Patient information on Cyanoacrylate Glue Closure for Varicose Veins

Who is this leaflet for and what is its aim?

This leaflet is for patients who have been diagnosed with varicose veins and have been recommended to have Cyanoacrylate Glue Closure.

This leaflet aims to explain the procedure and its risks.

Background information

Cyanoacrylate glue closure is a minimally invasive treatment for varicose veins. Cyanoacrylate glue (a special type of “superglue”) is used to seal off the main faulty veins (veins with leaky valves) in the leg. The procedure has the same effect as “stripping” the vein in a surgical operation, or closing veins by endothermal ablation (laser or radiofrequency heat treatment), but it avoids the surgical incisions needed for stripping and the multiple injections of anaesthetic fluid required for endothermal ablation.

The procedure is performed using a small amount of local anaesthetic and you will be able to go home on the day, straight after the treatment.

Most patients who are suitable for cyanoacrylate glue closure will be assessed by a consultant in the vascular clinic. They will undergo an ultrasound scan of their veins to see if they are suitable for this treatment. You will not need to attend the hospital again until the day of your procedure. Usually, there is no need to stop or change your usual medication before the procedure. However, if you are taking hormone replacement therapy (HRT) or the contraceptive pill, then please inform the medical team as these medicines may need to be stopped before the treatment.

The procedure

An ultrasound scan will be used to assess the veins that require treatment. A local anaesthetic injection will freeze the skin and a small flexible wire will be passed into the vein. A fine tube is passed over this wire into the vein and the glue is carefully injected into this tube. The position will be carefully checked using the ultrasound scanner. Small doses of glue are injected along the length of the vein (through the fine tube). After the injections, the surgeon will press on the skin for short periods to help seal off the vein.

Occasionally prominent varicose veins will be marked by the surgeon prior to the procedure and may be removed through small incisions (phlebectomies). This is not routine as in many cases, these veins will shrink away after treatment of the main faulty vein. Any small incisions are closed with glue or steristrips which can be removed after five days. For most patients, there is no need for a bandage or compression stockings after glue treatment.

Getting about after the procedure

After cyanoacrylate glue closure, you will be able to walk almost immediately and go home. You can walk as much as you like, as soon as you like. You will not cause any damage to your leg by walking. You should not drive home. If you are travelling for more than one hour from the hospital you should sit on the back seat with your leg(s) up. Stop every hour and walk around for five minutes.

Intended benefits

Cyanoacrylate glue closure is intended to seal off the main faulty veins in the leg, with the aim of improving your symptoms / quality of life and reducing the risks of complications from your varicose veins (such as eczema, discoloration of the skin and ulcers). For some patients, cyanoacrylate glue treatment may have specific advantages over other treatments, including less pain (as there are fewer injections needed), less bruising and the avoidance of compression bandaging or stockings after treatment (for most patients). However, like any other treatment you should understand the benefits and the risks of the glue procedure before you agree to undergo treatment.

Cyanoacrylate glue treatment is relatively new. NICE (the National Institute for Health and Care Excellence) has produced guidance on its use (Interventional Procedures Guidance 670 – Mar 2020). This describes evidence of good effectiveness with low risk of side-effects, so this treatment can be offered as a standard treatment.

Risks

• There is a small chance the vein may not be completely sealed after the glue procedure (this occurs in fewer than 5% of patients).
• As with any surgical procedure there is a small risk of blood clots forming in the main leg veins (DVT). However, this is less common after cyanoacrylate glue closure than conventional varicose vein surgery. DVT is less likely to occur if you start moving your legs and walking frequently soon after treatment.
• Some patients have noticed redness and discomfort over the treated vein within the first one to two weeks of treatment. This may be some inflammation in the treated vein (phlebitis), which will settle. If you get pain or tenderness then take an anti-inflammatory painkiller (e.g. ibuprofen) and/or paracetamol. This is not an infection and does not need antibiotics.
• Allergic reactions are rare but can happen as a result of glue. Relatively minor skin reactions (like ‘hives’) have been described, but as with any injection, more serious allergy is a rare possibility. Please tell the medical team if you have had any allergies using ‘superglue’ in the past.
• If any additional treatments (such as phlebectomy or ultrasound guided foam sclerotherapy) are performed at the same time as the glue procedure, then other side effects such as bruising, skin discoloration or tender lumps may occur.
• Some people develop a few new varicose veins over the years after any of the varicose vein treatments. Varicose veins may simply re-grow in the areas which have been dealt with, or they may develop in a different system of veins which was normal at the time of treatment. If veins develop again, they can be treated.

Alternatives

Varicose veins are a common condition. There are several alternative treatments available for varicose veins (listed below). Your doctor will discuss the options with you and where possible, offer the most appropriate option for your specific situation such as:

• Compression stockings and skin care.
• Conventional varicose vein surgery: this requires a general anaesthetic and often causes more bruising and discomfort and requires larger surgical incisions than minimally invasive methods.
• Radiofrequency ablation: this is a keyhole procedure where the faulty vein can be heated and destroyed, to seal it closed. Not all veins are suitable.
• Ultrasound guided foam sclerotherapy: This is also a minimally invasive procedure which is useful for some tortuous veins, or for patients with ulcers.

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP.

Please tell the ward staff about all of the medicines you use. During your stay If you wish to take your medication yourself (self-medicate) please speak with your nurse. Pharmacists visit the wards regularly and can help with any medicine queries.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on our website: MyChart

Contacts

We may give you additional patient information before or after the procedure, for example, leaflets that explain what to do after the procedure and what problems to look out for. If you have any questions or anxieties, please feel free to ask a member of staff or contact our Vascular Specialist Nurses via email or on 01223 348526.

Further information is available from:

• The Vascular Society website (opens in a new tab)
• Circulation Foundation UK website (opens in a new tab)