Lessons Learned at the Venaseal Varicose Vein Training Program
Varicose Vein Glue vs. Traditional Treatment for Varicose Veins
This article’s target audience is meant for both the vein doctor and the varicose vein patient audience.
I believe it will benefit both.
Medical jargon is explained simply so everyone can easily understand.
Recently, I attended the Advanced Chronic Venous Summit in Minneapolis sponsored by Medtronic, the manufacturer of the Venaseal Closure System.
This was a tremendous introduction to learn a new vein closing technique before treating patients. Included in the Medtronics program were didactic lectures by four acclaimed vascular surgeons who were well versed in the Venaseal system.
Thirty-three vein specialists from around the country shared a unique learning experience which included hands-on experience.
This VenaSeal physician training program also incorporated plastic model training of the system before the actual hands-on experience commenced.
My Take on Venaseal Closure Compared to Radiofrequency Closure and Laser Ablation
The Venaseal procedure is not difficult for a practicing vascular surgeon or vein specialist.
It may be a little faster than the ablation procedures of the saphenous veins done with laser or radiofrequency.
The adhesive is drawn up into a syringe which is screwed into a gun-like device. The trigger needs to be squeezed repeatedly to prime the tubing.
The tubing is introduced into the saphenous vein.
The tip of the tubing is placed under ultrasound guidance five centimeters from the sapheno-femoral junction.
The back table must be set up. The wet side of the table must be separated from the dry side.
If the adhesive accidentally touches water, it could set, harden and become unusable.
The packet comes with 5 cc of adhesive or glue. The average vein requires about 1.2 cc of glue.
Therefore, one package set could close three saphenous veins or 100 cm total vein length.
Normally, that could close two great saphenous veins and one small saphenous vein – if necessary.
Wires must be advanced into the proper position under ultrasound guidance. Sterile blue towels would be helpful to prevent these long wires from springing out and result in them being contaminated.
At this time, there is no insurance code to bill for this procedure.
Medtronics representatives told me that they expect an insurance code to be available early in 2018.
Medtronics charges the vein doctor $1500 in the U.S. for the entire disposable kit. The kit includes 5 ccs of cyanoacrylate adhesive or glue. It expires in two years.
It is recommended that doctors charge the same for the procedure as what is currently reimbursed by insurance companies for an equivalent procedure plus the $1500 cost of the Venaseal system.
That charge is at the doctor’s discretion since insurance companies do not reimburse for this FDA approved procedure at this time.
Current charges average between $3,000 to $3,500 per saphenous vein treated.
It’s not uncommon to require treatment for more than one saphenous vein.
Treating more than one saphenous vein at at time is more convenient for the patient.
A code for billing Medicare patients with Venaseal will be available in January 2018.
How Is Glue for Varicose Veins Performed?
The glue is applied inside of the saphenous vein a drop at a time. Every three centimeters along its length the adhesive is compressed with the doctor or their assistant’s hands and ultrasound probe.
The probe compression prevents accidental extrusion of the adhesive proximally into the deep venous system. Compression is initially held for three minutes. Thereafter, each drop is compressed for thirty seconds until the adhesive solidifies.
It hardens almost immediately.
Once set, it is permanent.
Therefore, Venaseal adhesive is an implantable device for all intents and purposes.
Experts with this technique recommend not using Venaseal on patients who are sensitive to adhesives, steri-strips or bandages. In about fifteen to twenty per cent of patients, an inflammatory reaction can be seen on the surface of the skin.
It is reported that anti-inflammatory medication like Ibuprofen hastens the recovery in these cases.
Occasionally steroids like a Medrol dose pack are required.
Most patients have little or no pain after the procedure.
Venaseal is the newest fix for varicose veins.
VenaSeal reduces discomfort and recovery time.
Twenty minutes or less is the normal treatment time for a doctor familiar with the technique.
Only one anesthetic needle pinch is needed.
No stockings are required before or after the treatment.
Insurance companies normally require a three-month trial of conservative medical management including stockings.
Since insurance companies don’t get involved at this time, that ridiculous rule is no longer needed.
Doctors have proven that symptomatic varicose veins should be treated without an initial three-month trial of compression stockings.
Another big advantage is that you can go to the gym right away. Vigorous exercise can be resumed immediately.
As far as pain goes, the reported incidence of discomfort is about the same as with radiofrequency. Sometimes the glue sticks as the tube is pulled out through the skin at the end of the procedure.
It needs to be sharply snapped off to prevent this discomfort.
Rarely, the a drop of glue could become stuck under the skin at the entry site and can be easily removed.
The Advantages of Venaseal Treatment
This glue or adhesive treatment is not a permanent solution in the sense that the visible veins don’t always go away.
In 50-80% of patients, there will be an improvement in appearance.
Remaining surface veins could enlarge over time.
It is recommended by the Venaseal consultants that you should come back in three months to see if you need further treatment of the remaining bumps if they remain symptomatic.
Insurance will cover any painful varicose veins that remain which are resistant to conservative medical management and interfere with activities of daily living.
If you choose glue, you don’t have to worry about these insurance rules that have no medical significance.
It has been proven that a trial of conservative medical management is not necessary before actually treating symptomatic varicose veins.
Therefore, a big advantage of Venaseal at this time is not having to wait to have the procedure done.
Complications of Venaseal Glue
The Venaseal consultants report that there has not been a reported case of deep vein thrombosis or DVT.
DVT occurs in 1-2% in cases of radiofrequency closure and endovenous ablation of saphenous veins.
No numbness or skin burns is a big advantage with Venaseal vs. a small per cent in laser and radiofrequency procedures that usually resolves with time.
Hyperpigmentation can occur if the treated vein is very close to the skin with any of these procedures.
Technology in the field of varicose vein treatments is evolving extremely rapidly.
Venaseal glue is another step forward.
One needle stick, no stockings and immediate return to all activities including heavy leg exercises are the advantages of Venaseal.
Another procedure to get rid of the surface bumps and prevent them from enlarging may be required just like with the currently practiced saphenous vein procedures including laser.
All vein procedures have advantages and disadvantages.
There is no perfect procedure for treating varicose veins.
Patients need to know all of the facts when presented with treatment options for their varicose veins.
Speak to your vein specialist to find out which procedure is best for you.