3 The procedure
3.1 Cyanoacrylate glue occlusion aims to close varicose veins by adherence then fibrosis of the lumen, without the need for tumescent anaesthesia (infusion of a large volume of dilute local anaesthetic around and along the entire length of the vein). The need for post‑operative compression therapy is also reduced.
3.2 The procedure is done using local anaesthesia. An introducer sheath is inserted into the distal great saphenous vein in the affected leg and, using ultrasound guidance, a delivery catheter is advanced into position just before the saphenofemoral junction. The proximal vein is compressed and a measured dose of cyanoacrylate glue is delivered through the tip of the catheter to seal the vein. The catheter is withdrawn in stages and the steps repeated to close the vein (that is, proximal vein compression and further measured doses) using ultrasound imaging to monitor progress. The procedure may also be done in a similar fashion for the small saphenous vein.