/34211617.Ontario Health (Quality). Nonthermal Endovenous Procedures for Varicose Veins: A Health Technology Assessment. Ont Health Technol Assess Ser. 2021;21(8):1–188. Available at: https://pubmed.ncbi.nlm.nih.gov/34211617.Morrison N., Gibson K., McEnroe S., Goldman M., King T., Weiss R. et al. Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous veins (VeClose). J Vasc Surg. 2015;61(4):985–994. https://doi.org/10.1016/j.jvs.2014.11.071.Morrison N., Gibson K., McEnroe S., Goldman M., King T., Weiss R. et al. Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous veins (VeClose). J Vasc Surg. 2015;61(4):985–994. https://doi.org/10.1016/j.jvs.2014.11.071.Morrison N., Kolluri R., Vasquez M., Madsen M., Jones A., Gibson K. Comparison of cyanoacrylate closure and radiofrequency ablation for the treatment of incompetent great saphenous veins: 36-Month outcomes of the VeClose randomized controlled trial. Phlebology. 2019;34(6):380–390. https://doi.org/10.1177/0268355518810259.Morrison N., Kolluri R., Vasquez M., Madsen M., Jones A., Gibson K. Comparison of cyanoacrylate closure and radiofrequency ablation for the treatment of incompetent great saphenous veins: 36-Month outcomes of the VeClose randomized controlled trial. Phlebology. 2019;34(6):380–390. https://doi.org/10.1177/0268355518810259.Morrison N., Gibson K., Vasquez M., Weiss R., Jones A. Five-year extension study of patients from a randomized clinical trial (VeClose) comparing cyanoacrylate closure versus radiofrequency ablation for the treatment of incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord. 2020;8(6):978–989. https://doi.org/10.1016/j.jvsv.2019.12.080.Morrison N., Gibson K., Vasquez M., Weiss R., Jones A. Five-year extension study of patients from a randomized clinical trial (VeClose) comparing cyanoacrylate closure versus radiofrequency ablation for the treatment of incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord. 2020;8(6):978–989. https://doi.org/10.1016/j.jvsv.2019.12.080.Gibson K., Ferris B. Cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of post-procedure compression: Initial outcomes of a post-market evaluation of the VenaSeal System (the WAVES Study). Vascular. 2017;25(2):149–156. https://doi.org/10.1177/1708538116651014.Gibson K., Ferris B. Cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of post-procedure compression: Initial outcomes of a post-market evaluation of the VenaSeal System (the WAVES Study). Vascular. 2017;25(2):149–156. https://doi.org/10.1177/1708538116651014.Gibson K., Minjarez R., Gunderson K., Ferris B. Need for adjunctive procedures following cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of postprocedure compression: Three-month data from a postmarket evaluation of the VenaSeal System (the WAVES Study). Phlebology. 2019;34(4):231–237. https://doi.org/10.1177/0268355518801641.Gibson K., Minjarez R., Gunderson K., Ferris B. Need for adjunctive procedures following cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of postprocedure compression: Three-month data from a postmarket evaluation of the VenaSeal System (the WAVES Study). Phlebology. 2019;34(4):231–237. https://doi.org/10.1177/0268355518801641.Bahi M., Guazzo L., Taumoepeau L. Real-world short-term VenaSeal ablation outcomes for symptomatic saphenous incompetence. Vascular. 2022:17085381221077511. https://doi.org/10.1177/17085381221077511.Bahi M., Guazzo L., Taumoepeau L. Real-world short-term VenaSeal ablation outcomes for symptomatic saphenous incompetence. Vascular. 