Venaseal is used to block off a main saphenous vein by passing a catheter up the vein introduced through a puncture needle under local anaesthetic with ultrasound guidance so as to allow injection of an adhesive substance. It has been extensively trialled in Europe and the United States over the past three years. Results published show a low risk of complications and excellent medium-term results. Two or more veins can be treated at the one session but no more. Visible varicose veins are usually treated by ultrasound-guided sclerotherapy (UGS) some 2-4 weeks later when they have decreased in size.
What are the advantages and disadvantages for Venaseal?
Advantages
- Minimal discomfort as there is no need for injection of anaesthetic agents around the vein.
- No need for support stockings after the procedure.
- Minimal time off work or interference with normal day to day activities.
- No admission to hospital or general anaesthesia.
Disadvantages
- Injected veins occasionally become inflamed and this can last for several weeks so that patience is required to allow this to settle.
What should you do before Venaseal?
- Do not shave your legs.
- Do not apply moisturiser to your legs on the day of treatment.
- Preoperative sedation is not required.
What happens during Venaseal?
- A sonographer or doctor will mark out veins to be treated.
- The procedure is performed with you lying on a treatment couch that is tilted at stages through the treatment.
- The vein is punctured through an anaesthetized site at about the knee for great saphenous reflux and back of calf for small saphenous reflux.
- A fine wire is passed up the vein, a long fine tube is passed over the wire and the Venaseal catheter is introduced through the tube.
- The catheter tip is precisely positioned just below the top end of the saphenous vein using ultrasound guidance.
- Injection of the chemical is commenced with firm pressure applied above the site. This is repeated in multiple segments down the full length of the vein. The procedure involves minimal discomfort.
- No compression is required after treatment.
What should you do after Venaseal?
- Walk for 15 minutes immediately after treatment.
- Arrange for someone to drive you home or go home by taxi - it is essential that the patient does not drive or take public transport on the day of treatment. Driving can resume on the following day.
- Walk as much as possible, at least 15 minutes per day.
- Maintain normal daytime activities and avoid standing still for long periods. Resume normal exercise activities within 24-36 hours.
- Avoid flights of greater than 4 hours duration for 4 weeks after treatment. If travel is unavoidable, then the flight should be covered by subcutaneous heparin injections given before departure and after arrival. Avoid treatment for 2 weeks after returning from a long flight
- A check ultrasound scan will be arranged within a week after treatment to ensure that the treated vein is occluded, determine whether any further veins require treatment and exclude the small risk of deep vein occlusion.
What can you expect following Venaseal?
The following features are expected. They are not a cause for concern although they should be reported at review:
- Mild pain may develop and persist for several days and shows that the treatment is working. The degree is related to the initial size of the veins. Pain is usually improved by walking or by Panadol or Nurofen.
- Inflammation over the vein rarely occurs early on. It usually disappears within 4-6 weeks. This indicates that treatment has been successful. It does not represent infection and does not require treatment with antibiotics.
- Recurrence. Treated veins can reopen or new veins can develop. For this reason, ultrasound surveillance is offered at two yearly intervals so that recurrent veins can be detected and easily treated by injections before they become too large.
- Itching (pruritis). Itching over treated veins can occur early on after treatment. If it occurs, contact the clinic to arrange for treatment by a cortisone or antihistamine cream.
What are the possible complications from Venaseal?
Complications can occur even with perfect technique.
- Deep vein thrombosis. Clots extending into the deep veins can occur. This potentially serious complication is rare. Minor clots develop in deep veins in less than 2% of our patients. If this is demonstrated on the postoperative scan then you may require treatment with daily heparin injections until further scans show the clot is resolving.
