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A Sticky End for Varicose Veins

Treatments for varicose veins have changed beyond recognition over the last ten years.

Treatments for varicose veins have changed beyond recognition over the last ten years.

Up until 1998, the only real option for the treatment of varicose veins and associated conditions (such as venous leg ulcers) was the infamous tying and stripping of varicose veins. This was painful, resulted in two weeks off work, large scars and, as our research showed in 2007, allows veins to grow back again in a large number of patients.

Following the introduction of endovenous surgery in America in 1998, and in the UK in March 1999 (I myself, performed the first case here in the UK), the treatment of varicose veins underwent a massive revolution. Radiofrequency ablation catheters or endovenous laser fibres are passed up the offending veins through a simple pinhole, usually below the knee, and guided into place in the groin using ultrasound.

Once in place, the radiofrequency current or laser is started, and heat is generated at the tip causing permanent closure of the vein - medically called "ablation". Of course this process is very hot and the radiofrequency or laser generated heat would burn the surrounding tissues and skin if the leg was not protected. Therefore, a process of injecting a large volume of local anaesthetic around the vein under ultrasound control is used also known as "tumescent anaesthesia".

The use of tumescent anaesthesia has allowed varicose vein surgery to become a true "walk in, walk out" operation as there is absolutely no need for general anaesthetic or sedation. The whole procedure can now be performed under local anaesthetic and, in the best vein units, this has been the way all of the operations have been performed since the mid 2000's. Indeed, because the tumescent anaesthesia prevents the heat generated in the vein from spreading and damaging surrounding tissues and skin, it is actually safer to perform these techniques under tumescent anaesthesia than general anaesthetic without the cooling fluid around the vein. Although this approach is a massive improvement over the stripping process in delivering a better cosmetic result, many patients still do not like the injections associated with the tumescent anaesthesia.

There are a couple of newer techniques that solve this problem as they ablate the vein without any heat.

Over the last year, we have been using "superglue" to close the vein, more commonly known as "Venaseal". As with superglue one can buy in the shops, this is a cyanoacrylate glue that has been modified for special use within the body. With this treatment, only one injection of local anaesthetic is needed to enable a long thin catheter to be inserted into the vein. As with all endovenous techniques, the catheter is then passed up the affected vein under ultrasound control. However, unlike endovenous radiofrequency ablation or endovenous laser ablation, there is absolutely no need for any further local anaesthetic or tumescent anaesthesia.

The patient is merely tipped into a head-down position, draining blood from the vein to be treated, and a specific amount of glue is injected into the vein. The glue is allowed to set and the catheter is withdrawn at a set rate, putting more glue into the vein as it is withdrawn.

At first, our concern was what the long-term effects of just gluing the vein shut would be. However over the last year, our research has confirmed that the glue causes a specific reaction within the vein that seems to destroy it in a way that we know results in permanent destruction of the vein as effectively as the destruction from radiofrequency ablation or endovenous laser ablation.

The "superglue" approach to the treatment of varicose veins is one of the latest of a very exciting group of new procedures which are revolutionising how we treat people with venous problems.

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