Vein bonding

Vein gluing in Poland

The doctors of the Phlebology Clinic team played a key role in the implementation of this innovative method of vein treatment in Poland. As the first in the country, as early as 2013, they performed varicose vein gluing procedures using the VenaSeal system. It is thanks to their commitment, knowledge, and experience that Polish Patients gained access to this modern therapy. Phlebologists Tomasz Grzela and Cezary Szary performed the first procedures in Poland using the VenaSeal system, and subsequently collaborated with manufacturers of vein gluing systems VariClose and VenaBlock (second-generation adhesive), introducing these technologies to the Polish market. The Phlebology Clinic has become a reference center for vein gluing, and our doctors have gained extensive experience in using this method of treating venous disease.

Varicose vein gluing with the VenaBlock system

Vein gluing versus laser vein ablation using a laser?

Varicose vein taping is a technique non-thermal, which means that it does not use thermal energy to close the incompetent vein. Unlike laser therapy (EVLA) or radiofrequency ablation (EVRF), there is no need for tumescent anesthesia, which requires multiple punctures and the administration of large volumes of local anesthetic. The vein gluing procedure was intended to be less invasive than thermal procedures and also much shorter. 1 Initially, vein gluing was mainly used to treat incompetent venous trunks, but over time it turned out to be a very versatile technique, finding application in the therapy of various venous diseases.

Although varicose vein gluing is an effective and valued method, at the Phlebology Clinic we emphasize that it is not always the most effective. Comparative studies conducted at our facility, comparing the VenaBlock system and the laser ablation technique using the ELVeS 1470 nm system, showed higher efficacy of the endovenous laser in longer-term observation, especially evident in the over 5-year assessment of Patients with lower limb venous insufficiency. Our observations and research on the venous system indicate that in the treatment of venous insufficiency, strategy and methodology are key, not the method itself as such.

The most important thing is that in the treatment of venous insufficiency, therapy should begin by addressing the cause (which is most often some form of pelvic venous insufficiency), and not from the symptom (i.e., closing a single varicose vein or venous trunk on the leg). In the treatment of venous disease, we currently use various methods and surgical techniques, and we already know that there is no single miracle method for everything. The most important thing is to treat the Patient in accordance with the principles of hemodynamics and with maximum preservation of the main vascular trunks in the legs.

What can be treated using tissue adhesive for veins?

The vein gluing method is used in the treatment of a wide range of venous diseases. The most common include:

• incompetence of the main venous trunks;
• varicose veins of the lower limbs of various diameters;
• atypical varicose veins that have formed outside the axis of the main venous trunks;
• incompetent perforating veins (so-called perforators);
• recurrent venous disease, including recurrent varicose veins;
• venous malformations;
• varicose veins of the intimate areas (very rarely).

Price range

Limitations of the vein gluing method

Despite its many advantages, the vein gluing method has certain limitations that should be considered when qualifying a Patient for the procedure. The most important of these include:

Description of the vein gluing procedure

The varicose vein gluing procedure is performed on an outpatient basis, without the need for hospitalization. Vein gluing on one leg usually takes between 15 and 30 minutes (it all depends on the extent of the changes and the type of vein gluing system used). A local anesthetic is administered at the access point to the venous vessel. Tumescent anesthesia, which is used in the case of thermal endovenous methods, is usually not required during the vein gluing procedure.

Next, after establishing vascular access under ultrasound guidance, a vascular catheter is introduced into the incompetent vein. Using a special dispenser (resembling a gun), tissue adhesive is applied to the inside of the diseased vein, causing it to stick together and close. The glued vein very often needs to be compressed from the skin side. It happens that the vascular catheter through which the adhesive is applied adheres to the vessel wall, and then it needs to be pulled out with force. This usually causes patient discomfort during the procedure. After the procedure, the Patient can return to daily activities. At the Phlebology Clinic, we recommend wearing compression stockings for most Patients. This improves the rate of varicose vein closure and reduces the percentage of complications, which after gluing procedures are not as few as previously anticipated.

After thorough anesthesia is administered, the procedure to close the incompetent vein begins. The energy delivered by the optical fiber heats the vessel wall, causing it to contract and close. The entire EVLA procedure is monitored using ultrasound equipment, which ensures exceptional precision while preserving the function of the remaining veins.

Varicose vein gluing – what does it involve?

Post-procedure care after vein gluing

After the varicose vein gluing procedure, it is recommended to:

• temporarily refrain from intense physical exercise (we usually recommend stopping strength training for 7-10 days after the procedure);
• wear compression stockings continuously for 24 hours after the procedure, and then for 7-14 days from the day it was performed
• careful observation for the occurrence of inflammatory and allergic reactions (in the case of tissue adhesive, we have noted foreign body-type reactions more than once);

• take prescribed anticoagulant and anti-inflammatory medications;
• after the procedure, you can immediately return to most daily activities;
• a follow-up visit with a Doppler ultrasound examination of the veins at the time determined by the phlebologist.

The first post-operative follow-up visit, which takes place 3 to 8 weeks later and is combined with a follow-up examination. Doppler ultrasound of the veins. Based on this examination, the effectiveness of the treatment is assessed and further management is planned, including any additional procedures, if necessary. During this visit, the physician also evaluates the healing process and any symptoms reported by the patient. In some cases, a complementary or aesthetic procedure (such as microsclerotherapy) may be performed during the same visit to optimize the cosmetic outcome.

Contraindications for vein glue treatment

Main contraindications for vein glue treatment

• known hypersensitivity to cyanoacrylate adhesives
• acute phase of superficial thrombophlebitis
• migrating thrombophlebitis (thrombophlebitis migrans)
• deep vein thrombosis in the acute or subacute phase
• localized tissue infection and systemic infections (sepsis)

Aarterial insufficiency, allergy to compression products, neurological disorders, and musculoskeletal dysfunctions are not considered contraindications for vein glue treatment.

Complications of vein glue treatment for venous trunks and varicose veins of the limbs

Complications after vein glue treatment for varicose veins can occur and include both those typical of endovenous procedures and those specific to the method used (resulting from the administration of cyanoacrylate glue into the venous bed).

The most common complications after vein glue treatment are:

• allergic reactions: There is a risk of an allergic reaction to cyanoacrylate glue; in some cases, this is a Type IV reaction requiring treatment with corticosteroids and antihistamines. Studies show a variable incidence of hypersensitivity reactions ranging from 6% to 25%.
• deep vein thrombosis (DVT) and secondary pulmonary embolism: The risk of this complication may increase if the glue reaches the area of the wide opening of the great saphenous vein.
• glue-induced thrombosis (Endovenous Glue-Induced Thrombosis, EGIT): This is one of the complications that may occur and it can extend beyond the area treated.
• glue migration: The migration of glue beyond the treated area, especially near the vein junctions, is possible and may lead to distant organ complications.
• Recanalization: In the case of veins with a larger diameter, especially those over 10 mm, there is a higher risk of recanalization (reopening of the vein) and the flushing of the glue injected into the vessel. Studies have shown that a vein diameter greater than 7 mm increases the risk of recanalization to nearly 40%!
• phlebitis: Inflammation of the vein after glue treatment is often a mixed reaction, with the overlap of typical allergic mechanisms.
• complications at the access site: Complications such as bleeding, hematoma, and infection may occur at the needle insertion site.
• sensory disturbances.

At the Phlebology Clinic we make every effort to minimise the risk of complications and our specialists remain available to patients during the recovery period. If you experience any worrying symptoms, please contact our Registry immediately.