Saphenion® fact-check vein glue for varicose veins

Saphenion® fact-check vein glue for varicose veins – update 36

The Saphenion® fact-check vein glue for varicose veins has been published by us in regular succession for 7 years and aims to compare international publications on the subject with our own experiences and to remain meaningful. Our patients are now very well informed about this therapy method for varicose veins, which has been offered for 10 years. After 9 years of use, including June / 2021, we have so far treated 1676 patients on 3281 saphenous veins – over 300,000 patients worldwide have now been treated with the vein glue VenaSeal®.

In the meantime, we have successfully used the vein glue VenaSeal® to cleanse the venous system in 12 patients with COVID-19 infection after they have recovered. Of course, slightly adapted hygiene measures in the operating room and in the practice are necessary. However, these are kept within practical limits in an outpatient specialist practice that works surgically and with catheter medicine, since the hygiene status is already primarily increased.

Saphenion® fact-check vein glue for varicose veins-News from the german specialist association for vein medicine

The German Society for Vein Medicine (DGP) also includes therapy with the vein glue VenaSeal® as a therapy recommendation for the therapy of trunk varicosis in the current guidelines „S2k -guideline for diagnosis and therapy of varicosis“.

Together with colleagues from Munich, Hildesheim, Cologne, Düsseldorf, Saphenion® Berlin / Rostock discussed and founded a „VenaSeal® network“ in spring 2020 on the occasion of the „Bonn Vein Days“. Our aim is to summarize the results of the therapy with the vein glue, to exchange experiences and to communicate them to our patients, and also to become scientifically active. In November 2020 our joint „German Multicenter Study VenaSeal®“ was published.

Saphenion® fact-check vein glue for varicose veins

109 months ago we were started using vein glue in the treatment of varicose veins. There are now 3281 treated veins in the surgery book. We have used vein glue in 1676 patients so far.

In addition to many well-informed patients who are now directly requesting this therapy method, statutory health insurance companies have also recognized the – no longer so new – a procedure in some cases.

Saphenion® factcheck vein glue for varicose veins – Most private insurance companies have also accepted the therapy option of vein gluing varicose veins as part of the cost estimates presented. Likewise, according to reports from our patients, the federal aid offices, the states of Berlin / Brandenburg, Mecklenburg, Saxony / Anhalt, Saxony, and Thuringia as well as Lower Saxony and Schleswig – Holstein are ready to cover the costs of this therapy method, which was approved in Europe in 2011. If in doubt, our patients should speak to their insurance company before arranging a therapy appointment.

Saphenion® fact check vein glue for varicose veins – long-term results

After 109 months of practical work with the vein glue, we see – like the international studies – the high effectiveness with a very low rate of side effects. Initially approved and used by the manufacturer exclusively for normal-caliber saphenous veins, the adhesive has conquered other areas of application in endovenous therapy. Ectatic veins and aneurysms are now successfully treated with venous glue.

This becomes clear in the analysis of the literature. Colleagues from the USA, Korea and Holland, Russia and Hong Kong have presented 3-5 year studies. In addition to our own 8-year long-term study and the German VenaSeal® multicenter study, Morrisson et al. A 5-year study was presented, as was Gibbson et al. The results are almost identical in all studies, the closure rate after these long periods of time is between 94-97%.

Our results after 109 months of use are a 96,05% closure rate.

This means that the vein glue is more effective than the established radio wave system – but with significantly fewer side effects and a shorter post-op recovery phase. The ability to work is restored on the same day approx. 3 hours after the therapy – or – if sedation is used, the following day.

Gibson K, Morrison N, Kolluri R, Vasquez M, Weiss R, Cher D, Madsen M, Jones A. Twenty-four month results from a randomized trial of cyanoacrylate closure versus radiofrequency ablation for the treatment of incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord. 2018 Sep;6(5):606-613. doi: 10.1016/j.jvsv.2018.04.009. Epub 2018 Jun 15. PubMed PMID: 29914814.

Tang TY, Yap CJQ, Chan SL, Soon SXY, Yap HY, Lee SQW, Choke ETC, Chong TT. Early results of an Asian prospective multicenter VenaSeal real-world postmarket evaluation to investigate the efficacy and safety of cyanoacrylate endovenous ablation for varicose veins. J Vasc Surg Venous Lymphat Disord. 2021 Mar;9(2):335-345.e2. doi: 10.1016/j.jvsv.2020.03.020. Epub 2020 May 7. PMID: 32387378.

