VenaSeal™Closure at Parkside Hospital

VenaSeal is a treatment for varicose veins caused by a faulty vein in the leg, most often the great saphenous vein. Instead of heat, it uses a small amount of medical adhesive, delivered through a thin tube, to seal the vein shut so blood reroutes through healthier veins nearby.

What conditions does it treat?

VenaSeal treats symptomatic venous reflux, where faulty valves let blood flow backwards and pool in the leg instead of returning to the heart. It's generally used for a vein measuring around 3 to 12mm in diameter, confirmed by an ultrasound scan showing reflux.

• Varicose veins caused by a faulty great saphenous vein or similar superficial leg vein
• Aching, throbbing, heaviness or fatigue in the leg
• Swelling, itching, night cramps, or a restless, uncomfortable leg.

It's licensed for use in adults. Safety and effectiveness haven't been established in pregnant women or children.

What are the benefits of having VenaSeal?

In the main clinical trial supporting its approval, VenaSeal closed 99% of treated veins at 3 months and 96.8% at 12 months, similar to or slightly ahead of radiofrequency ablation, a heat-based alternative. Longer-term data reported by the manufacturer shows a closure rate of 94.6% at 5 years.

Because it doesn't use heat, VenaSeal needs far less local anaesthetic than heat-based treatments, since there's no need for the multiple numbing injections used to protect surrounding tissue from heat.

Patients in the main trial also had noticeably less bruising than those having radiofrequency ablation, and most don't need to wear compression stockings afterwards, though some may still benefit from them.

Are there different types of surgical approach?

VenaSeal is one of several ways to close a faulty vein. The main alternative is heat-based treatment, using radiofrequency or laser energy, which needs a good deal of local anaesthetic injected around the vein to protect the surrounding tissue from the heat.

Foam sclerotherapy is another option, using an injected chemical foam instead of heat or glue – manufacturer-reported data found lower one-year closure with foam (around 73%) compared with VenaSeal (around 97%), alongside a higher reported chance of a blood clot (DVT).

Within VenaSeal itself, your clinician delivers the adhesive in small segments along the vein, adjusting the number of injections to the length of vein being treated.

What happens before the operation?

Before treatment, you'll have a consultation and a duplex ultrasound scan to map the faulty vein and confirm you're suitable for VenaSeal.

• Tell your clinician about any known allergy to cyanoacrylate adhesives (sometimes called ‘superglue’-type adhesives)
• Mention any history of a blood clot, vein inflammation (phlebitis), or a current infection, since these can rule out VenaSeal as an option
• No fasting is usually needed, since the procedure is done under local anaesthetic while you stay awake.

What happens during the procedure?

The procedure typically takes well under an hour, around 24 minutes on average in the main clinical trial, varying with the length of vein being treated. In general, it follows these steps:

1. Local anaesthetic is injected once, at the point where the catheter will enter the vein, usually in the lower thigh or calf
2. A thin catheter is guided into the faulty vein under ultrasound guidance
3. Small, precise amounts of medical adhesive are delivered along the vein through the catheter, while your clinician applies compression to the leg from the outside
4. The catheter is gradually withdrawn as more adhesive is delivered in segments, sealing the vein closed along its length
5. Once the vein is sealed, the catheter is removed and a small dressing is placed over the entry point.

What does recovery look like?

VenaSeal is usually done as a walk-in, walk-out procedure in a clinic rather than a hospital ward, so you go home the same day, often within an hour or so of the treatment finishing.

Most people return to normal day-to-day activities straight away or the next day. Mild bruising, tenderness or discomfort around the treated area is common in the first few days and usually settles on its own.

Compression stockings usually aren't needed afterwards, which is one of the differences between VenaSeal and heat-based treatments, though some people may still benefit from wearing them.

Longer-term data reported by clinics following NICE guidance suggests around 97% of treated veins remain closed at 6 months, over 94% at 12 months, and 92 to 95% at 2 to 3 years, with around 8.6% recurring by 5 years, broadly similar to radiofrequency ablation over that timeframe.

What are the risks and complications?

As with any vein procedure, there are risks to be aware of. The main clinical trial found a somewhat higher overall rate of mild side effects with VenaSeal than with radiofrequency ablation, mostly explained by the two items below marked with an asterisk.

Reported risks include:

• Bruising, tenderness or mild pain around the treated area
• *Phlebitis (inflammation of the vein), which occurred somewhat more often with VenaSeal than with radiofrequency ablation in the main trial, though cases were generally mild and settled with anti-inflammatory medication if needed
• *Superficial thrombophlebitis (inflammation with a small clot in a surface vein), also somewhat more common with VenaSeal in the same trial
• Numbness or tingling (paresthesia) in the treated area
• An allergic reaction to the adhesive, ranging from a mild skin reaction to, very rarely, a severe reaction (anaphylaxis)
• Infection at the point where the catheter entered the skin
• A blood clot (deep vein thrombosis) or, rarely, a clot that travels to the lungs (pulmonary embolism); neither occurred in the main clinical trial, though both remain listed risks
• Visible scarring, skin discolouration, or, rarely, damage to the vein wall.

VenaSeal shouldn't be used if you have a known allergy to the adhesive, a current vein clot or inflammation, or a significant infection elsewhere in the body.