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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018
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AFRICA
patients. The results of our administration are similar.
Inflammation is activated when an organism is triggered by
stimulants. An acute inflammatory reaction is characterised by
neutrophil predominance in the region of the event.
17
Neutrophil
and leukocyte counts in the blood are increased during acute
inflammation. No statistically significant changes were detected
between pre- and postoperative counts of either WBC or
neutrophils in our study. Acute inflammation in the endovenous
administration of NBCA was therefore most likely localised
in the vein wall and surrounding tissues. There are reports
in the literature demonstrating that NBCA causes a local
inflammation,
10,12
but there are no studies that have evaluated the
systemic response.
The acute-phase response includes endocrinological,
neurological and immunological events.
18
Proteins, whose levels
increase or decrease during this period, are called acute-phase
proteins or acute-phase reactants.
19
Change in the levels of
acute-phase proteins demonstrate the presence and severity of
inflammation.
20
Cytokines are released as a response to stress by inflammatory
cells such as neutrophils and macrophages. Interleukine-6,
interleukine-1 and tumour necrosis factor-
α
induce CRP
secretion from the hepatocytes.
21
CRP has a pro- and anti-
inflammatory effect. Its pro-inflammatory effects result in the
activation of the complement system and the induction of tissue
factor and inflammatory cytokines from the monocytes, but its
most important role is its anti-inflammatory effect.
22
Erythrocyte sedimentation rate (ESR) is a frequently used
test for the evaluation of acute-phase response.
23
ESR increases
from the start of the inflammation and resolution may take up
to a month.
24
In our study, no statistically significant change was
seen in the CRP level and sedimentation rate between the pre-
and post-procedure states of endovenous NBCA use. Changes
in sedimentation rate from the pre- to the postoperative values
by gender were statistically significant in the male patients
(
p
<
0.05); however they were within the normal range, and
postoperatively showed a decreasing trend. CRP levels were
similar between the pre- and post-procedural states by gender
and in the overall group of patients. Since there was no change
demonstrated in the CRP level and sedimentation rate, and in the
neutrophil and WBC counts, it can be concluded that NBCA did
not cause an acute systemic inflammatory response.
Sensitivity has been detected in patients when NBCA was
used to repair skin wounds, and also in individuals who
were occupationally exposed to CA.
25
In a study by Quinn
et al
., eosinophilic inflammation was detected at a rate of
approximately 2% following NBCA use in the closure of
intracranial arteriovenous malformations. The authors reported
that no history of sensitivity against or exposure to CA was
previously detected in those patients.
25
When our patients was
evaluated, no statistically significant changes in the pre- and
postoperative eosinophil and basophil counts were found. From
these results, we concluded that NBCA caused no allergic
reaction in this patient group.
Conclusion
The greatest advantage of the endovenous medical ablation
method using NBCA is that tumescent anaesthesia and thermal
energy are not necessary. In addition, since it causes no systemic
allergic or acute inflammatory reaction, it appears safe to use.
However, we suggest that evaluations should be performed in a
larger group of patients to confirm the results.
Referances
1.
Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiol-
ogy of chronic venous insufficiency and varicose veins.
Ann Epidemiol
2005;
15
: 175–184.
2.
Chiesa R, Marone EM, Limoni C,
et al
. Chronic venous insufficiency
in Italy: the 24-cities cohort study.
Eur J Vasc Endovasc Surg
2005;
30
:
422–429.
3.
Perrin MR, Guex JJ, Ruckley CV, dePalma RF, Royle JP, Eklof B,
et al
.
Recurrent varies after surgery (REVAS), a consensus document. REVAS
group.
Cardiovasc Surg
2000;
8
: 233–245.
4.
Van den Bos R, Arends L, Kockaert M, Neumann M, Nijsten T.
Endovenous therapies of lower extremity varicosities: a meta-analysis.
J
Vasc Surg
2009;
49
: 230–239.
5.
Witte ME, Reijnen MM, de Vries JP, Zeebregts CJ. Mechanochemical
endovenous occlusion of varicose veins using the ClariVein
®
device.
Surg
Technol Int
2015;
26
: 210–225.
6.
Rassmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B.
Randomized clinical trial comparing endovenous laser ablation, radio-
frequency ablation, foam sclerotherapy and surgical sripping for great
saphenous varicose veins.
Br J Surg
2011;
98
: 1079–1087.
7.
Ameida JI, Kaufmann J, Gockeritz O, Chopra P, Evans MT, Hoheim
DF,
et al
. Radiofrequency Endovenous Closure FAST Versus laser abla-
tion for the treatment of great saphenous vein Reflux: a multicenter,
single-blinded, randomized study (RECOVERY study).
J Vasc Interv
Radiol
2009;
20
: 752–759.
8.
Coover HW. Discovery of superglue shows power of pursuing the
unexplained. Research Technology Management. 1 September 2000.
See
http://www.allbusiness. com/medicine-health/medical-treatments-
procedures/ 10616945-1.html (last checked 14 May 2010).
9.
Akahoshi T, Hashizume M, Shimabukuro R,
et al
. Long-term results of
endoscopic histoacryl injection sclerotherapy for gastric variceal bleed-
ing: a 10-year experience.
Surgery
2002;
131
: 176–781.
10. Min RJ, Almeida JI, McLean DJ, Madsen M, Raabe R. Novel vein
closure procedure using a proprietary cyanoacrylate adhesive: 30-day
swine model results.
Phlebology
2012;
27
: 398–403.
11. Bootun R, Lane TR, Davies AH. The advent of non-thermal, non-
tumescent techniques for treatment of varicouse veins.
Phebology
2016;
31
(1): 5–14.
12. Levrier O, Mekkaoui C, Rolland PH, Murphy K, Cabrol P, Moulin G,
et al
. Efficacy and low vascular toxicity of embolization with radical
versus anionic polimerizaytion of N-butly-2-cyanoacriylate (NBCA) :an
experimental study in the swine.
J Neuroradiol
2003;
30
: 95–102.
13. Chan YC, Ting AC, Yiu WK, Cheng SW. Cyanoacrylate superglue to
treat varicose veins: truly office based and minimally invasive?
Eur J
Vasc Endovasc Surg
2013;
45
: 176–177.
14. Pollack JS, White RI. The use of cyanoacrylate adhesive in peripheral
embolization.
J Vasc Interv Radiol
2001;
12
: 908–913.
15. Almeida JI, Min RJ, Raabe R, McLean DJ, Madsen M. Cyanoacrylate
adhesive for the closure of truncal veins: 60-day swine model results.
Vasc Endovascular Surg
2011;
45
: 631–635.
16. Kailasnath P, Chaloupka JC. Quantitative assessment of polymeriza-
tion-binding mechanics of cyanoacrylates: model development and
validation.
Am J Nueroradiol
2002;
23
: 772–778.
17. Anderson JM, Rodriguez A, Chang DT. Foreing body reaction to
biomaterials.
Semin Immunol
2008;
20
: 86–100.