Saphenion® fact-check: Vein glue for varicose veins – therapy extension leg ulcer

The treatment of the so-called „open leg“ (ulcus cruris) has become much simpler, more effective, and more effective. The vein glue can also be used in a minimally invasive manner for the most severe findings. So far we have used the venous glue in 26 patients with leg ulcers – with great success!

O’Banion LA, Reynolds KB, Kochubey M, Cutler B, Tefera EA, Dirks R, Kiguchi MM. Treatment of superficial venous reflux in CEAP 6 patients: a comparison of cyanoacrylate glue and radiofrequency ablation techniques. J Vasc Surg Venous Lymphat Disord. 2021 Jan 13:S2213-333X(21)00001-9. doi: 10.1016/j.jvsv.2020.12.082. Epub ahead of print. PMID: 33453440.

Park I. Successful use of VenaSeal system for the treatment of large great saphenous vein of 2.84-cm diameter. Ann Surg Treat Res. 2018 Apr;94(4):219-221. doi: 10.4174/astr.2018.94.4.219. Epub 2018 Mar 26. PubMed PMID: 29629358; PubMed Central PMCID: PMC5880981.

Saphenion® fact-check vein glue for varicose veins – sealing perforator veins

The human venous system has around 140 pairs of perforated veins, the majority of which are located on the lower leg. Of these connecting veins, about 18-20 pairs of veins are of clinical importance. That is why they are also called key perforation veins. In over 60% of cases, these veins appear as a pair and accompany skin arteries as they pass through muscle fascia to the skin.

Therapy of perforating varicose veins with venous glue: This technique provides an elegant and safe way to close the perforating veins at the same time as the therapy of the trunk varicose veins using venous glue. On the one hand, perforation veins are already closed during the catheter maneuvre in the trunk vein by dispensing an additional drop of glue at the mouth (ultrasound control!). On the other hand, after sealing the saphenous veins, we also puncture and glue the perforating vein directly under sight in the same session with the puncture needle lying on the operating table.

Kiguchi MM, Reynolds KB, Cutler B, Tefera E, Kochubey M, Dirks R, Abramowitz SD, Woo EY, O’Banion LA. The need for perforator treatment after VenaSeal and ClosureFast endovenous saphenous vein closure in CEAP 6 patients. J Vasc Surg Venous Lymphat Disord. 2021 Jun 7:S2213-333X(21)00295-X. doi: 10.1016/j.jvsv.2021.04.020. Epub ahead of print. PMID: 34111593.

Saphenion® fact-check vein glue for varicose veins: arterial occlusion

Saphenion has also started to treat patients who are suffering from an arterial occlusive disease (smoker’s leg) and at the same time also have functionally defective truncal varicose veins using VenaSeal® at the same time – or before the operation on the arteries – initially on the diseased veins. With this, a weighty dogma of vascular surgery – the primacy of arterial therapy – could now be repealed!

Saphenion® fact-check vein glue for varicose veins – outpatient therapy for seriously ill people

We now treat dementia or debilitating patients, Parkinson’s disease sufferers, and trisomy patients on an outpatient basis with light sedative medication. Systemic infectious diseases such as hepatitis, Covid-19, or HIV are also not a contraindication – patients with these underlying diseases have been successfully treated with the venous glue several times – without side effects.

Multiallergic diseases are also no contraindications for treatment with vein glue. Patients with lifelong thrombosis/embolism therapy can be successfully treated on an outpatient basis without discontinuing or changing the permanently necessary medication.

Saphenion® fact-check vein glue for varicose veins: Therapy for adolescents

In the past, varicose vein therapy was practiced with great caution in children and adolescents. The well-known radical surgical „stripping“ – pulling out the trunk and side branch varicose veins was, in the imagination of the vascular surgeons, really unsuitable for working on the legs of young people – unless there was an acutely life-threatening finding (thrombosis) or a malformation (vascular tumor).

Since the year 2000, catheter-supported procedures have been introduced into the therapy of stem varicosis – microfoam, radio wave, laser, superheated steam, vein glue. Long-term results are now available – the radio wave and the vein glue have also been proven to be effective in large-caliber veins> 1.5 cm in diameter. No more reason to exercise restraint with the young patient. No longer a reason to practice a medically senseless wait-and-see attitude with the proven varicose vein because of radical surgical techniques. This no longer heals, not with cream, gel, or tablet and not even with compression stocking!

