Varicose Vein Cyanoacrylate Glue treatment
Varicose veins 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 veins have no symptoms, but varicose veins may cause aching, heaviness, throbbing, and itching in the legs. For some people, chronic venous insufficiency can lead 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 discolouration 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 a standard method of treatment for varicose veins (NICE IPG 670 March 2020).
What is Cyanoacrylate Glue Treatment?
Cyanoacrylate glue – a special type of “superglue” – is used to seal off the main incompetent 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 the multiple injections of anaesthetic fluid which are required for laser or radiofrequency to prevent heat damage to surrounding tissues, and pain.
- Glue may avoid the minor discomfort that can occur after endothermal treatments like laser and it causes less bruising than surgical stripping.
- No compression bandaging or stockings are required over veins that have been glued, unlike after other kinds of treatment, when bandages and/or stockings are commonly advised for several days. Just 24 hours of compression is used to minimise bruising when veins are removed through tiny incisions (phlebectomies) at the time of glue treatment.
- Glue may occasionally avoid the need to remove varicose veins through tiny incisions (phlebectomies) but these are usually needed, to get rid of all the varicose veins predictably, at a single procedure.
What happens at the time of glue treatment?
An injection of local anaesthetic is given to freeze the skin near the knee or the ankle. Once the skin is numb a needle is inserted into a vein and then a 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 if varicose veins have been removed surgically then you will have some bandaging and may feel bruised, but you can still get active as quickly as you feel able. You will need to avoid getting the adhesive strips on phlebectomy wounds wet – no showers for the first few days. Please see advice to people having glue 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/ligate them surgically at the same procedure.
What are the current uncertainties 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 recognised. 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 about cost?
The cost of glue treatment is similar to laser treatment of varicose veins. A scan is required before treatment to be sure that veins are suitable: The costs are:
For one leg – Procedure under local anaesthetic £2,650 + £130 for scan (total £2,780)
For both legs – Procedure under local anaesthetic £3,900 + £195 for scan (total £4,095)
These procedures are usually done under local anaesthetic. If you would like to have sedation (given by an anaesthetist, to make you sleepy) then there is an additional charge of £375 for one leg and £475 for both legs.
For a copy of this information in print form, please download it here.
For further advice
For advice for those that are going to undergo this treatment, click here.
Professor Bruce Campbell is one of the UK’s best known vein experts. He specialises in microsclerotherapy treatment for thread veins as well as varicose vein treatments. He has been a leader of major research studies on varicose vein treatments and how patients benefit from them. He is particularly recognised for giving people good information and informed choice. He has been a vascular consultant at the Royal Devon and Exeter Hospital since 1986.