Glue and seal diseased veins with minimum pain and recovery time
A NEW medical-grade superglue can seal up veins with impaired function with minimum pain and recovery time. Inject, glue and seal.
That about sums up a new treatment for venous insufficiency, a condition where blood flows back towards the feet instead of returning to the heart because of faulty vein valves, and which commonly manifests as varicose veins.
“Treatment is simple, painless and fast,” said Dr Chong Tze Tec, Senior Consultant and Head, Department of Vascular Surgery, Singapore General Hospital (SGH). “There is minimal or no bruising at all, and patients can resume their normal activities immediately without having to wear compression stockings afterwards.”
The procedure makes use of cyanoacrylate adhesive, a medical-grade superglue which has been used in surgeries and other treatments since the 1950s. Its use in the treatment of venous insufficiency was approved by the US Food and Drug Administration in 2015, and by Singapore’s Health Sciences Authority in 2016.
SGH started offering the treatment in the first quarter of 2016, and since then, more than 100 patients have opted for it.
In the procedure, done under local anaesthesia, a small tube or catheter is inserted into the diseased vein. Ultrasound is used to guide and position the catheter along segments of the vein, and then small amounts of the superglue is pumped through the catheter at 3cm intervals and pressed down – three minutes for the first seal and 30 seconds for the subsequent portions. No suturing or stitching is needed – just an adhesive plaster that is placed over the puncture wound.
While not who suffers from everyone venous insufficiency or reflux has varicose veins, those who do can have the large, twisted veins removed after the superglue procedure.
Surgeons make small incisions – 3mminto the skin – to “pull out the veins”, said Dr Chong. Stab avulsion is usually done under local anaesthesia, but if many or large veins have to be taken out, it is done under general anaesthesia, he added.
As with other methods to close or take out diseased veins, blood is rerouted to other, healthy veins. Conventional methods of treating the condition include stripping, an invasive and painful option that involves removing the diseased veins surgically, and requires a recovery period of weeks.
Radiofrequency and laser ablation are other methods, but the use of intense heat to seal diseased veins can injure or darken the skin, especially slim patients whose veins are close to the skin. Some treatments also require multiple injections.
Patients who undergo conventional treatments usually take a longer time to recover. They also have to wear compression stockings for one to three weeks after treatment, which can be uncomfortable in Singapore’s hot and humid weather. With the superglue treatment, patients are able to go home within an hour of the procedure.
According to some studies, the superglue method is as effective as conventional techniques. The condition did not recur for 99 per cent of patients three months after the procedure, and for 94 per cent after two years.
Venous insufficiency is a common condition: one in five people suffer from it worldwide. However, according to Dr Chong, this condition is largely undiagnosed and untreated.
“Most people just don’t know about it. Their legs may feel heavy and they may see unsightly varicose veins and pigmentation, which they think is a normal part of ageing. They also tend to think it is just a cosmetic problem even though it is not. It can become a serious medical condition,” he said.
In its early stages, putting the feet up is often enough to relieve the feelings of heaviness or fatigue. As the condition advances, however, unsightly varicose veins, swelling of the leg, discolouration of the skin, eczema and ulcers can develop. One study suggests that 30 per cent of untreated patients will have more serious problems within six years, including the chance of the vein rupturing and bleeding heavily.
The condition tends to affect the elderly, the obese, pregnant women and those who have to stand for long periods of time. It also is more common among people with a family history of the problem.
Patients who notice symptoms such as swelling of the legs and ankles, feelings of heaviness, fatigue, aching, cramping, burning or itching in the legs, as well as a discoloration of the skin, ulcers and open wounds should seek medical advice.
Beyond aesthetic improvements, symptoms such as swelling, heaviness, aching, cramping and itching should be alleviated once venous insufficiency is treated, Dr Chong said. “After a long day, legs will feel lighter and patients will experience an improvement to their quality of life.”
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