Vein 'Glue' or Medical Adhesives Closure

Venaseal® and Venablock® are two new N- butyl cyanoacrylate glue products which have now been approved for use in Australia for the treatment of varicose veins. Cyanoacrylate has been widely used for nearly 40 years for the treatment of various medical conditions such as vascular malformations and arterial conditions. Millions of patients have been treated with cyanoacrylate and there has been no record of increased carcinogenicity.

The use of cyanoacrylate in the treatment of varicose veins has now become established following initial trials which started about ten years ago. There are now several peer reviewed randomized controlled studies in the scientific literature which now support the use of glue in terms of safety and efficacy.(1) (2)(3)(4)

Glue is inserted through a small catheter which is passed up inside a refluxing saphenous vein which is responsible for causing the varicose veins lower down the leg.  As the catheter is withdrawn the glue is injected inside the vein. The vein is immediately sealed due to adhesion of the vein walls. Low grade inflammation over the ensuing weeks leads to fibrosis and permanent occlusion of the vein. Over time the glue is broken down and dissolved.

Terms used to describe the use of glue to treat varicose veins include

  • Endovenous adhesive ablation (EAA)
  • Cyanoacrylate adhesive ablation (CAA)
  • Cyanoacrylate embolization (CAE)

Advantages

  • High degree of safety. Theoretically no risk of injury to nerves or arteries or lymphatics.
  • Minimal discomfort. Just one injection of local anaesthetic for insertion of the catheter.
  • Relatively quick procedure.
  • No compression stockings. Walk straight out and resume normal activities.
  • Next to no discomfort following the procedure (except inflammation on occasions)
  • Success rates equivalent to endovenous thermal ablation (Laser and Radiofrequency).

Disadvantages

  • Not suitable for treatment of superficial varicose veins or surface veins.
  • Does not treat superficial varicose veins. Glue can’t be extended out to treat tributary varicose veins extending from the saphenous trunk. Glue only treats underlying refluxing veins such as incompetent saphenous veins which are the cause of superficial varicose veins. The same limitations as endovenous laser ablation and radiofrequency ablation.
  • Inflammation (phlebitis) can sometimes occur.

Conclusions

Glue is a useful addition as another method to treat varicose veins and with no serious side effects. 
Glue has proven to be safe and effective.

References

1.           Eroglu E, Yasim A, Ari M, Ekerbicer H, Kocarslan A, Kabalci M, et al. Mid-term results in the treatment of varicose veins with N-butyl cyanoacrylate. Phlebology. 2017;32(10):665–9.

2.           Bootun R, Lane TRA, Davies AH. The advent of non-thermal, non-tumescent techniques for treatment of varicose veins. Phlebology. 2016.

3.           Chan YC, Law Y, Cheung GC, Ting AC, Cheng SW. Cyanoacrylate glue used to treat great saphenous reflux: Measures of outcome. Phlebology. 2017;

4.            Bellam Premnath KP, Joy B, Raghavendra VA, Toms A, Sleeba T. Cyanoacrylate adhesive embolization and sclerotherapy for primary varicose veins. Phlebol J Venous Dis. 2017;