Plymouth Veins

1.  Introduction

The Plymouth Vein Clinic is one of the first specialist vein centres in the South West to introduce this new "walk in, walk out" treatment for varicose veins. Venaseal® is a system that enables specially formulated Cyanoacrylate glue ("Superglue") to be delivered into the relevant veins by a catheter under ultrasound-guidance. The glue seals the vein walls together and the vein closes off. Initial studies have shown this to be a very safe and reliable non-thermal, non-tumescent treatment option.

 

2.  Procedure

The procedure using VenaSeal® requires insertion only of a thin catheter under local anaesthesia injected at the insertion site in the lower thigh or calf. Ultrasound scanning is used to place the catheter into the correct position. Precise delivery of very small quantities of glue are achieved with a special dispensing gun. Glue is then injected at intervals along the vein as the catheter is gradually withdrawn. This results in complete occlusion of the vein. The procedure takes about 25 minutes and is virtually painless. Most patients do not require any compression stockings afterwards and can literally walk out and continue with normal daily activities immediately.

 

3.  Potential advantages over endovenous thermal ablation

During endovenous radiofrequency or laser thermal ablations treatments, tumescent anaesthesia is used to protect the surrounding tissue against heat damage. This involves multiple injections of local anaesthetic plus saline fluid into the soft tissues surrounding the vein. If the entire procedure is performed under local anaesthetic, these multiple injections and the internal pressure within the leg caused by the high volume of saline injected can be quite uncomfortable. No tumescent anaesthetic is required with VenaSeal, and hence there are no multiple injections and the procedure is far less painful especially if both legs are treated in one sitting. This is a potential advantage of VenaSeal® over thermal ablation catheter techniques. There is less bruising and less risk of heat-induced nerve or soft tissue injury. Another major advantage of VenaSeal is there is no necessity to wear any compression stockings after the procedure unlike with other techniques and rapid return to normal activities.

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4. Side effects and risks

Secondary treatment for residual varicose veins (e.g. sclerotherapy) is required in about one third of patients. Pain and redness at the site of treatment due to localised allergic reaction and / or phlebitis in 10-20% patients. More severe allergic reactions can occur in about 1% patients. Small risk of pigmentation and pins and needles. Rarely deep vein thrombosis and pulmonary embolism. 

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5.  Longer term outcome

VenaSeal® is a new technique so very long term follow up of patients is not yet available to compare the results with Laser or Radiofrequency over periods of longer than two years. Published data so far suggests that VenaSeal® is as durable as these techniques at 24 months after treatment with over 94% treated veins remaining closed. Further follow up of cases is needed to assess effectiveness in the longer term - this information will be published in the open medical literature as it is acquired. VenaSeal® is approved by NICE with special measures for consent, follow up and audit.