Varicose Vein Cyanoacrylate Glue treatment

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1 The South West s premier independent healthcare and cosmetic clinic Varicose Vein Cyanoacrylate Glue treatment Varicose veins are a sign of underlying venous insufficiency and affect 20 30% of adults. Most people with varicose veins have no symptoms, but varicose veins may cause aching, heaviness, throbbing, and itching in the legs. Chronic venous insufficiency can lead to skin discoloration, eczema, and ulceration. Many people with varicose veins do not get any symptoms or need treatment on medical grounds, but treating varicose veins can relieve troublesome symptoms, as well as improving the appearance of your legs. Treatment can prevent worsening of eczema or skin discolouration that may otherwise lead to ulcers, and treating the veins is important if ulcers or bleeding have occurred. Treatment options include endothermal ablation (laser or radiofrequency), ultrasound guided foam sclerotherapy, and surgery (usually stripping and phlebectomies). Exeter Medical now offers varicose vein treatment using cyanoacrylate glue, which has some advantages over the other treatments, when used in properly selected cases. What is Cyanoacrylate Glue Treatment? Cyanoacrylate glue a special type of superglue is used to seal off the main incompetent veins with leaky valves, which need to be dealt with when treating varicose veins. It does the same job as closing veins by endothermal ablation (laser or radiofrequency treatments, which seal the vein off by intense heat) or stripping in a surgical operation. Page 1 of 7 - Update: 14/6/18 Tel :

2 Varicose Vein Glue Treatment Exeter Medical - The South West s premier independent healthcare and cosmetic clinic What are the Advantages of glue treatment? Having glue treatment is similar to endothermal ablation (laser, radiofrequency) but there is no need for the multiple injections of anaesthetic fluid which are required for laser or radiofrequency to prevent heat damage to surrounding tissues, and pain. Glue may avoid the minor discomfort that can occur after endothermal treatments like laser and it causes less bruising than surgical stripping. No compression bandaging or stockings are required over veins that have been glued, unlike after other kinds of treatment, when bandages and/or stockings are commonly advised for several days. Just 24 hours of compression is used to minimise bruising when veins are removed through tiny incisions (phlebectomies) at the time of glue treatment. Glue may sometimes avoid the need to remove varicose veins through tiny incisions (phlebectomies). What happens at the time of glue treatment? An injection of local anaesthetic is given to freeze the skin near the knee or the ankle. Once the skin is numb a needle is inserted into a vein and then a fine catheter is passed up the main vein to the groin. The glue is injected as the catheter is slowly withdrawn: pressure is applied to be sure that the walls of the vein are glued firmly together. All this is done using ultrasound pictures of the veins for guidance. You can get up and walk about normally as soon as the procedure has finished and get back to normal activities without any special precautions. You may feel some Page 2 of 7 - Update: 14/6/18 Tel :

3 discomfort in your thigh and if varicose veins have been removed surgically then you will have some bandaging and feel bruised, but you can still get active as quickly as you feel able. Do varicose veins need to be removed surgically at the time of glue treatment? When treating varicose veins by endothermal ablation (laser or radiofrequency) it is common practice to remove obvious varicose veins through tiny incisions (phlebectomies) under local anaesthetic at the same time. This may cause some bruising and lumpiness. If there are large and extensive varicose veins then doing phlebectomies at the same time as glue treatment is a good idea. However, it is possible that varicose veins of small size and limited extent may go away after glue treatment, without needing to be removed surgically. We will discuss with you the option of having glue treatment; then being reviewed; and then having injections or phlebectomies on a later occasion only if necessary. The choice will be yours. What are the current uncertainties about glue treatment? Cyanoacrylate glue treatment is still quite new and is the subject of NICE guidance (IPG526 June 2015) which points out that the amount of evidence published on its use is relatively small and it is possible that there are rare or uncommon risks which have not yet been recognised. The NICE guidance acknowledges the potential advantages of glue treatment. It makes some recommendations about who should be using this treatment. Since the NICE guidance, evidence has been published supporting the longer term effectiveness of cyanoacrylate glue treatment. What about cost? The cost of glue treatment is similar to laser treatment of varicose veins. A scan is required before treatment to be sure that veins are suitable: Cyanoacrylate Glue Unilateral treatment (for one leg) - 2, for scan Cyanoacrylate Glue Bilateral treatment (for both legs) - 3, for scan These procedures are usually done under local anaesthetic. If you would like to have sedation (given by an anaesthetist, to make you sleepy) then there is an additional charge of 375 for one leg and 475 for both legs. Page 3 of 7 - Update: 14/6/18 Tel :

4 Advice for people having glue treatment These notes are intended as a guide to exactly what happens and what to expect after treatment. Getting ready for glue treatment There is no need to avoid eating or drinking before glue treatment because it is done under local anaesthetic. It is a good idea to wear loose fitting clothing and comfortable shoes. You should be able to walk about normally after treatment, but it is a advisable to arrange for somebody to drive you home, especially if you are having phlebectomies (removal of varicose veins through tiny incisions). If you are having sedation then you should definitely not drive yourself home. We will check your records and scans, and will ask you to sign a consent form. All the normal safety checks will be done, just as if you were having a bigger operation. If you are having phlebectomies your varicose veins will be marked carefully. The procedure itself An injection of local anaesthetic is given to freeze the skin near the knee or the ankle. Once the skin is numb a needle is inserted into a vein: all this is done using ultrasound pictures of the veins for guidance. A guide wire is then passed up the incompetent vein to the groin, followed by a catheter, which is positioned carefully near the top of the vein. You may feel something going up your leg but this is not usually painful. Another catheter is prepared, containing the glue, and this is passed up through the first one. Pressure is then applied Page 4 of 7 - Update: 14/6/18 Tel :

