VenaSeal glue closure for varicose veins in Cairns
VenaSeal™ is a treatment option for some patients with varicose veins. Treatment involves delivering a medical adhesive (cyanoacrylate) into the affected vein through a small catheter, and applying pressure. Dr Freeman uses ultrasound guidance and local anaesthetic to perform the procedure in his Cairns clinic rooms.
Not all patients are suitable for this treatment. Suitability is determined by duplex ultrasound assessment. As with all procedures there are risks, which will be discussed with you before treatment.
How it differs from heat-based treatment
Endovenous ablation closes a vein using heat, whether from a laser fibre or a radiofrequency catheter. Because heat is being delivered inside the leg, local anaesthetic has to be infiltrated along the whole length of the vein to numb it and to protect the surrounding tissue — a series of injections along the thigh or calf.
VenaSeal closes the vein with an adhesive rather than heat. No energy is delivered to the surrounding tissue, so that tumescent anaesthetic is not required. Local anaesthetic is used only at the single point where the catheter enters the vein.
In practice that means fewer needles and, for most people, a more comfortable procedure. It does not make VenaSeal the right choice for every vein.
Who it suits
Suitability comes out of the duplex ultrasound. VenaSeal is generally considered where there is reflux in the great or small saphenous vein and the anatomy is appropriate for a catheter-based approach.
It can be a particularly useful option where multiple needle injections would be poorly tolerated, or where the vein lies close to a sensory nerve and heat-based treatment would carry a higher risk of numbness.
It is not suitable for everyone. Known sensitivity to cyanoacrylate adhesives is a contraindication, as is active infection or acute thrombosis in the vein. Very tortuous veins, or veins lying immediately under the skin, may be better treated another way.
What is involved
The leg is scanned on the day and the vein marked.
Local anaesthetic is placed at the entry point, usually below the knee or in the calf, and the vein is accessed with a needle. A catheter is advanced inside the vein under ultrasound guidance to the point where the reflux begins.
Small amounts of adhesive are delivered at intervals as the catheter is withdrawn, with pressure applied over each segment for a short period to hold the vein walls together while the adhesive sets.
Surface branch veins may be treated at the same visit or with sclerotherapy at a later sitting.
Afterwards
Most patients are able to return to their usual daily activities soon after the procedure, including driving.
Walking is encouraged — thirty minutes a day. Avoid hot baths and strenuous gym work until you have been reviewed. Avoid long periods of sitting or standing still in the first week.
Simple over-the-counter pain relief is usually sufficient. Avoid aspirin-based products unless specifically advised.
You will be reviewed between one and two weeks after treatment, with an ultrasound scan to check for deep vein thrombosis.
Contact the rooms promptly if you develop a temperature above 38°C, or pain or swelling that is severe or worsening.
Risks
Bruising and tenderness over the treated vein are common and settle over a few weeks. A firm cord along the line of the vein can be felt for some time.
Inflammation of the vein — phlebitis — occurs in a minority of cases and is managed with anti-inflammatory medication and compression.
A localised inflammatory reaction to the adhesive can occur, producing a red, itchy, sometimes tender area along the vein. It is usually self-limiting but can take some weeks to settle and occasionally requires treatment.
Allergic reaction to cyanoacrylate is uncommon but is the reason you are asked about adhesive sensitivity beforehand.
Deep vein thrombosis is uncommon, and extension of adhesive or thrombus into the deep vein is specifically looked for at the review scan.
Infection and bleeding at the access site are recognised but uncommon. The vein may not close completely, or may reopen, and further treatment is sometimes needed. Varicose veins can recur over the years with any technique.
The adhesive remains in the leg permanently as the vein is absorbed around it. This is expected rather than a complication, and it is one of the differences from heat-based treatment worth discussing.
All risks are discussed in full before treatment is agreed.
Common questions
Is glue closure better than laser?
Neither is uniformly better. Both close the vein effectively in appropriate anatomy. Glue avoids the tumescent anaesthetic injections and carries a lower risk of nerve-related numbness; heat-based treatment has a longer published track record and a different cost profile. The right choice depends on your duplex findings and on what matters to you, and that is what the consultation is for.
How long does the vein take to disappear?
The vein seals immediately, but is absorbed by the body gradually over months. Visible surface branches often need separate treatment; closing the underlying vein does not necessarily make them disappear.
Can I have both legs done?
Usually on separate occasions rather than in one sitting. This is discussed at the consultation.
Referral and appointments
GPs and referrers: referrals can be sent to the rooms by fax or through the online referral form.
Patients: phone the rooms on (07) 4254 5006. Suite 9, Level 1, 193 Lake Street, Cairns.