N-Butil cianoacrilato como alternativa na venoablação para o tratamento da insuficiência da veia safena magna: revisão sistemática

Abstract

BACKGROUND: The safenectomy, despite new technological advances, is still very important in our environment, with high complication rates, and recurrence rates. Recent techniques, minimally invasive, aim the occlusion of the saphenous veins by thermal action, reducing surgical trauma, and times of healing and postoperative recovery. These techniques make it possible to perform the procedure under local anesthesia. Although minimally invasive, it presents risks of superficial neurological thermal lesions. More recently, new nonthermal venoablation methods have been used, with reduced risks of neurological lesions. Sclerotherapy with microfoam and newer, minimally invasive methods, such as intravenous ablation chemistry-mechanical and cyanoacrylate venoablation, have been used instead of thermoablation. The existence of this research was made with the purpose to evaluate and to determine if the cyanoacrylate venoablation, presents satisfactory results, with lower rates of complications, and therefore, being the first choice for the treatment of patients with saphenous vein insufficiency. OBJECTIVES: They consist of evaluating the occlusion rate in the treatment of reflux of the great saphenous veins and evaluate the improvement in the quality of life through the Venous Clinical Severity Score (VCSS) and the Aberdeen Varicose Veins Questionnaire (AVVQ) and the occurrence of adverse events. METHODS: This is a systematic review study conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) methodology. We searched the PUBMED / Medline, Scopus and Cochrane Library databases with the key words "cyanoacrylate" OR "cyanoacrylates" AND "varicose veins" OR "varicose vein" OR "varix" OR "varices" AND "saphenous vein" for research bibliographical, according to the descriptors contained in the MESH. RESULTS: Nine hundred sixty nine (969) papers were found, of which 92 duplicates. Two independent researchers initially screened 877 articles, based on reading the title and abstract. After the initial evaluation, 57 articles were considered relevant. The two authors made the final reading and selection, being considered 23 articles eligible for the systematic review, with the analysis, based on inclusion and exclusion criteria. Most of the included clinical trials were from prospective studies, of which only four papers were comparative. A total of 3,423 patients were evaluated, with a mean age of 47.17 years, of which 61.2% were female. In the overall evaluation, the mean occlusion rate in the treatment of NBCA venoablation was 96.48%, ranging from 75.7% to 100%, in a mean follow-up of 13.28 months (ranging from 1 to 36 months), with low rates of adverse events, with ecchymosis and thrombophlebitis being the most frequent events in the series studied, being present in 11.74% and 9.71% of the patients, respectively. In all included studies, improvements were observed in the CEAP indices, the Venous Clinical Severity Score (VCSS) and, when present, in the indices of the Aberdeeen Varicose Vein Questionnaire (AVVQ). CONCLUSIONS: Based on the published clinical trials, the venoablation with the use of N-Butyl Cyanoacrylate shows high success rates, with improvement of the clinical symptoms and therefore the quality of life. It presents short procedural time, can be performed with local anesthesia, and does not require perivenosa tumescence, as well as the use of elastic compression stockings after the procedure. This new technique proved to be safe and effective and could be an alternative method to intravenous thermoablation. However, other long-term studies of the method are necessary, especially to evaluate success rates in patients with large saphenous vein diameters.