Dr. Polyvios Pavlidis
Consultant – Vascular Surgeon
Varicose vein affect 20-30% of adults. They are a sign of underlying venous insufficiency, which means that the valves in the veins no longer work properly, causing abnormally high pressure in the veins. Most people with varicose have no symptoms, but varicose veins may cause aching, heaviness, throbbing, and itching in legs to skin discoloration, eczema, and ulceration.
Many people with varicose veins do not get any symptoms or need treatment on medical grounds, but treating varicose veins can relieve troublesome symptoms, as well as improving the appearance of your legs. Treatment is important for eczema or skin discoloration that may otherwise lead to ulcers, and treating the veins is essential if ulcers or bleeding have occurred.
Treatment options include endothermal ablation (laser or radiofrequency), ultrasound guided foam sclerotherapy, and surgery (usually stripping and phlebectomies). Exeter medical also offers varicose vein treatment using cyanoacrylate glue, which has advantages over the other treatments (less injections, less painful, less need for compression) when used in properly selected cases. Cyanoacrylate glue treatment is now recommended by NICE as standard method of treatment for varicose veins (NICE IPG 670 March 2020).
What is Cyanoacrylate (bioadhesive) Glue Treatment?
Cyanoacrylate glue – a special type of “superglue” – is used to seal off the main veins with incompetent valves, which need to be dealt with when treating varicose veins- usually the long (great) saphenous vein on the inner side of the leg. Cyanoacrylate glue does the same job as closing veins by endothermal ablation (laser or radiofrequency treatments), which seal the vein off by intense heat) or stripping” in a surgical operation.
What are the advantages of glue treatment?
- Having glue treatment is similar to endothermal ablation (laser, radiofrequency) but there is no need for multiple injection of anaesthetic fluid which are required for laser or radiofrequency to prevent heat damage to surrounding tissues, and pain.
- No compression bandaging stockings are required over veins that have been glue, unlike after other kinds of treatment, when bandages and/or stocking are commonly advised for several days. Just 24 hours of compression is removed through tiny incisions (phlebectomies) at the time of glue treatment.
- Glue may avoid the minor discomfort that can occur after endothermal treatments like laser and it cause less bruising that surgical stripping.
What are the current uncertain less about glue treatment?
Cyanoacrylate glue treatment is still quite new and is the subject of NICE guidance (IPG526 – June 2015) which points out that it is possible that there are rare or uncommon risks which have not yet been recognized. The NICE guidance acknowledges the potential advantages of glue treatment. It makes some recommendations about who should be using this treatment. NICE is reviewing this guidance (2019) now that much more evidence has been published supporting the longer-term effectiveness of cyanoacrylate glue treatment.
What happens at the time of glue treatment?
An injection of local anesthetic is given to freeze the skin near the knee. Once skin is numb a needle is inserted into a vein and then fine catheter is passed up the main vein to the groin. The glue is injected as the catheter is slowly withdrawn pressure is applied to be sure that the walls of the vein are glued firmly together. All this is done using ultrasound pictures of the veins for guidance.
You can get up and walk about normally as soon as the procedure has finished and get back to normal activities without any special precautions. You may feel some discomfort in your thigh, and you will probably be bruised where varicose veins have been removed
surgically by phlebectomies, but you can still get active as quickly as you feel able. You will need to avoid getting the adhesive strips on phlebectomy strips wounds wet -no shower for the first few days. Please see advice to people having this treatment for more details.
Do varicose veins need to be removed surgically at the time of glue treatment?
When treating varicose veins by cyanoacrylate glue ablation, or by endothermal ablation (laser or radiofrequency) it is common practice to remove obvious varicose veins through tiny incisions (phlebectomies) under local anaesthetic at the same time. This may cause some bruising and lumpiness. It is possible that varicose veins of small size and limited extent may go away after glue treatment, but for a predictable and really thorough result, it is better to remove and to ligate them surgically at the same procedure.