On the contrary, catheter procedures offer considerable advantages, especially for the young patient group, when one thinks of the side effects and complications of radical surgical techniques. And fully thought of the end of the therapy options, the cold „non-thermal“ procedures vein glue and microfoam are the best for the therapy of young patients. No anesthesia, no extensive anesthesia – injections and with the VenaSeal® vein glue no more compression stockings. And we achieve immediate mobility for the adolescent patient.

Saphenion® fact-check vein glue for varicose veins: pregnancy

The classic therapy methods here are compression therapy with custom-made stockings or, better still, tights, manual lymph and tissue massages and alternating showers, cold showers, and lots of exercises – midwives and obstetricians are very familiar with this.

The situation is different with functionally defective side branches and trunk varicose veins. Incidentally, as is known from reticulate veins and spider veins, these do not largely regress after delivery and weaning! There is a risk of serious complications, such as phlebitis or even thrombosis, especially during pregnancy (hormones and mechanical stress).

So far, the dogma has been that no active therapy methods are used to treat truncal varicosis during pregnancy!

Phlebitis is treated with compression therapy, the administration of antithrombotic drugs that do not flow through the placenta into the unborn child, and, if necessary, suction of the thrombosed blood from the inflamed vein. Under certain circumstances, however, active therapy on the trunk varicose veins may also be necessary from a prophylactic point of view. This must not result in anesthesia or large-scale injections of local anesthetics, as these drugs also reach the fetus via the placenta. A small local anesthetic must be enough! Conventional methods, stripping and phlebectomy are completely eliminated, lasers and radio waves are not feasible without general anesthesia or tumescence.

In clinical use for 10 years, we now have a catheter-supported procedure with the necessary criteria for use during pregnancy, vein gluing using VenaSeal® – Closure. Anesthesia is no longer necessary, the adhesive cannot cross the placenta after extensive tests by the American health authority FDA and the pregnant woman is in no way immobilized after the minimally invasive catheter operation.

Under strict consideration of the indications for this procedure – severe pain symptoms in the patient, phlebitis and threatened thrombosis as well as severe infectious skin changes and ulcerations – this can be carried out after extensive information and the sole will of the patient.

Saphenion® fact-check vein glue for varicose veins – side effects and complications

A current search in the international specialist literature in preparation for this update has described the occurrence of contact dermatitis (skin inflammation after contact with cyanoacrylate) in 4 cases (in > 290,000 patients!) And in only one case an – alleged – VenaSeal® – allergy. Further complications during use or in the post-op course are still not shown. Even after 1676 patients and 3281 treated veins, we have not yet seen a VenaSeal® allergy

Fiengo L, Gwozdz A, Tincknell L, Harvey V, Watts T, Black S. VenaSeal closure despite an allergic reaction to n-butyl cyanoacrylate. J Vasc Surg Cases Innov Tech. 2020;6(2):269-271. Published 2020 Apr 10th. doi:10.1016/j.jvscit.2020.03.011

Jones AD, Boyle EM, Woltjer R, Jundt JP, Williams AN.J Vasc Surg Cases Innov Tech. 2019 Aug 7;5(3):372-374. doi: 10.1016/j.jvscit.2019.05.004. eCollection 2019 Sep.PMID: 31440717 

Navarro-Triviño FJ, Cuenca-Manteca J, Ruiz-Villaverde R. Allergic contact dermatitis with systemic symptoms caused by VenaSeal. Contact Dermatitis. 2020;82(3):185-187. doi:10.1111/cod.13431

Watts TJ, Thursfield D, Haque R. Allergic contact dermatitis caused by VenaSeal tissue adhesive. Contact Dermatitis. 2019;80(6):393-395. doi:10.1111/cod.13206

Our own experiences with the allergy in question to the vein glue have recently been presented in an international publication:

Our statement on alleged phlebitis after the venous glue – it is a tissue reaction of the surrounding tissue – has also been confirmed many times in further scientific studies:

Gibson K, Minjarez R, Rinehardt E, Ferris B. Frequency and severity of hypersensitivity reactions in patients after VenaSeal™ cyanoacrylate treatment of superficial venous insufficiency. Phlebology. 2020;35(5):337-344. doi:10.1177/0268355519878618

Nasser H, Ivanics T, Shakaroun D, Lin J. Severe phlebitis-like abnormal reaction following great saphenous vein cyanoacrylate closure. J Vasc Surg Venous Lymphat Disord. 2019 Jul;7(4):578-582. doi: 10.1016/j.jvsv.2019.03.010. Epub 2019 May 8. PubMed PMID: 31078516.

