Cyanoacrylate adhesive closure for varicose veins: An Indian expert consensus using a modified Delphi method

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Medical Device Technology

Background:

• Saphenous reflux is a primary cause of symptomatic varicose veins.
• Traditional thermal ablation methods carry risks of discomfort and bruising.
• Cyanoacrylate adhesive closure (CAC) presents a non-thermal, non-tumescent alternative.

Purpose of the Study:

• To establish an evidence-based expert consensus on the application of CAC for varicose vein management in India.
• To standardize procedural guidelines and patient selection criteria for CAC.
• To define the role of CAC across various clinical presentations of venous insufficiency.

Main Methods:

• A modified Delphi consensus process involving 12 experienced Indian interventional radiologists.
• Anonymized voting and iterative discussions to achieve consensus (≥80% agreement).
• Development of 29 consensus statements covering procedural aspects and patient management.

Main Results:

• Unanimous consensus (100% agreement) achieved on 29 statements.
• CAC is recommended for clinical-etiological-anatomical-pathophysiological classes C2-C6 and saphenous veins 4-20 mm in diameter.
• Outpatient, non-tumescent procedure with reduced discomfort and bruising compared to thermal ablation.

Conclusions:

• CAC is a safe and effective outpatient treatment for saphenous reflux.
• Standardized procedural algorithm and patient selection criteria enhance CAC application.
• Recommendations include encouraging early ambulation and structured follow-up, with specific guidance on managing complications.