Dr Tobias Hirsch, Halle, Germany
Dr Hirsch made a presentation to the Liepzig Interventional Course on the side effects of glue in the treatment of varicose veins, which has been published in Venous News March 2019
In 2011 the American Venous Forum recommended thermal ablation (Heat with either laser or radiofrequency) as standard treatment of varicose veins. However these methods require large volumes of local anaesthetic which is painful , can cause discolouration of the skin (hyperpigmentation) and nerve damage in up to 10%. Therefore newer methods have been looked for.
Cyanoacrylate glue has been shown not to be inferior to other treatments like Laser, RF or ClariVein in its ability to ablate the primary vein. It is simple to do but the manufacturers advise not to inject glue within 5cms of the junction with a deep vein as this could lead to a Deep Vein Thrombosis (DVT). However most recurrences come from the top 5cms which is untreated with glue therapy. This is obviously of concern.
With cyanoacrylate glue “we have to consider toxicity and allergenic risk especially as it takes along time for adhesive to be reabsorbed. All trials show an excellent occlusion rate, but all trials also show a phlebitis-like reaction in up to 20% of cases” Therefore patients may have pain for 1 to 2 weeks and experience generalised skin affections. Talking about side effects Hirsch said that “acrylates are known to cause allergic reactions such as contact eczema. The only way to treat contact eczema is to halt exposure” Obviously the glue injected into varicose veins cannot be removed. Other symptoms such as hives and itching can be treated with antihistamines.
In choosing what method is used to treat varicose veins, the key issues are:-
a) Does it ablate the vein treated ? – in this respect most treatments are equivalent
b) What side effects are there ? – Pain and nerve damage for Laser and Radio-frequency, Painful phlebitis and skin rashes for cyanoacrylate glue, None for ClariVein
c) What is the recurrence rate? Being unable to treat the top 5cms safely with Glue is concerning. Recurrence for ClariVein/Laser/RF are equivalent