Glue Therapy for Incompetent Perforator Management in Varicose Vein Disease -A New Approach at IR Facilities.

Varicose vein disease is a  venous  disorder affecting the superficial veins of legs  leading to  symptoms like pain, swelling, and complications like venous ulcers. One of the important cause of varicose vein disease  are  incompetent perforators  which distorts normal venous circulation leading to  symptoms and can lead to failure of  therapy. Traditional treatments for incompetent perforator veins include open surgery, sclerotherapy, radio frequency ablation  and endogenous laser therapy . 

In recent times a new technique has been used called glue therapy using cyanoacrylate adhesive .It has emerged as an effective, painless, and minimally invasive alternative for managing incompetent perforator . This innovative approach offers high success rates with little discomfort thus making it a promising choice for both patients and vascular specialists.

Incompetent Perforator Veins -Anatomy 

Perforator veins are connections between  the superficial venous system and  deep veins .It allows.  proper blood circulation. When these veins become incompetent due to failure of valves ,it leads to reverse flow leading to increased venous pressure. This contributes to varicose vein symptoms such as:

• Leg pain and heaviness
• Swelling and skin changes
• Venous ulcers (in severe cases)

Addressing IPV reflux is essential to preventing disease progression and improving patient outcomes.

What Is Glue Therapy?

Glue therapy is a new technique which uses glue  adhesive to block incompetent perforators .Originally it was used for  treating saphenous vein incompetence and has gained importance  for perforator vein management due to its efficacy and minimal pain.

Procedure 

• The incompetent perforators  are identified using  ultrasound in sitting and standing position.
• A  small needle is used to deliver the glue  into the vein.
• The glue polymerizes in its contact with blood, sealing the vein .
• Over time, the treated vein hardens and is naturally absorbed.

Unlike thermal-based treatments (RFA, EVLT), glue therapy does not require heat or tumescent anesthesia, making it nearly painless and reducing the risk of complications.

Advantages of Glue Therapy for IPVs

• Painless and Comfortable Procedure.
• No need for local or tumescent anesthesia (which can cause discomfort).
• No thermal energy, avoiding nerve injury or burns.
• Quick procedure with minimal patient discomfort.

Minimally Invasive

Performed using small needle puncture, and requiring no major  incisions .

 Patients can resume daily activities immediately, unlike surgery or laser treatments that may require longer recovery.

 High Efficacy and Long-Term Results

Studies indicate high closure rates (90-95%) for perforator veins treated with cyanoacrylate glue.

Long-lasting results, with sealed veins gradually disappearing over months.

Low Risk of Complications

Unlike thermal ablation, glue therapy does not damage surrounding nerves (a major concern with RFA and EVLT).

There is minimal risk of deep vein thrombosis  or hyperpigmentation, which may occur with sclerotherapy.

The procedure is associated with minimal bruising, inflammation, or discomfort post-procedure.

Who Can Benefit from Glue Therapy?

This treatment is ideal for patients who:

• Present with incompetent perforator veins confirmed by Doppler ultrasound.

• Patient aspiring  for a painless, non-surgical option with a fast recovery time.

• Want to avoid the risks of thermal or chemical treatments.

• Have recurrent varicose veins despite prior interventions.

• Comparison with Other treatments.

Glue therapy stands out as the least painful and most convenient option, especially for patients with perforator vein incompetence.

Potential Limitations of Glue Therapy

While glue therapy is highly effective, some considerations include:

• Some patients may experience localized redness or itching.

• Allergic reactions to glue are Rare but possible.

• The treatment may be more expensive than sclerotherapy .

Conclusion

Glue therapy for incompetent pretreatment  is a novel  advancement in varicose vein treatment. It  not only minimizes the need for painful injections, heat-based perforator in  interventions. It also offers short recovery time and nearly painless, highly effective, and safe alternative.

There is  growing support for  glue therapy in perforator management and has  become the gold standard for treating incompetent perforator veins. Patients have lasting relief and improved quality of life.