Park I, Jeong MH, Park CJ, Park WI, Park DW, Joh JH. Clinical Features and Management of „Phlebitis-like Abnormal Reaction“ After Cyanoacrylate Closure for the Treatment of Incompetent Saphenous Veins. Ann Vasc Surg. 2019;55:239-245. doi:10.1016/j.avsg.2018.07.040

Park I. Human Saphenous Vein Histopathology 2 Years After Cyanoacrylate Closure Using the VenaSeal™ System. Ann Vasc Surg. 2021 Feb;71:534.e17-534.e21. doi: 10.1016/j.avsg.2020.09.017. Epub 2020 Sep 16. PMID: 32949737.

Tang TY, Tiwari A. The VenaSeal™ Abnormal Red Skin Reaction: Looks Like but is not Phlebitis!. Eur J Vasc Endovasc Surg. 2018;55(6):841. doi:10.1016/j.ejvs.2018.02.003

In a large American meta-analysis, all results and experiences on VenaSeal® therapy published by us and presented in our news were confirmed:

Kolluri R, Chung J, Kim S, Nath N, Bhalla BB, Jain T, Zygmunt J, Davies A. Network meta-analysis to compare VenaSeal with other superficial venous therapies for chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 2020 Feb 13. PII: S2213-333X(19)30702-4. doi: 10.1016/j.jvsv.2019.12.061. [Epub ahead of print] Review. PubMed PMID: 32063522.

Saphenion® fact-check vein glue for varicose veins – 109 months of therapy experience

Based on the 109 months of practical experience with 3281 treated saphenous veins in 1676 patients, we would like to confirm from our clinical and professional point of view for the fact check:

The vein glue is fully biocompatible, so far, after 9 years of use (109 months), we have not seen any allergies. There are two works in the literature that describe a contact allergy of the skin after touching the glue. Allergies after injection into the varicose veins have only been described in one case worldwide.

The rate of side effects is therefore well below that of comparable thermal endovenous techniques (laser, radio wave) in the treatment of truncal varicose veins.

The bioresorption of the glue takes between 12 and 24 months. The same resorption processes can also be found in humans as in the more than 150 publications on bioresorption in animals. The resorption models in animal experiments all show a biological degradation of the cyanoacrylate adhesive between 4 and 9 months. The absorption of the adhesive can also be followed macroscopically with regular ultrasound controls.

But not only that: We now have our own histological findings from human veins 10-14 months after endovenous cyanoacrylate adhesion. All four cases examined, show a complete breakdown of the glue in the remnants of the vein. And here too, in addition to our own results, there is now another publication:

Almeida JI, Murray SP, Romero ME. Saphenous vein histopathology 5.5 years after cyanoacrylate closure. J Vasc Surg Venous Lymphat Disord. 2019 Jul 4. PII: S2213-333X(19)30325-7. doi: 10.1016/j.jvsv.2019.04.014. [Epub ahead of print] PubMed PMID: 31281102.

Saphenion® fact-check vein glue for varicose veins – therapy on the lower leg veins, risk of recurrence

Thermal therapy (laser, radio wave, superheated steam) on the lower leg has now been put in a critical light internationally and also nationally, since the number of nerve lesions after thermal therapy cannot be neglected. At the annual meeting of the German Society for Vein Medicine in early September 2020 in Leipzig, this topic was discussed again openly. As a result, the majority took a critical stance on thermal therapy of the small saphenous vein and the great saphenous vein on the lower leg as well as the therapy of perforating veins using laser or radio waves. These reservations now also apply to the treatment of recurrent varicose veins after radical surgical stripping.

Here, many colleagues now recommend doing without the thermal laser and radio wave methods; alternatively, catheter-supported microfoam therapy or vein glue is possible. Based on our experience, based on our own study on over 1000 patients, we have defined an indication for microfoam or VenaSeal®. We treat trunk veins on the lower leg with a diameter of up to 0.45 cm with microfoam, trunk veins with a larger diameter are treated with venous glue.

This means that our alternative recommendation for radio waves for the saphenous veins on the lower leg, as we have previously stated in our educational discussions, is no longer applicable. We are now treating the lower leg exclusively with non-thermal methods.

