Endovenous cyanoacrylate ablation for chronic venous insufficiency and varicose veins among Asians

INTRODUCTION@#Endovenous cyanoacrylate glue (CAG) ablation for the treatment of chronic venous insufficiency (CVI) and varicose veins has shown non-inferior outcomes with an excellent safety profile, high patient satisfaction rate, and excellent efficacy when compared to the gold standard of endothermal ablation. A review of the current literature for CAG use in CVI showed that most studies and longer-term data are from Caucasian-based populations, which are subject to different anatomical venous variations and socio-economical contexts. This review aimed to gather the current evidence for CAG use in Asian CVI patients.@*METHODS@#Asian studies for the use of CAG in CVI were included in this review. Successful ablation rates, quality of life improvement and novel complications such as glue hypersensitivity reactions are described, along with anatomical descriptions of superficial venous anatomy in study patients. Use of CAG in Singapore and Asia was addressed.@*RESULTS@#CAG has been gaining traction as an option for CVI treatment in Asians. In Singapore, it has been adopted with comparable low complication rates and significant improvement of quality of life after treatment. As we increase our understanding of the variations in venous anatomy in the Asian population, new techniques such as retrograde deployment of the device and use of CAG ablation for venous leg ulcers have been developed.@*CONCLUSION@#Further robust evidence in terms of large randomised control trials along with cost effectiveness studies are needed to determine the true value of CAG ablation in the Asian setting.

An improved in vivo method for atrioventricular node ablation via thoracotomy

The atrioventricular (AV) node is permanently damaged in approximately 3 percent of congenital heart surgery operations, requiring implantation of a permanent pacemaker. Improvements in pacemaker design and in alternative treatment modalities require an effective in vivo model of complete heart block (CHB) before testing can be performed in humans. Such a model should enable accurate, reliable, and detectable induction of the surgical pathology. Through our laboratory’s efforts in developing a tissue engineering therapy for CHB, we describe here an improved in vivo model for inducing chronic AV block. The method employs a right thoracotomy in the adult rabbit, from which the right atrial appendage may be retracted to expose an access channel for the AV node. A novel injection device was designed, which both physically restricts needle depth and provides electrical information via electrocardiogram interface. This combination of features provides real-time guidance to the researcher for confirming contact with the AV node, and documents its ablation upon formalin injection. While all animals tested could be induced to acute AV block, those with ECG guidance were more likely to maintain chronic heart block >12 h. Our model enables the researcher to reproduce both CHB and the associated peripheral fibrosis that would be present in an open congenital heart surgery, and which would inevitably impact the design and utility of a tissue engineered AV node replacement.