Advice for people having glue treatment
These notes are intended as a guide to exactly what happens and what to expect after treatment.
Getting ready for glue treatment
There is no need to avoid eating or drinking before glue treatment because it is done under local anaesthetic. It is a good idea to wear loose fitting clothing and comfortable shoes.
You should be able to walk about normally after treatment, but it is a advisable to arrange for somebody to drive you home, especially if you are having phlebectomies (removal of varicose veins through tiny incisions). If you are having sedation then you should definitely not drive yourself home.
We will check your records and scans, and will ask you to sign a consent form. All the normal safety checks will be done, just as if you were having a bigger operation. If you are having phlebectomies your varicose veins will be marked carefully.
The procedure itself
An injection of local anaesthetic is given to freeze the skin near the knee. Once the skin is numb a needle is inserted into a vein: all this is done using ultrasound pictures of the veins for guidance.
A guide wire is then passed up the incompetent vein to the groin, followed by a catheter, which is positioned carefully near the top of the vein. You may feel something going up your leg but this is not usually painful. Another catheter is prepared, containing the glue, and this is passed up through the first one. Pressure is then applied in the groin and injections of glue are given: a full three minutes of pressure are needed after the first injection, to ensure that the top part of the vein has been sealed off.
The catheter is then withdrawn, 3cm at a time, giving injections (0.1 ml glue) to each 3cm length of vein. After each injection pressure is applied for 30 seconds. Injecting a long (great) saphenous vein from the groin to below the knee typically takes about 15-20 minutes in total. You should not feel the glue injections – but you will feel the pressure which is applied to be sure that the glue works properly. If other main veins are incompetent and need to be treated, then the gluing process is repeated for those. Scanning is then done to be sure the vein is properly sealed off.
If you are having phlebectomies (removal of obvious varicose veins) this is done through tiny incisions after injecting local anaesthetic all around them. The incisions are closed with adhesive strips.
There is no need for any compression by bandaging or a stocking (unlike other varicose vein treatments) over the vein which has been glued, but a bandage is applied over the part of the leg where phlebectomies have been done for just 24 hours, to minimise any bruising.
After the procedure
An immediate walk
Immediately following the procedure, once you have dressed, you should go for a 10 minute walk in or around the Exeter Medical building. This minimises the remote chance of DVT (deep vein thrombosis) and ensures that you are safely mobile before you leave the vicinity of Exeter Medical.
Leaving Exeter Medical
You can leave Exeter Medical as soon as you feel ready to do so. It is generally a good idea to go for your ten minute walk either within the building or nearby and then perhaps to have a cup of tea or coffee before going home. Please let the Reception staff know that you leaving.
Any oozing through the bandage will be of bloodstained local anaesthetic fluid, which can sometimes escape through one or other of the little incisions. Any bleeding will not be serious. Some further bandaging can be applied before you leave, if necessary.
Get back to normal as quickly as you can. Once you are home, aim to get back to all your normal activities just as soon as you are able.
You can walk as much as you want, as soon as you want. Frequent walking is a good idea in the days after a varicose vein procedure. There is no special advantage in going for a single long walk during the day, although you may walk as far as you wish. Frequent walking is more important than walking a long distance.
You can return to work the following day. If you have had phlebectomies for large or extensive varicose veins and you do a physically active job or spend long days on your feet then it is sensible to arrange two or three days off work, in case you are tender or bruised.
You can return to sporting activity as soon after treatment as you feel sufficiently comfortable. Do not go swimming for two weeks after phlebectomies, to be sure that the little wounds are well healed.
You can drive as soon as you feel confident that you can make an emergency stop safely. It is probably best you not to drive yourself home following glue treatment, but other than that you can drive as soon as you feel able.
Bathing and showering
If you have had plebectomies to remove varicose veins, then it is a good idea to keep the adhesive strips over the wounds dry for ten days. A shower may be possible before this by covering your leg with a big plastic bag or (better) a protector such a Limbo (Thesis Technology, Chichester OP18 8AT or on prescription). After ten days, soak the adhesive strips off in a shower or bath, and thereafter shower or bath normally.
The risk of DVT during long air flights or other long journeys in cramped seating is very low, but the normal advice is to avoid air travel for a month before or after any varicose vein treatment. Short flights may be reasonable: this is a matter for discussion.
Aches, twinges, and areas of tenderness are quite common. These will settle down, and should not discourage you from becoming fully active as soon as you are able.
Numbness or tingling
Areas of numbness or tingling in the skin can occasionally occur at the places where varicose veins were removed or rarely where they have been glued. This is because small nerves to the skin have been damaged. The numbness usually recovers over a period of months, but occasionally a patch of numbness may persist.
Thread veins and discolouration
Any varicose vein treatment can occasionally be followed by the appearance of tiny red or blue veins in the areas where veins were, but this is rare. Brownish discoloration can also occur: usually this fades but it may take many months to do so.
Superficial Vein Thrombosis (Phlebitis) and inflammation
The area over veins which have been glued can sometimes become red and tender. This usually settles within a few days. If you get pain or tenderness then take an anti-inflammatory painkiller (e.g. ibuprofen) and/or paracetamol. This is not an infection and does not need antibiotics.
Deep vein thrombosis (DVT)
DVT is known to be a risk after any kind of varicose vein treatment, but the risk after glue treatment is very low (less than 1%). If you are at special risk of DVT (e.g. you have had DVT before or you are on a contraceptive pill or HRT) we will discuss special preventative measures with you. An injection of heparin is often given at the end of procedures on both legs, to minimise the risk of DVT and may be advised for longer if you are at special risk.
Reactions to the glue
Allergic reactions are rare but can happen as a result of glue. The ones that have been described have consisted of skin reactions (like “hives”) but more serious allergy is a possibility. There has been a very small number of reports of glue causing inflammation and skin damage, or becoming infected, requiring it to be removed by a surgical operation; this appears to be very rare (less than 1 in 10,000 risk).
Some bruising and tender lumps under the skin are common. These appear during the first few days after treatment and will all go away over a period of weeks. Delayed healing, infection and discharge of lymph fluid can occur, but are rare. The possibilities of numbness and tingling, due to interference with tiny nerves, is described above.
Will varicose veins come back?
Some people develop new varicose veins over the years after any of the varicose vein treatments. Varicose veins may simply re-grow in the areas which have been dealt with, or they may develop in a different system of veins which was normal at the time of treatment. If veins develop again they can be treated.
Information updated 20th June 2019