This procedure was currently also anchored in the „Current guidelines for the therapy of varicosis“ of the DGP.

Saphenion® fact-check vein glue for varicose veins – varicose vein aneurysm

Also in aneurysmatic varicose veins until a diameter of 2,8 cm, VenaSeal® vein glue is effective and safe in therapy.

Saphenion® fact-check vein glue – spider veins and reticular veins?

The vein glue for varicose veins is not – as can be read here and there and also requested – suitable for the therapy of cosmetically disturbing reticular veins and spider veins. The microfoam, which has been the „gold standard“ since 2010, is available as a combination therapy.

A simultaneous double therapy with microfoam (ethoxysklerol) is possible but carries the risk of phlebitis. Scientific studies on this combination therapy have Gibson et al. submitted. It is important to first wait for the trunk varicose veins to heal – in many cases, there is a significant decrease in the lateral branch varicosis! This fact is also taken into account with Saphenion® and we only carry out the necessary microfoam therapies 14-21 days after the VenaSeal® – therapy.

Photo / Video: Claudia, Madleen, Utzius

Papers / Links

Copy of page 11 of the FDA approval for the biocompatibility of the VenaSeal® vein adhesive:

Table 4: Results of Biocompatibility Testing – VenaSeal Adhesive (Polymerized and the Unpolymerized States) Test Method Reference Results Cytotoxicity (Elution Method) ISO 10993-5.

The cumulative results of the VenaSeal adhesive material cytotoxicity testing, in combination with assessments of toxicological risk and in vivo use, support an overall favorable cytotoxicity profile for the VenaSeal adhesive material per its intended use.

ISO MaximizationSensitization Study(Guinea Pigs)ISO 10993-10VenaSeal adhesive does not elicit a sensitization response

ISO Intracutaneous Reactivity – ISO 10993-10: The cumulative results support that the VenaSeal® adhesive material does not cause intracutaneous reactivity (Material Mediated Rabbit Pyrogenicity

ISO 10993-5US Pharmacopeia Section 151: The cumulative results support that the VenaSeal adhesive material is non-pyrogenic.

Acute Systemic Toxicity- ISO 10993-11: The cumulative results support that the VenaSeal adhesive material is not considered to cause acute systemic toxicity

Subacute / Subchronic ToxicityImplantation (13 weeks) – ISO 10993-11 / ISO 10993-6: The cumulative results support that the VenaSeal adhesive material does not result in any specific adverse systemic toxicological findings in the tissues examined Genotoxicity (Bacterial Mutagenicity, invitro Mouse Lymphoma Assay, Mouse Micronucleus Assay)

ISO 10993-3: The cumulative results support that the VenaSeal adhesive material is non-mutagenic Hemo-compatibility (Hemolysis, Complement Activation, Partial Thromboplastin Time, Platelet and Leukocyte Count), ASTM F-756-08

ISO 10993-4: The cumulative results support that the VenaSeal adhesive material is non-hemolytic and not chronic toxicity Implantation (26 Weeks)

ISO 10993-11/ ISO 10993-6: The cumulative results support that VenaSeal – adhesive does not cause any significant adverse systemic or local toxicity in the tissues examined.

Quelle: Summary – Food and Drug Administration / FDA

Almeida JI, Murray SP, Romero ME. Saphenous vein histopathology 5.5 years after cyanoacrylate closure. J Vasc Surg Venous Lymphat Disord. 2020 Mar;8(2):280-284. doi: 10.1016/j.jvsv.2019.04.014. Epub 2019 Jul 4. PubMed PMID: 31281102.

Chan YC, Law Y, Cheung GC, Ting AC, Cheng SW. Cyanoacrylate glue used to treat great saphenous reflux: Measures of the outcome. Phlebology. 2017 Mar;32(2):99-106. doi: 10.1177/0268355516638200. Epub 2016 Jul 9. PubMed PMID: 27052039.

Chan SSJ, Yap CJQ, Tan SG, Choke ETC, Chong TT, Tang TY. The utility of endovenous cyanoacrylate glue ablation for incompetent saphenous veins in the setting of venous leg ulcers. J Vasc Surg Venous Lymphat Disord. 2020 Mar 20. PII: S2213-333X(20)30100-1. doi: 10.1016/j.jvsv.2020.01.013. [Epub ahead of print] PubMed PMID: 32205130.

