From the experience of more than 1000 glue ablation procedures for varicose veins: how to do it

Abstract

Cyanoacrylate adhesive closure (CAC) is currently one of the main non-thermal ablation modalities of incompetent saphenous veins. High efficacy and safety of the method is supported by international clinical practice guidelines as well as the real-world practice. In contrast to thermal ablation, CAC is advantageous in terms of low periprocedural pain and bruising, fast procedure time and postprocedural recovery, high patient comfort and satisfaction rates as well as avoidance of postprocedural compression. This publication summarises the practical tips and tricks of glue ablation procedure based on 5-year experience (2019–2023) at the “SM-Clinic” Phlebology Centre, Moscow. Indications for the preferred use of CAC are formulated, such as: low pain threshold; contraindications (or unwillingness) to postprocedural compression; extensive comorbidity and fragile patients; concomitant morbid obesity; the presence of axial reflux along the saphenous veins; the need for simultaneous ablation of several incompetent truncal veins; below-the-knee incompetence of saphenous veins, including recurrent varicose veins; extensive lipodermatosclerosis and/or venous leg ulcer; patient’s HIV and viral hepatitis positive status. A step-by-step interventional protocol of glue ablation is described, including the modified protocols of the procedure. The immediate and long-term outcomes of the CAC according to current data are discussed. Special attention is paid to adverse events following CAC, as well as technical aspects of their prevention. Despite high efficacy and safety profile, today’s limitations for adoption and wider use of CAC are cost issues and lack of reimbursement.