Outcomes of cyanoacrylate-assisted venous closure compared with thermal ablation in chronic venous ulcers

Objective: To compare the outcomes of venous closure using cyanoacrylate glue (VenaSeal, Medtronic) vs thermal ablation techniques (radiofrequency ablation and endovenous laser therapy) for venous ulcer healing in patients with Clinical, Etiological, Anatomical, Pathophysiological (CEAP) class 6 chronic venous insufficiency. Methods: We retrospectively reviewed 84 limbs in 74 CEAP class 6 patients treated for active venous leg ulcers by a single vascular surgeon at a single tertiary care center between 2012 and 2022. Patients underwent either thermal ablation (29 limbs) or cyanoacrylate closure with VenaSeal (55 limbs) after ≥3 months of conservative therapy and duplex-confirmed superficial reflux. The primary outcome was ulcer healing; secondary outcomes included time to healing, length of follow-up, treatment of multiple venous segments, ulcer recurrence, and postprocedural complications. Results: Patients in the VenaSeal group were older (66.6 ± 16.0 years vs 57.2 ± 13.5 years; P = .006), with similar ulcer duration, prior interventions, and history of deep vein thrombosis. VenaSeal was more frequently used to treat distal venous targets and was associated with a markedly higher rate of multisegment treatment (94.5% vs 17.2%; all P < .05). Ulcers healed in 69% of limbs in the VenaSeal group vs 34.5% in the thermal group (P = .002), with comparable time to healing among healed ulcers (4.8 months vs 4.4 months; P = .87) despite a longer follow-up in the VenaSeal group (19.6 months vs 12.8 months; P = .052). Ulcer recurrence occurred in 45% of healed ulcers in the VenaSeal group and in 0% in the thermal group (P < .05); all recurrences were managed nonoperatively with compression and wound care. Postprocedural deep vein thrombosis was rare (1 thermal limb vs 0 VenaSeal limbs; P = .35), and overall complications were infrequent and similar between groups (10.3% vs 5.5%; P = .41), including wound infection, hospital readmission, and one unrelated late death in the thermal group. Conclusions: In patients with CEAP class 6 chronic venous insufficiency, cyanoacrylate closure with VenaSeal was associated with a higher ulcer healing rate compared with thermal ablation. VenaSeal appears to be a safe and effective nonthermal option that facilitates the treatment of multiple venous segments in the management of chronic venous ulcers.