Adjunctive procedure utilization and cost comparison of cyanoacrylate versus endothermal ablation for saphenous vein reflux

Background: The study compared adjunctive procedures in limbs with saphenous reflux treated by endothermal ablation (ETA) or cyanoacrylate closure (CAC). Secondary outcomes included adverse events (AEs), unscheduled care, and treatment costs. Methods: We retrospectively reviewed 654 limbs (327 CAC, 327 ETA). Demographics, Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) classification, revised Venous Clinical Severity Score (rVCSS), adjunctive procedures, and AEs within 6 months were recorded. Costs included index and adjunctive procedures, unscheduled visits, and imaging; all costs are reported in US dollars. Results: Concurrent adjunctive procedures were more frequent in ETA than CAC (phlebectomy 48% vs 6%; sclerotherapy 40% vs 7%, both p < 0.001). The need for staged procedures did not differ, and rVCSS improvement was comparable (ETA 5.0 ± 2.2 vs CAC 4.8 ± 2.3, p = 0.4). ETA patients had more unscheduled visits (9% vs 3%, p = 0.006) and ultrasounds (7% vs 2%, p = 0.007). Initial CAC treatment costs were higher ($2479 ± 617 vs $2332 ± 449, p = 0.001). Overall costs were higher for CAC (+$210, 95% CI: $104-317, p <0.001). In ETA, AEs increased costs ($2520 vs $2354, p = 0.008), AE-related costs with CAC were not significantly different ($2571 vs $2496, p = 0.298). Conclusions: ETA was associated with more adjunctive procedures and unscheduled care. CAC achieved similar clinical improvement with fewer concurrent procedures and unplanned follow up. Although total expenditures converged, CAC had higher upfront charges, whereas ETA accrued more downstream costs related to adjunctive treatment and AEs. (ClinicalTrials.gov Identifier: NCT04006184)