Cyanoacrylate glue for saphenous ablation

Although surgical treatment of saphenous vein incompetence is still the most adopted approach worldwide, endovenous thermal ablation of superficial truncal veins is firmly established in the armamentarium of phlebologists in some countries for the ablation of saphenous and non-saphenous veins. Reported results are equal to or better than surgical treatment in terms of postoperative pain and return to full activities.¹ One of the technical challenges of the thermal ablation procedure is the instillation of tumescent anesthesia into the saphenous sheath under ultrasound guidance. This promotes patient comfort allowing the procedure to be carried out in an ambulatory setting. Ultrasound guided tumescent anesthesia is arguably the most difficult hurdle for operators who are new to the procedure. It also represents the most painful part of thermal ablation for the patient. While there is no high-level scientific evidence to support the use of compression following thermal ablation, in practice, nearly everyone utilizes some form of compression for up to several weeks following the procedure because anecdotal evidence suggests that patients are significantly more comfortable and enjoy better postoperative recovery.