2 The condition, current treatments and procedure
2.1 Varicose veins are a sign of underlying venous insufficiency. Primary valvular incompetence is the most common underlying cause of varicose veins. The saphenous veins are the most frequently affected vessels. Most people with varicose veins have no symptoms, but venous insufficiency may cause fatigue, heaviness, aching, throbbing, itching and cramps in the legs. Chronic venous insufficiency can lead to skin discoloration, inflammatory dermatitis and ulceration.
2.2 NICE's guideline describes the diagnosis and management of varicose veins. Interventional treatment options include endothermal ablation (such as radiofrequency ablation and endovenous laser ablation therapy), foam sclerotherapy, mechanochemical ablation and surgery (usually stripping and ligation of the great and small saphenous veins, and phlebectomies).
2.3 Cyanoacrylate glue occlusion for varicose veins aims to close the veins by adherence then fibrosis of the lumen, without the need for tumescent anaesthesia and with reduced need for postoperative compression therapy.
2.4 The procedure is done using local anaesthesia. An introducer sheath is inserted into the distal great saphenous vein and, using ultrasound guidance, a delivery catheter is advanced into position before the saphenofemoral junction. The proximal vein is compressed, and medical glue is delivered in measured doses through the tip of the catheter to seal the vein.
2.5 This is repeated at different positions as the catheter is withdrawn, using ultrasound imaging to monitor the procedure. The procedure may also be done in a similar way for the small saphenous vein.