The Ultra-rapidly Acting Cyanoactylate Embolization Compared with Micro-Pulsed Laser ablation
12313Naoki Sakakibara , Tomohiro Imai , Kan Kajimoto , Hirokazu Akashi , Atsushi Amano
1Edogawa Hospital, 2Tokyo Vascular and Vein Clinic, 3Juntendo University school of Medicine, Tokyo, JapanEDOGAWA HOSPITALINTRODUCTIONMETHODSRESULTSThe ultra-rapidly acting n-butyl cyanoacrylate (uNBCA) has been introduced
as a new non-thermal and non-tumescent endovenous ablation modality.
The second generation of uNBCA kit (VariClose®) uses the radial delivery
catheter by dispersing uNBCA evenly at the same time.

Since June 2016, there have been 140 patients with incompetent varicose
veins who were treated with an endovenous embolization of uNBCA (n=70) or
EMPLA (n=70).
Tumescent anesthesia and compression stockings were only used in theEMPLA group.
The preprocedural, intraprocedural, postprocedural and follow-up data of thepatients were collected and restrospectively compared.

 The mean age was 63±11 in the uNBCA group and 68±10 in the EMPLAgroup.
 The average length of the veins treated were 32.4±10.7 cm and 27.0±9.8
cm respectively, while 472±147 mL of tumescent anesthesia was used onlyfor EMPLA.
 The average procedure times, including concomitant procedures, were27.3±10.8 and 32.6±11.2 minutes.
 uNBCA delivery was accomplished within 20 seconds during the target veinembolization, whereas it took much longer (258±89 seconds) in the EMPLAgroup.
 By the end of the treatment, all procedures were successfully occluded inboth groups, with the total occlusion rate being 96 % and 100 % at 6 and 12months.
 The venous clinical severity score improved significantly with no quantifiable
difference between groups.
 Postprocedural phlebitis was observed early on in 7 patients (10 %) only inthe uNBCA group. However it disappeared after prophylactic antiinflammatory medication. Those patients returned to normal daily life
immediately following the procedure.

The micro-pulsed YAG laser (1320nm, 100 microseconds pulse duration)
has also provided a more advanced thermal modality that allows for painless
ablation using a bare fiber.
The aim of this study is to retrospectively compare uNBCA based ablation
with endovenous micro-pulsed laser ablation (EMPLA).

TOKYO VASCULAR & VEIN CLINIC

Ultra-rapidly acting n-butyl cyanoacrylate (uNBCA)
using the radial delivery catheter

Longitudinal Ultrasound Image of uNBCA after 1 Week

Radially Sprinkling

JUNTENDO UNIVERSITY
1 WeekMicro-Pulsed YAG Laser: Basic concept
Photoacoustic transient

CONTACT
Naoki Sakakibara, MD, PhD
Edogawa Hpspital
Email: naokisk22418@gmail.com
Phone: +81-3-3673-1221

Advantages of EMPLA•••••Minimal heat accumulation in the blood
Minimal EHIT
Bare fiber provides the best result.
No postoperative pain without use of analgesics
No bruising after procedure

Chracteristics of uNBCA (VariClose®） Viscosity : More like water, harder after polymerization
 Catheter positioning: 3cm back from junction
 Pullback: Continuous pull back at 2cm/seconds
 Squeeze trigger: Every 5 seconds/10cm
 Amount of NBCA delivery: 0.03cc for each cm
 Worldwide total cases: 50,000 patients

Change of Cross Section US Image of uNBCA

Preop

1M

3M

CONCLUSIONSThe uNBCA is more likely to provide a faster and safer procedure thanEMPLA, without any risk of tumescent, thermal damage, or use ofcompression stockings .