Endovenous glue-induced thrombosis complications

We read with great interest the article by Cho et al,1Cho S. Gibson K. Lee S.H. Kim S.Y. Joh J.H. Incidence, classification, and risk factors of endovenous glue-induced thrombosis after cyanoacrylate closure of the incompetent saphenous vein.J Vasc Surg Venous Lymphat Disord. 2020; 8: 991-998Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar entitled, “Incidence, classification, and risk factors of endovenous glue-induced thrombosis after cyanoacrylate closure of the incompetent saphenous vein.” Glue ablation is a new and successful technique in treatment of superficial saphenous vein insufficiency, but also has some disadvantages.2Bademci M.Ş. Kocaaslan C. Aldag M. Yalvaç E.Ş.D. Oztekin A. Bulut N. et al.Single-center retrospective review of early outcomes of radiofrequency ablation versus cyanoacrylate ablation of isolated great saphenous vein insufficiency.J Vasc Surg Venous Lymphat Disord. 2019; 7: 480-485Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar Endovenous glue-induced thrombosis (EGIT), as reported in this study, is a little-known but potentially serious complication of lower extremity endovenous interventions in which glue is used. We have some questions and concerns regarding the study from Cho et al. EGIT is a phenomenon similar to endovenous heat-induced thrombosis (EHIT), wherein patients with early threadlike thrombus have extension across the saphenofemoral or saphenopopliteal junction.3Pillutla A. Hendrix M.P. Ha J. Endovenous glue-induced thrombosis in nonthermal glue closure therapy for greater saphenous vein insufficiency: a single-center experience.J Vasc Interv Radiol. 2019; 30: 1075-1080Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar In the study by Cho et al,1Cho S. Gibson K. Lee S.H. Kim S.Y. Joh J.H. Incidence, classification, and risk factors of endovenous glue-induced thrombosis after cyanoacrylate closure of the incompetent saphenous vein.J Vasc Surg Venous Lymphat Disord. 2020; 8: 991-998Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar EGIT developed in 11 patients (5.8%). EGIT grades I and II developed in seven (63.6%) and four (36.4%) patients, respectively. None of those patients were treated with systemic anticoagulant or antiplatelet therapy. Korepta et al4Korepta L.M. Watson J.J. Mansour M.A. Chambers C.M. Cuff R.F. Slaikeu J.D. et al.Outcomes of a single-center experience with classification and treatment of endothermal heat-induced thrombosis after endovenous ablation.J Vasc Surg Venous Lymphat Disord. 2017; 5: 332-338Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar reported the importance of antiplatelet therapy (325 mg acetylsalicylic acid) for EHIT grades I and II, and anticoagulant therapy for patients with grades III and IV EHIT to prevent thrombus propagation. The choice and duration of anticoagulant or antiaggregant therapy were left to the discretion of surgeon, as in the study. Did the authors perform manual ultrasound probe compression of the saphenofemoral junction during glue injection for the recommended time? This technique, with a longer compression time, can decrease the rate of this kind of complication. In the study, two patients had previous deep venous thrombosis history, as seen in Table II. How did the authors decide to perform this procedure for these patients? Did they evaluate the outflow venous segments (profunda femoral vein and iliac veins) preoperatively? Performing this intervention in cases with occluded venous outflow may cause significant adverse events. We congratulate Cho et al1Cho S. Gibson K. Lee S.H. Kim S.Y. Joh J.H. Incidence, classification, and risk factors of endovenous glue-induced thrombosis after cyanoacrylate closure of the incompetent saphenous vein.J Vasc Surg Venous Lymphat Disord. 2020; 8: 991-998Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar for this study and for highlighting this little-known complication of glue ablation in the treatment of incompetent saphenous vein. We would like to hear the authors' opinions on these matters. ReplyJournal of Vascular Surgery: Venous and Lymphatic DisordersVol. 8Issue 6PreviewWe appreciate Bayraktar et al for their comments and important questions regarding our article that was recently published in the Journal of Vascular Surgery: Venous and Lymphatic Disorders.1 Full-Text PDF