Cho S, Park HS, Lee T, Byun SJ, Yun WS, Yang SS, Kim H, Kim WS, Joh JH, Jung IM. CASS (CyanoAcrylate closure versus Surgical Stripping for incompetent saphenous veins) study a randomized controlled trial comparing clinical outcomes after cyanoacrylate closure and surgical stripping for the treatment of incompetent saphenous veins. Trials. 2020 Jun 3;21(1):460. doi: 10.1186/s13063-020-04393-0. PMID: 32493398; PMCID: PMC7268719.

Gibson K, Ferris B. Cyanoacrylate closure of incompetent great, small, and accessory saphenous veins without the use of post-procedure compression: Initial outcomes of a post-market evaluation of the VenaSeal System (the WAVES Study). Vascular. 2017 Apr;25(2):149-156. doi: 10.1177/1708538116651014. Epub 2016 Jul 9. PubMed PMID: 27206470.

Gibson K, Morrison N, Kolluri R, Vasquez M, Weiss R, Cher D, Madsen M, Jones A. Twenty-four month results from a randomized trial of cyanoacrylate closure versus radiofrequency ablation for the treatment of incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord. 2018 Sep;6(5):606-613. doi: 10.1016/j.jvsv.2018.04.009. Epub 2018 Jun 15. PubMed PMID: 29914814.

Jones AD, Boyle EM, Woltjer R, Jundt JP, Williams AN.J Vasc Surg Cases Innov Tech. 2019 Aug 7;5(3):372-374. doi: 10.1016/j.jvscit.2019.05.004. eCollection 2019 Sep.PMID: 31440717 

Jones AD, Boyle EM, Woltjer R, Jundt JP, Williams AN. Persistent type IV hypersensitivity after cyanoacrylate closure of the great saphenous vein. J Vasc Surg Cases Innov Tech. 2019 Aug 7;5(3):372-374. doi: 10.1016/j.jvscit.2019.05.004. eCollection 2019 Sep. PubMed PMID: 31440717; PubMed Central PMCID: PMC6699189.

Kiguchi MM, Reynolds KB, Cutler B, Tefera E, Kochubey M, Dirks R, Abramowitz SD, Woo EY, O’Banion LA. The need for perforator treatment after VenaSeal and ClosureFast endovenous saphenous vein closure in CEAP 6 patients. J Vasc Surg Venous Lymphat Disord. 2021 Jun 7:S2213-333X(21)00295-X. doi: 10.1016/j.jvsv.2021.04.020. Epub ahead of print. PMID: 34111593.

Kolluri R, Chung J, Kim S, Nath N, Bhalla BB, Jain T, Zygmunt J, Davies A. Network meta-analysis to compare VenaSeal with other superficial venous therapies for chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 2020 Feb 13. PII: S2213-333X(19)30702-4. doi: 10.1016/j.jvsv.2019.12.061. [Epub ahead of print] Review. PubMed PMID: 32063522.

Nasser H, Ivanics T, Shakaroun D, Lin J. Severe phlebitis-like abnormal reaction following great saphenous vein cyanoacrylate closure. J Vasc Surg Venous Lymphat Disord. 2019 Jul;7(4):578-582. doi: 10.1016/j.jvsv.2019.03.010. Epub 2019 May 8. PubMed PMID: 31078516. 

Navarro-Triviño FJ, Cuenca-Manteca J, Ruiz-Villaverde R. Allergic contact dermatitis with systemic symptoms caused by VenaSeal. Contact Dermatitis. 2020 Mar;82(3):185-187. doi: 10.1111/cod.13431. Epub 2019 Nov 15. PubMed PMID: 31674037.

Park I. Successful use of VenaSeal system for the treatment of large great saphenous vein of 2.84-cm diameter. Ann Surg Treat Res. 2018 Apr;94(4):219-221. doi: 10.4174/astr.2018.94.4.219. Epub 2018 Mar 26. PubMed PMID: 29629358; PubMed Central PMCID: PMC5880981.

Park I. Initial Outcomes of Cyanoacrylate Closure, VenaSeal System, for the Treatment of the Incompetent Great and Small Saphenous Veins. Vasc Endovascular Surg. 2017 Nov;51(8):545-549. doi: 10.1177/1538574417729272. Epub 2017 Oct 2. PubMed PMID: 28969499.

