Cyanoacrylate closure in the treatment of varicose veins - what is the evidence?

Introduction Cyanoacrylate ablation for incompetent saphenous veins is a recent addition to the armamentarium of venous surgeons. It does not require the instillation of tumescent anesthesia during the procedure, thus reducing patient discomfort, and neither are compression hose necessary after treatment. Early cyanoacrylate ablation trials VenaSeal (TM) (Medtronic, Minnesota, USA) was the first reported use of a formulation of cyanoacrylate used in the ablation of incompetent saphenous veins. Clinical series and randomized controlled clinical trials demonstrated the safety and efficacy of this ablation method. The VeClose trial compared VenaSeal (TM) to the radiofrequency ablation (RFA) method and showed clear noninferiority of safety and efficacy compared with RFA. Subsequent VenaSeal (TM) trials The WAVES trial demonstrated efficacy of VenaSeal (TM) in large great saphenous veins without the use of compression hose. And in a 60-month extension study of patients from the VeClose trial, long-term occlusion success and freedom from adverse events has been confirmed. Other cyanoacrylate formulation studies Among alternative cyanoacrylate formulations first reported was N-butyl cyanoacrylate adhesive (NBCA), used successfully in saphenous vein ablations in Turkey. Several trial reports have been published comparing NBCA with thermal ablation techniques, showing equal or better efficacy and safety for NBCA ablation. Conclusion The safety and efficacy of differing formulations of cyanoacrylate for ablation of incompetent saphenous veins have been demonstrated through many clinical trials internationally.