Three-year outcomes after cyanoacrylate closure of superficial truncal veins: A single-center practice cohort study

Objective To evaluate mid-term durability, clinical outcomes, and patient-reported outcomes after cyanoacrylate closure (CAC) of superficial truncal veins in routine practice, with limb- and vein-level analyses. Methods Single-center, retrospective cohort study of adults previously treated with CAC of the great saphenous vein (GSV), small saphenous vein (SSV), anterior saphenous vein (ASV), or posterior accessory saphenous vein (PASV), with standardized follow-up assessments. Eligible patients were invited for standardized follow-up including duplex ultrasound (DUS), CEAP class, revised Venous Clinical Severity Score (rVCSS), EuroQol 5-dimension survey (EQ-5D), and Aberdeen Varicose Vein Questionnaire (AVVQ). The primary endpoint was complete closure of the primary target vein (PTV) on DUS, defined as no ≥5-cm contiguous patency within the treated segment. Secondary endpoints included vein-level patency, new clinically significant varicose veins, adverse events (AEs), and satisfaction with symptoms and cosmetic appearance. Analyses accounted for clustering of veins/limbs within patients using generalized estimating equations. Results The study enrolled 89 patients (76.4% female; median age 53 years) representing 110 limbs and 156 treated veins. Median time from treatment to follow-up was 3.7 years. PTV complete closure at the limb level was 97.3% (107/110; 95% CI, 91.9–99.1). At follow-up, patency in any treated vein was present in 10.9% of limbs and 7.7% of veins. At follow-up, rVCSS decreased from 6 [IQR 4–8] to 1 [0–2] (mean change −4.5±2.5; p<.001) and AVVQ scores improved among the subset with paired data (mean change −7.7±8.9; p<.001). New clinically significant varicose veins were present in 19.1% of limbs (95% CI, 12.7–27.8), often involving the ASV . Higher baseline body mass index (BMI) was associated with vein-level patency on univariable analysis (median 33 vs 24 kg/m 2 ; p<.001) and remained an independent predictor in exploratory multivariable models. Patient satisfaction per limb was 97% (completely/somewhat satisfied) but was significantly lower when any treated vein remained patent (completely satisfied 41.7%; p<.001). Limb-level AEs occurred in 20.0% (95% CI, 12.9–29.7%), with localized tenderness/phlebitis most commonly encountered; no deep venous events were observed. Conclusion Complete closure rates of all treated veins with CAC remain high at a median of 3.7 years post treatment with sustained clinical and patient-reported outcome improvements. Incomplete closure and recurrent varicose veins correlate with worse symptoms, visual appearance and patient satisfaction.