Impact of a Modified Ultrasound-Guided Compression Protocol on Glue Migration in Endovenous Ablation Therapy: A Single-Centre, Prospective, Exploratory Pilot Comparative Cohort Study

Background/Objectives: Proximal glue migration toward the saphenofemoral junction (SFJ) and endovenous glue-induced thrombosis are recognised concerns during cyanoacrylate ablation. This exploratory pilot study compared standard and modified ultrasound-guided compression protocols. Methods: Thirty patients with incompetent great saphenous veins (GSVs) were allocated non-randomly, in two sequential cohorts, to a standard (n = 15) or modified (n = 15) protocol. The modified protocol added a “release-and-check” duplex assessment after the initial 3 min compression, a 1 min recompression, and an extra minute for veins > 5.5 mm. The primary outcome was glue migration distance from the compression level, measured immediately postoperatively. Clinical and thromboembolic outcomes were not systematically ascertained; follow-up was one week. Results: Baseline variables were comparable (standardised differences ≤ 0.31). Mean migration distance was lower with the modified protocol (0.80 ± 0.34 vs. 1.97 ± 0.51 cm; mean difference −1.17 cm, 95% CI −1.50 to −0.85; p < 0.0001), persisting after covariate adjustment. Residual stump length was greater (4.41 ± 0.34 vs. 2.49 ± 1.27 cm; p < 0.001), although this SFJ-referenced measure is confounded by the unrecorded compression distance. Deep venous extension occurred in 3/15 standard and 0/15 modified limbs (p = 0.22); all three were asymptomatic Cho grade III events, resolved at one week. Immediate migration was recorded in 7/15 versus 0/15 limbs (p = 0.006). Conclusions: In this small, non-randomised exploratory cohort, a “release-and-check” modification was associated with shorter immediate glue migration. These hypothesis-generating findings rest on an unblinded surrogate endpoint with one-week follow-up and do not establish clinical safety, effectiveness or durability; adequately powered randomised trials with blinded assessment and adjudicated endpoints are required.