- Ultrasound imaging
- Vascular diagnostic imaging
- Specialist consultations
- Compression therapy
- Endovenous procedures
- Mechano-chemical ablation with Phlebogriffe
- Endovenous laser ablation ELVeS 1470 nm
- Glue treatment of varicose veins (VenaSeal and VariClose)
- Endovenous embolization
- Venous stenting
- Venous surgery
- Hybrid procedures
- Proctological procedures
dr Cezary Szary
"Idea of glue treatment consists in painless and exceptionally effective method of treatment of leg varicose veins. When we were introducing this method to Poland, we were certain about its success!"
Physicians of the Clinic of Phlebology team from Warsaw were the first who introduced pioneer glue treatment of varicose veins of lower extremities. Our physicians: Tomasz Grzela, Cezary Szary, Agnieszka Krawczyk and Justyna Wilczko started to perform it after they have participated in certified training on glue treatment of varicose veins. It was led by the doctor Jens Alm from Hamburg.
For the first two years, American VenaSeal system was the only method for endovenous glue treatment of incompetent venous trunks available on the market (system was introduced at the turn of 2011/12). At the beginning of its history, it was distributed by American company - Sapheon. Since 2014, product is also present in the portfolio of Medtronic.
The results of the first main clinical trial called VeClose, whose objective was to compare the effectiveness of two endovenous systems: VenaSeal and ClosureFast (EVRF), that was used for years, confirmed higher effectiveness of glue treatment. A half-year observation showed that the percentage of successfully closed varicose veins was 98.9% and 94.3% for VenaSeal and ClosureFast, respectively. Following 12 month-observation, the percentage of closed veins was comparable, i.e. ca 97%.
Shortly afterwards, another innovative system for minimally invasive glue treatment of varicose veins of lower extremities through percutaneous access appeared on the European market (2014). In our country, first procedures of the VariClose glue treatment in collaboration with its producer - Biolas, were performed in spring 2015 by the physicians Tomasz Grzela and Cezary Szary.
What makes glue treatment distinct compared to other minimally invasive methods of varicose vein removal?
Glue treatment of varicose veins of lower extremities is classified to the group of non-thermal and non-tumescent procedures. In practice, it means that contrary to laser, steam or ablation using radio waves, we do not use thermal energy as a means of varicose vein closure. Thanks to these properties, anaesthesia is not required in the majority of such procedures.
What is the difference between VariClose and VenaSeal?
In both systems of glue treatment of varicose veins (VariClose; VenaSeal: Latin ‘vena’ - vein), the same rule of tissue adhesive action (cyano-acrylate group) is applied. Mixture of specially prepared chemical compounds intended for endovenous use polymerize in a controlled manner in the vessel, initiating the process of gluing and then irreversible fibrosis. Following several years (rarely months), the lumen of vessel is closed and deactivated.
The difference between aforesaid systems results from various density and viscosity of both adhesives and different time of polymerization. VariClose provides new possibilities, allows for elimination of more twisted varicose veins compared to VenaSeal. Additionally, the closure of varicose veins using VariClose became quicker than in case of VenaSeal. From our practice transpires that the majority of glue procedures with VariClose last for 20 minutes, while with VenaSeal this time is longer by ca 10-15 minutes.
How the procedure of glue treatment of varicose veins looks like?
In the majority of cases, glue treatment of leg varicose veins replaces classic surgical methods. It is carried out in outpatient settings, under comfort conditions for patient. Glue treatment of varicose veins on one leg lasts up to 20-25 minutes on average, while on both legs – usually up to 40-45 minutes. All procedures of glue treatment of varicose veins are performed in the Clinic of Phlebology by two physicians under the guidance of high-resolution ultrasound. Such method of treating varicose veins ensures precision and easy, non-surgical (no incisions) access to the vessel.
Besides local anaesthesia at the site of percutaneous access to the varicose vein, glue treatment does not require tumescent anaesthesia, which is used in endovenous thermal procedures such as endovenous laser therapy (EVLA), endovenous radio frequency ablation (EVRF) or steam vein sclerosis (SVS).
In the Clinic of Phlebology, an access to the vein is mainly achieved by using exceptionally delicate sets for puncture. Thus, we avoid making skin incisions and bringing veins out. Following the procedure, skin does not have any unsightly scars.
In both methods (VenaSeal and VariClose), injection of the adhesive to the lumen of vessel proceeds with different speed. Adhesive is administered using especially calibrated dispenser resembling the gun. Such method of adhesive administration ensures adequate precision and safety of patient during the procedure.
New technologies introduced to VariClose system allow for the closure of varicose veins of smaller calibre. On the other hand, VenaSeal works perfectly in the gluing process of large varicose veins, which was also suggested in VeClose study.
What are the advantages of glue treatment with VariClose and VenaSeal?
Glue treatment of varicose veins of lower extremities is the most modern and promising technique out of all minimally invasive methods of treatment. In our practice, we use glue treatment of varicose veins also in combination with universal foam sclerotherapy, adopting various modifications of this method. The techniques we apply help us to increase the effectiveness of glue treatment.
Glue treatment with VariClose and VenaSeal has a number of important advantages compared to other surgical and modern non-surgical methods.
The main advantages of glue treatment of varicose veins of lower extremities are:
- small invasiveness of the procedure (non-tumescent anaesthesia, no skin incisions)
- short time of procedure, following which patient leaves the Clinic and immediately returns to his/her everyday activities (no sick leave is required)
- period of refraining from greater physical burden is shorter compared to sclerotherapy, laser or radio frequency ablation
- in the majority of cases, there is no necessity for wearing compression stockingin post-procedure period
- low risk of skin discolouration and tissue inflammation in the region of closed veins
- possibility of simultaneous performing procedures on two legs
- exceptionally high effectiveness of procedure (according to VeClose study, in 12 month-observation, complete closure of varicose vein amounted to 97%)
For what kind of clinical situations is glue treatment of varicose veins a method of choice?
There are special groups of patients for whom glue treatment is a method of choice. These are: individuals who want to remove varicose veins in summer, when wearing of compression devices is quite burdensome and the risk of discolouration resulting from the exposure to sun is very high.
The following patients are especially qualified for the glue treatment of varicose veins of lower extremities: those with serious peripheral artery disease of the legs (PAD), obesity, adipose and lymphatic swelling. In case of such patients, selection of compression devices or the risk of side effects resulting from their use may be too high. Glue treatment is ideal solution for patients with limited mobility who are qualified for different types of orthopaedic procedures (knee or iliac replacement).
- glue treatment is used worldwide since 2011/2012, since that time it achieved a great recognition due to its high effectiveness which was confirmed in VeClose study
- currently, glue treatment of varicose veins is the only method following which patient does not have to wear compression devices
- non-tumescent anaesthesia is used in case of VenaSeal and VariClose
- glue treatment is the method of treatment of varicose veins which is highly tolerated in summer