Hamit Serdar BASBUG, Kanat OZISIK A novel application of Cyanoacrylate adhesive: Ultrasound-guided percutaneous perforator sealing Hamit Serdar BASBUG, Kanat OZISIK Department of Cardiovascular Surgery, Kafkas University Faculty of Medicine, Kars, Turkey Endovenous delivery of the Cyanoacrylate adhesive has been used as a new procedure for the treatment of venous insufficiency.(1) It is a non- ablative technique and it was accepted as an implantable medical device in the United States for the treatment of arteriovenous malformations and intracranial aneurysms.(2) In this article, we present a novel usage of the cyanoacrylate glue in the incompetent perforating veins of the lower extremity. A 38-year-old woman admitted to our outpatient clinic with the complaints of edema and itching on her left leg. Color Doppler ultrasound (DUS) revealed an insufficiency in the posterotibial perforator (Cockett-2) of the affected limb (Figure 1). The great saphenous vein and the small saphenous veins were totally normal. The Cockett-2 perforator was punctured percutaneously under the DUS guidance, and the cyanoacrylate glue was injected (Figure 2). After five minutes of external compression over the vein, the DUS images demonstrated the collapsed perforator with no color inside (Figure 3). Figure 1. Ultrasound image is showing the dilated Cockett-2 perforating vein (A). Color Doppler ultrasound image is showing the Cockett-2 perforating vein with a massive insufficiency (B). Perforating veins of the lower extremities can entirely be responsible for the chronic venous insufficiency symptoms and the leg ulcers in the absence of an axial vein insufficiency. The medical treatment, subfascial endoscopic ligation, percutaneous thermal ablation, and the DUS-assisted ligation with mini incisions are the preferred methods for the current perforating vein treatment.(3) We suggest the DUS-guided cyanoacrylate injection as a new alternative modality for the treatment of the perforating vein insufficiency. Figure 3. Perforator vein was filled with cyanoacrylate glue and coding no color inside the vein with Doppler ultrasound examination Figure 2. Ultrasound guided percutaneous perforator access. References 1. Almeida JI, Javier JJ, Mackay E, Bautista C, Proebstle TM. First human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. J Vasc Surg: Venous and Lym Dis 2013;1(2):174-80. 2. Linfante I, Wakhloo AK. Brain aneurysms and arteriovenous malformations: advancements and emerging treatments in endovascular embolization. Stroke 2007;38(4):1411-7. 3. Basbug HS, Bitargil M, Babaroğlu S, Günerhan Y, Göçer H, Özışık K. Is color Doppler ultrasound-assisted perforating vein ligation with a mini-incision still a viable alternative? Turk Gogus Kalp Dama 2015;23(3):493-8.