We read with great interest the article by Zhou et al1 recently published in the Journal of Vascular Surgery: Venous and Lymphatic Disorders and evaluating the safety and efficacy of coils plus glue vs coils plus sclerosant in treating pelvic venous disorders (PeVDs).
First, we would like to congratulate the authors for their study, which represents the first series to date showing increased efficacy and reduced complications with the use of glue as compared with sclerosants in such a setting.1 Various embolic materials can be used during endovascular treatment of PeVDs, the most common of which involve sclerosants and coils.2, 3, 4 Unfortunately, solid data supporting the superiority of one material over another are lacking. However, the promising results of this study may be attributed to the properties of cyanoacrylates and highlight the rationale of using them for occluding the pelvic reservoir, which has similarities with the nidus of an arteriovenous malformation.5, 6, 7 Indeed, the cyanoacrylate/ethiodized oil ratio affects the radiopacity and the viscosity of the mixture, as well as the glue polymerization time, helping to achieve a more visible and safer embolization of the pelvic varices and ovarian veins than that with sclerosants.8 It allows for a lower risk of lung migration and systemic complications than fluid sclerosants, as reported here. Furthermore, glue functions independently of the coagulation parameters, such that polymerization occurs immediately upon contact with blood, leading to fast, complete, and durable occlusion of large insufficient veins, with the potential to treat the small tributaries that are often associated and may cause pelvic pain recurrence.8 It is of utmost importance compared with sclerosants, whose maximum quantity that can be used is limited.9 The occlusion obtained with cyanoacrylates is then more efficient, avoiding the need for multiple coils, as shown here.
In conclusion, glue embolization seems to be a safer and better option than foam sclerosis for patients with PeVDs. It can be used to perform a more complete and durable embolization of pelvic varicosities, without the risk of the migration of embolic material. For these reasons, this is our first choice. Large studies are warranted to confirm these findings.
References
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