Real-World Safety and Efficiency of Treating Symptomatic Varicose Veins with Endovenous Closure of Great, Small, and Anterior Accessory Veins Using Cyanoacrylate Glue (VenaSeal™): A Single-surgeon Multicenter Retrospective Study

Phil Yi Jun Lu; Casey Hiu Ching Fung; Christopher Brooks

doi:10.1016/j.avsg.2024.11.101

Real-World Safety and Efficiency of Treating Symptomatic Varicose Veins with Endovenous Closure of Great, Small, and Anterior Accessory Veins Using Cyanoacrylate Glue (VenaSeal™): A Single-surgeon Multicenter Retrospective Study

Ann Vasc Surg. 2024 Dec 12:112:3-9. doi: 10.1016/j.avsg.2024.11.101. Online ahead of print.

Authors

Phil Yi Jun Lu¹, Casey Hiu Ching Fung², Christopher Brooks²

Affiliations

¹ Vascular Surgery, Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia. Electronic address: drphillu@gmail.com.
² Vascular Surgery, Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia.

PMID: 39672268
DOI: 10.1016/j.avsg.2024.11.101

Abstract

Background: Treatment of symptomatic varicose veins has changed dramatically in the last few years with guidelines now recommending endovenous surgery as first-line intervention. Previously, this was achieved by laser or radiofrequency ablation of the target vein, requiring infiltration of tumescent anesthesia to reduce the risks of thermal damage to surrounding tissue. Endovenous cyanoacrylate injection (VenaSeal™) is a nonthermal, nontumescent endovenous closure technique, increasing patient comfort and is readily performed under local anesthesia only and thus is a feasible technique for in-room treatment. The aim of this study was to investigate the 16 month closure rates and safety of the VenaSeal system for the treatment of lower limb varicose vein surgery.

Methods: This is a retrospective, single-surgeon, multicenter study reporting outcomes for the treatment of varicose veins using endovenous closure with cyanoacrylate closure (CAC) using the VenaSeal system. Varicose tributary treatment was performed with ultrasound-guided foam sclerotherapy. Patients were followed up with duplex ultrasound within 72 hours, 4 months, and 16 months. The primary outcome of the study was the successful closure of the target vein. Secondary outcomes were complications including deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding, admission, and mortality.

Results: Briefly, 804 incompetent saphenous veins in 480 patients (712 legs) underwent CAC between December 2018 and August 2022. The sonographic closure rate was 99.6% (791/794) at first follow-up, 99.3% (731/736) at second follow-up, and 97.2% (520/535) at third follow-up. Secondary outcomes across all follow-ups included 0 clinically symptomatic or occlusive DVTs, or endovenous glue-induced thrombosis. Incidentally, there were 30 nonocclusive below-knee DVTs related to foam sclerotherapy, and 8 glue thrombus extension, all of which were successfully treated with anticoagulation and resolved by 3 months. There were no occlusive or above knee DVTs, related PEs, bleeding events, deaths, or complications requiring admission.

Conclusions: Our real-world study illustrates that CAC is an effective and safe method for treating saphenous incompetence.