2022:17085381221077511. https://doi.org/10.1177/17085381221077511.Kolluri R., Chung J., Kim S., Nath N., Bhalla B.B., Jain T. et al. Network meta-analysis to compare VenaSeal with other superficial venous therapies for chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 2020;8(3):472–481.e3. https://doi.org/10.1016/j.jvsv.2019.12.061.Kolluri R., Chung J., Kim S., Nath N., Bhalla B.B., Jain T. et al. Network meta-analysis to compare VenaSeal with other superficial venous therapies for chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 2020;8(3):472–481.e3. https://doi.org/10.1016/j.jvsv.2019.12.061.El Kilic H., Bektas N., Bitargil M., Balkaya I.A., Demir T., Koramaz I. Long-term outcomes of endovenous laser ablation, n-butyl cyanoacrylate, and radiofrequency ablation for treatment of chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 2022;10(4):865–871. https://doi.org/10.1016/j.jvsv.2021.10.009.El Kilic H., Bektas N., Bitargil M., Balkaya I.A., Demir T., Koramaz I. Long-term outcomes of endovenous laser ablation, n-butyl cyanoacrylate, and radiofrequency ablation for treatment of chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 2022;10(4):865–871. https://doi.org/10.1016/j.jvsv.2021.10.009.Kubat E., Ünal C.S., Geldi O., Çetin E., Keskin A., Karapınar K. Comparison of different approaches to small saphenous vein reflux treatment: a retrospective study in two centers. Sao Paulo Med J. 2020;138(2):98–105. https://doi.org/10.1590/1516-3180.2019.0230.r1.06112019.Kubat E., Ünal C.S., Geldi O., Çetin E., Keskin A., Karapınar K. Comparison of different approaches to small saphenous vein reflux treatment: a retrospective study in two centers. Sao Paulo Med J. 2020;138(2):98–105. https://doi.org/10.1590/1516-3180.2019.0230.r1.06112019.Park I., Jeong M.H., Park C.J., Park W.I., Park D.W., Joh J.H. Clinical Features and Management of “Phlebitis-like Abnormal Reaction” After Cyanoacrylate Closure for the Treatment of Incompetent Saphenous Veins. Ann Vasc Surg. 2019;55:239–245. https://doi.org/10.1016/j.avsg.2018.07.040.Park I., Jeong M.H., Park C.J., Park W.I., Park D.W., Joh J.H. Clinical Features and Management of “Phlebitis-like Abnormal Reaction” After Cyanoacrylate Closure for the Treatment of Incompetent Saphenous Veins. Ann Vasc Surg. 2019;55:239–245. https://doi.org/10.1016/j.avsg.2018.07.040.Gibson K., Minjarez R., Rinehardt E., Ferris B. Frequency and severity of hypersensitivity reactions in patients after VenaSeal™ cyanoacrylate treatment of superficial venous insufficiency. Phlebology. 2020;35(5):337–344. https://doi.org/10.1177/0268355519878618.Gibson K., Minjarez R., Rinehardt E., Ferris B. Frequency and severity of hypersensitivity reactions in patients after VenaSeal™ cyanoacrylate treatment of superficial venous insufficiency. Phlebology. 2020;35(5):337–344. https://doi.org/10.1177/0268355519878618.Toonder I.M., Lam Y.L., Lawson J., Wittens C.H. Cyanoacrylate adhesive perforator embolization (CAPE) of incompetent perforating veins of the leg, a feasibility study. Phlebology. 2014;29(1 Suppl.):49–54. https://doi.org/10.1177/0268355514529696.Toonder I.M., Lam Y.L., Lawson J., Wittens C.H. Cyanoacrylate adhesive perforator embolization (CAPE) of incompetent perforating veins of the leg, a feasibility study. Phlebology. 2014;29(1 Suppl.):49–54. https://doi.org/10.1177/0268355514529696.Joh J.H., Lee T., Byun S.J., Cho S., Park H.S., Yun W.S. et al. A multicenter randomized controlled trial of cyanoacrylate closure and surgical stripping for incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord. 2022;10(2):353–359. https://doi.org/10.1016/j.jvsv.2021.08.012.Joh J.H., Lee T., Byun S.J., Cho S., Park H.S., Yun W.S. et al. A multicenter randomized controlled trial of cyanoacrylate closure and surgical stripping for incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord. 2022;10(2):353–359. https://doi.org/10.1016/j.jvsv.2021.08.012.Cho S., Joh J.H. Cyanoacrylate Closure of Small Saphenous Vein Insufficiency. Dermatol Surg. 2021;47(3):381–384. https://doi.org/10.1097/DSS.0000000000002748.Cho S., Joh J.H. Cyanoacrylate Closure of Small Saphenous Vein Insufficiency. Dermatol Surg. 2021;47(3):381–384. https://doi.org/10.1097/DSS.0000000000002748.

The authors declare that there are no conflicts of interest present.