Comparison Of The Safety And Efficacy Of Endovenous Laser Ablation Under Ultrasound Guided Regional Nerve Blocks With Cyanoacrylate Glue Ablation (Venaseal) In The Treatment Of Lower Limb Varicose Veins

Abstract

Background: In India, varicose veins often go untreated until complications develop. Treatment options include surgery and endovenous ablation techniques, which can be thermal or non-thermal. While Western guidelines usually favor thermal ablation, non-thermal methods, such as cyanoacrylate glue ablation (CGA, VenaSeal), provide alternatives without the discomfort of tumescent anaesthesia. 

Aims and Objectives:  This study compared Endovenous Laser Ablation (EVLA), under regional anaesthesia with VenaSeal for the treatment of lower limb varicose veins. The assessment looked at occlusion rates, pain levels during and after the procedure, changes in r-VCSS and AVVQ scores, complications, time to return to activities, and ulcer healing rates. 

Materials and Methods: After obtaining ethical approval, the study was conducted from January 2024 to February 2025, with a six-month follow-up period. Out of 194 patients enrolled, 170 were included, with 85 in the EVLA group and 85 in the VenaSeal group. Medical histories, exams, and ultrasound evaluations were done, and baseline VCSS and AVVQ scores were noted. Pain was assessed during and after the procedures. Patients were checked one week, one month, three months, and six months after the procedure. Follow-ups evaluated occlusion rate, VCSS and AVVQ scores, ulcer size, complications, return to activities, and reflux. 

Results and Observation: Both EVLA and VenaSeal achieved complete vein occlusion in all patients. VenaSeal showed lower AVVQ scores and rVCSS compared to EVLA. Ulcer healing rates were similar at six months. EVLA experienced more complications (27.1%), primarily bruising, while VenaSeal's main issue was phlebitis. Using regional anaesthesia during EVLA reduced periprocedural pain, but 62% of patients had severe motor block. There was no difference in post-procedure pain between the two interventions. Patients treated with VenaSeal returned to activities and work sooner than those treated with EVLA. 

Conclusion: VenaSeal, a non-thermal technique, is more effective than EVLA with regional anaesthesia. It offers a better quality of life, fewer complications, and quicker recovery