Vein Glue ( Cyanoacrylate/ Venaseal) Gains Traction, But Some Doctors Express Reservations

A medical adhesive, cyanoacrylate (marketed as VenaSeal), secured FDA approval in 2015 and has rapidly become a common method for treating varicose veins, now boasting its CPT ( billing) code (36482). The procedure has garnered favor among some clinicians, citing potentially higher reimbursement rates, the elimination of tumescent injection (a technique some find technically demanding), and the promise of shorter procedure times.

For patients, the initial FDA trials, which did not mandate post-procedure compression stockings, offered an appealing prospect of avoiding these often cumbersome garments.

However, some physicians, including me who have undergone training and performed the procedure are now expressing reservations, particularly when considering younger patients.

One key concern centers on allergic reactions, with approximately 10 percent of patients exhibiting moderate to severe symptoms such as swelling, itching, and hives in response to the glue.

This has led many clinicians to routinely prescribe post-operative steroid packs. Furthermore, the adhesive can cause significant and often permanent shadowing along the treated superficial veins, complicating the crucial postoperative ultrasound evaluation of deep veins for potential blood clots (deep vein thrombosis or DVT).

Alarmingly, a growing number of reported complications, including death and stroke as detailed in the referenced article, stand in contrast to the well-established safety profiles of alternative vein treatments.

The long-term consequences of permanently introducing this adhesive into the body remain unknown. The procedure also necessitates a large procedure room with a dedicated table for device preparation.

Additionally, coverage by commercial insurance plans is not universal.

Counterintuitively, at least for me, the actual procedure time for VenaSeal has often proven longer than that for radiofrequency ablation.

In conclusion, cyanoacrylate adhesive might be a reasonable option for an elderly Medicare patient in their 80s with insurance coverage and a life expectancy of 15 to 20 years, provided they are closely monitored.

However, the same endorsement cannot be extended to younger patients in their 30s and 40s, particularly those without insurance coverage. For this demographic, the long-term safety profile beyond two to three decades remains uncertain. Especially in a setting of safe and effective alternative treatments with broader insurance coverage are readily available.