Park I, Kim D. Correlation Between the Immediate Remnant Stump Length and Vein Diameter After Cyanoacrylate Closure Using the VenaSeal System During Treatment of an Incompetent Great Saphenous Vein. Vasc Endovascular Surg. 2019 Oct 3:1538574419879563. doi:10.1177/1538574419879563. [Epub ahead of print] PubMed PMID: 31581906.

Shaĭdakov EV, Mel’tsova AZ, Porembskaia OI, Kudinova EA, Korzhevskiĭ DÉ, Kirik OV, Sukhorukova EG. [Experience with using cyanoacrylate glue in endovascular treatment of varicose veins]. Angiol Sosud Khir. 2017;23(4):62-67. Russian. PubMed PMID: 29240057.

Lam YL, De Maeseneer M, Lawson J, De Borst GJ, Boersma D. Expert review on the VenaSeal® system for endovenous cyanoacrylate adhesive ablation of incompetent saphenous trunks in patients with varicose veins. Expert Rev Med Devices. 2017 Oct;14(10):755-762. doi: 10.1080/17434440.2017.1378093. Review. PubMed PMID: 28892412.

Lane TR, Kelleher D, Moore HM, Franklin IJ, Davies AH. Cyanoacrylate glue for the treatment of great saphenous vein incompetence in the anticoagulated patient. J Vasc Surg Venous Lymphat Disord. 2013 Jul;1(3):298-300. doi: 10.1016/j.jvsv.2012.09.007. Epub 2013 Feb 15. PubMed PMID: 26992590.

Morrison N, Gibson K, McEnroe S, Goldman M, King T, Weiss R, Cher D, Jones A. Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous veins (VeClose). J Vasc Surg. 2015 Apr;61(4):985-94. doi: 10.1016/j.jvs.2014.11.071. Epub 2015 Jan 31. PubMed PMID: 25650040.

Morrison N, Gibson K, Vasquez M, Weiss R, Jones A. Five-year extension study of patients from a randomized clinical trial (VeClose) comparing cyanoacrylate closure versus radiofrequency ablation for the treatment of incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord. 2020 Mar 20. PII: S2213-333X(20)30105-0. doi: 10.1016/j.jvsv.2019.12.080. [Epub ahead of print] PubMed PMID: 32205125.

O’Banion LA, Reynolds KB, Kochubey M, Cutler B, Tefera EA, Dirks R, Kiguchi MM. Treatment of superficial venous reflux in CEAP 6 patients: a comparison of cyanoacrylate glue and radiofrequency ablation techniques. J Vasc Surg Venous Lymphat Disord. 2021 Jan 13:S2213-333X(21)00001-9. doi: 10.1016/j.jvsv.2020.12.082. Epub ahead of print. PMID: 33453440.

Park I. Human Saphenous Vein Histopathology 2 Years After Cyanoacrylate Closure Using the VenaSeal™ System. Ann Vasc Surg. 2021 Feb;71:534.e17-534.e21. doi: 10.1016/j.avsg.2020.09.017. Epub 2020 Sep 16. PMID: 32949737.

Tang TY, Yap CJQ, Chan SL, Soon SXY, Yap HY, Lee SQW, Choke ETC, Chong TT. Early results of an Asian prospective multicenter VenaSeal real-world postmarket evaluation to investigate the efficacy and safety of cyanoacrylate endovenous ablation for varicose veins. J Vasc Surg Venous Lymphat Disord. 2021 Mar;9(2):335-345.e2. doi: 10.1016/j.jvsv.2020.03.020. Epub 2020 May 7. PMID: 32387378.

Watts TJ, Thursfield D, Haque R. Allergic contact dermatitis caused by VenaSeal tissue adhesive. Contact Dermatitis. 2019 Jun;80(6):393-395. doi: 10.1111/cod.13206. Epub 2019 Jan 30. PubMed PMID: 30582174.

https://scholar.google.de/scholarq=Resorption+2+butyl+cyanoacrylate&hl=de&as_sdt=0&as_vis=1&oi=scholart

http://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/pdf-Ordner/GOAE/endovenoese_Radiofrequenzobliteration.pdf

Zierau UT and Lahl W: Recurrence Discussion in Varicose Veins Therapy – A Critical Examination of the Vein Stump discussion; J. Vasc. Endovasc. Therapy 2019, Vol.4 No.2:13http://www.saphenion.de/news/konsensus-1-neef-endovenoese-krampfadertherapie/embed/#?secret=kPFV94HWjphttps://vascularnews.com/veclose-venaseal-safe/embed/#?secret=5Wfx465gUI

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