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Updated: Jun 24, 2026
Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane
Published on: December 9, 2022
Management of recanalization after cyanoacrylate closure: A single-center experience
Takaya Murayama1, Kazuyo Sujino1, Mitsumi Yamashita1
1Kannai Medical Clinic, Yokohama, Japan.
Insights
Recanalization after cyanoacrylate closure (CAC) for varicose veins shows varied patterns. Ultrasound-guided foam sclerotherapy (UGFS) achieved an 80% success rate, suggesting it as a potential first-line treatment. Radiofrequency ablation (RFA) also showed favorable outcomes without complications.
Area of Science:
- Vascular Surgery
- Minimally Invasive Procedures
- Medical Device Technology
Background:
- Cyanoacrylate closure (CAC) is a standard treatment for lower extremity varicose veins.
- Recanalization, though uncommon, presents management challenges.
- Optimal secondary treatment strategies for CAC recanalization require investigation.
Purpose of the Study:
- To retrospectively analyze cases of CAC recanalization.
- To evaluate the effectiveness of secondary treatments: UGFS, EVLA, and RFA.
- To explore the interaction between treatment modalities and polymerized cyanoacrylate (CA).
Main Methods:
- Retrospective review of 335 patients undergoing CAC procedures.
- Analysis of 23 recanalization cases defined by ultrasound criteria.
- Assessment of treatment outcomes for UGFS, EVLA, and RFA.
- Ex vivo experiment on CA interaction with laser ablation, RFA, and polidocanol.
Main Results:
- Recanalization patterns were often discontinuous and irregular.
- UGFS achieved 80% successful occlusion in 15 cases.
- EVLA and RFA were technically feasible; RFA showed no CA deformation, unlike EVLA.
- Ex vivo tests indicated laser ablation caused CA deformation/carbonization, while RFA did not.
Conclusions:
- Recanalization after CAC is heterogeneous.
- UGFS is an effective first-line treatment for CAC recanalization.
- EVLA and RFA are feasible secondary options; RFA may avoid CA-related complications.
- Further clinical validation is needed for laser ablation's interaction with CA.
Objective:
Cyanoacrylate closure (CAC) is an established treatment for lower-extremity varicose veins. Recanalization after CAC is an uncommon but clinically relevant event for which optimal management strategies have not been well described. The objective of this study was to retrospectively review cases of CAC recanalization at a single center and to descriptively evaluate the secondary treatment approaches, including ultrasound-guided foam sclerotherapy (UGFS), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA).
Methods:
We retrospectively reviewed 335 patients who underwent CAC procedures at Kannai Medical Clinic between August 2020 and November 2025. Recanalization was defined as partial or complete restoration of luminal flow within the treated vein segment on duplex ultrasound during follow-up. The detailed definition of recanalization is as follows: reflux flow of 0.5 seconds or more, being compressible, a segment length of 5 cm or more, and symptomatic cases. Twenty-three cases with recanalization were identified and analyzed. Treatment outcomes following UGFS, 1470 nm EVLA, or RFA were assessed. In addition, as a supplement, a preliminary ex vivo experiment was conducted to observe the effects of laser ablation, RFA, and polidocanol on cyanoacrylate (CA) polymerized with blood.
Results:
Among the 23 recanalization cases, recanalization patterns were frequently discontinuous and irregular. UGFS was performed in 15 cases, and recanalization was successfully occluded in 12 cases (80%). EVLA was performed in 2 cases; one required multiple direct punctures because of complex recanalization, and recanalization was successfully occluded in both cases. However, deformation of CA was observed by ultrasound during laser ablation. RFA was performed in 7 cases using multiple direct punctures with a 12G needle with a plastic cannula; all procedures were completed without CA deformation and with favorable occlusion. In the ex vivo experiment, laser ablation caused CA deformation and carbonization, and temperature measurement reached 193 to 200 °C during ablation in CA, whereas RFA produced no structural changes with 80 to 93 °C temperature. Polidocanol had no observable effect on CA.
Conclusions:
Recanalization after CAC demonstrates heterogeneous and often discontinuous patterns. UGFS achieved successful occlusion at an 80% success rate. UGFS may be an effective first-line treatment in many cases. EVLA and RFA were technically feasible in selected cases, without observed complications. Laser ablation may have unique interactions with polymerized CA, as suggested by preliminary experimental observations. However, these observations are exploratory and require further clinical validation. Careful consideration is warranted when selecting secondary treatment modalities for CAC recanalization.
