Venaseal

System for the endovenous, non-thermal closure of a deficient vein by means of N-butyl cyanoacrylate adhesive So far it has only been approved for the therapy of the truncal vein. Approval has been granted in Europe since 9/2011 and in the USA since 2/2015 - and as of 2016 it is the most expensive procedure on the market.

The special mixture of the adhesive differs from the cyanoacrylate adhesives previously used in medicine by the following properties:

• Reduced polymerization time
• Viscosity increased - risk of embolization minimized
• Galenics have been changed - patient notices the adhesive neither in movement nor at rest

Contact of the adhesive with anionic substances (e.g. blood cells, vascular endothelium, blood plasma) leads to polymerisation with consecutive destruction of endothelium and underlying muscularis. This leads to a fibrotic remodelling process of the vein with (preferably complete) closure.

The study data published so far show good results. The occlusion rates in monocentric and multicentric studies are 93-100% with a follow-up of up to 12 months. The risk of recanalization increases from a vein diameter of 10mm with increasing cross section.

• Ultrasound-guided puncture of the vein with a G18 venous indwelling cannula below the distal insufficiency point
• Insertion of the guide wire using the Seldinger technique
• Small incision expansion at the puncture site
• Inserting the sheath over the guide wire
• Ultrasonic controlled placement of the airlock in the area of the crossbar
• Guide wire and dilator removal
• Block of the lock with saline syringe
• Ultrasound controlled placement of the airlock in front of the cross
• Insertion of the adhesive catheter through the sheath - placement 5cm in front of the deep vein (CAVE - in case of the saphenous vein this placement has to be adapted to the anatomical conditions!)
• Tilt the treatment table to 5 degrees head-down position
• Impression of the crosses with the ultrasound head and insertion of 0.10ml adhesive
• Retraction of the catheter by 1cm, renewed delivery of 0.10ml adhesive
• Retraction of the catheter by 3cm
• Compression of the bonded part by hand (3 minutes)
• Compression of the vein with the ultrasound probe and insertion of 0.10 ml adhesive
• Retraction of the catheter by 3cm
• Compression of the bonded part by hand (30 seconds)
• Repeat the last two steps until the puncture site
• CAVE - do not leave any adhesive in the puncture site when removing the catheter!

• often painful postoperatively when treating superficial vein sections
• thrombosis, embolism
• on the part of current users, further risks such as haematomas, incorrect pigmentation or neuropathies known from other varicose vein therapies are negated.

The Venaseal system allows treatment without tumescent anesthesia or general anesthesia. Complications such as nerve injuries, haematoma formation or burns - as with thermal procedures - do not occur. Immediately after the treatment, the patient can go about his daily activities and do sports. Compression therapy is also not necessary.

• Alm J (2015) Venous adhesive Venaseal in:Endovenous procedure. Schattauer Stuttgart, 1st edition, 136-156
• Proebstle et al (2013) The European multicenter study on cyanoacrylate embolization of refluxing great saphenous veins without tumescent anaesthesia and without compression therapy. J Vasc Surg 1:101