5 in the groin and injections of glue are given: a full three minutes of pressure are needed after the first injection, to ensure that the top part of the vein has been sealed off. The catheter is then withdrawn, 3cm at a time, giving injections to each 3cm length of vein. After each injection pressure is applied for 30 seconds. Injecting a great saphenous vein from the groin to below the knee typically takes about minutes in total. You should not feel the glue injections but you will feel the pressure which is applied to be sure that the glue works properly. If other main veins are incompetent and need to be treated, then the gluing process is repeated for those. If you are having phlebectomies (removal of obvious varicose veins) this is done through tiny incisions after injecting local anaesthetic all around them. The incisions are closed with adhesive strips. There is no need for any compression by bandaging or a stocking (unlike other varicose vein treatments) when glue treatment alone has been used. If phlebectomies have been done then a bandage is applied just for 24 hours. After the procedure An immediate walk Immediately following the procedure, once you have dressed, you should go for a 10 minute walk in or around the Exeter Medical building. This minimises the remote chance of DVT (deep vein thrombosis) and ensures that you are safely mobile before you leave the vicinity of Exeter Medical. Leaving Exeter Medical You can leave Exeter Medical as soon as you feel ready to do so. It is generally a good idea to go for your ten minute walk either within the building or nearby and then perhaps to have a cup of tea or coffee before going home. Please let the Reception staff know that you leaving. Get back to normal as quickly as you can. Once you are home, aim to get back to all your normal activities just as soon as you are able. Walking You can walk as much as you want, as soon as you want. Frequent walking is a good idea in the days after a varicose vein procedure. There is no special advantage in going for a single long walk during the day, although you may walk as far as you wish. Frequent walking is more important than walking a long distance. Page 5 of 7 - Update: 14/6/18 Tel :

6 Work You can return to work the following day. If you have had phlebectomies for large or extensive varicose veins and you do a physically active job or spend long days on your feet then it is sensible to arrange two or three days off work, in case you are tender or bruised. Sports You can return to sporting activity as soon after treatment as you feel sufficiently comfortable. Do not go swimming for about three days after glue treatment (to let the tiny skin wound start to heal) or for two weeks after phlebectomies. Driving You can drive as soon as you feel confident that you can make an emergency stop safely. It is probably best you not to drive yourself home following glue treatment, but other than that you can drive as soon as you feel able. Bathing and showering If you have had plebectomies to remove varicose veins, then it is a good idea to keep the adhesive strips over the wounds dry for ten days. A shower may be possible before this by covering your leg with a big plastic bag or (better) a protector such a Limbo (Thesis Technology, Chichester OP18 8AT or on prescription). After ten days, soak the adhesive strips off in a shower or bath, and thereafter shower or bath normally. Air travel The risk of DVT during long air flights or other long journeys in cramped seating is very low, but the normal advice is to avoid air travel for a month before or after any varicose vein treatment. Short flights may be reasonable: this is a matter for discussion. Possible problems Aches, twinges, and areas of tenderness are quite common. These will settle down, and should not discourage you from becoming fully active as soon as you are able. Numbness or tingling Areas of numbness or tingling in the skin can occasionally occur at the places where varicose veins were removed or rarely where they have been glued. This is because tiny nerves have been damaged. The numbness usually recovers over a period of months, but occasionally a patch of numbness may persist. Page 6 of 7 - Update: 14/6/18 Tel :

7 Thread veins and discolouration Any varicose vein treatment can occasionally be followed by the appearance of tiny red or blue veins in the areas where veins were, but this is rare. Brownish discoloration can also occur: usually this fades but it may take many months to do so. Superficial Vein Thrombosis (Phlebitis) and inflammation The area over veins which have been glued can sometimes become red and tender. This usually settles within a few days. If you get pain or tenderness then take an antiinflammatory painkiller (e.g. ibuprofen) and/or paracetamol. This is not an infection and does not need antibiotics. Deep vein thrombosis (DVT) DVT is known to be a risk after other kinds of varicose vein treatments, but to date no patients are known to have developed serious DVT after glue treatment. If you are at special risk of DVT (e.g. you have had DVT before) we will discuss special preventative measures with you. An injection of heparin is often given at the end of operations on both legs, to minimise the risk of DVT. Allergic reactions These are rare but can happen as a result of glue. The ones that have been described have consisted of skin reactions (like hives ) but more serious allergy is a possibility. After phlebectomies Some bruising and tender lumps under the skin are common. These appear during the first few days after treatment and will all go away over a period of weeks. Delayed healing, infection and discharge of lymph fluid can occur, but are rare. The possibilities of numbness and tingling, due to interference with tiny nerves, is described above. Will varicose veins come back? Some people develop 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. Page 7 of 7 - Update: 14/6/18 Tel :