Last week I was teaching advanced varicose vein surgical techniques at the Charing Cross International vascular conference.

There were a number of presentations and discussions about the Sapheon Glue system for varicose veins surgery, and there has been some discussion in the press about it as well.

The next ‘frontier’ in vein surgery is how to close the leaky vein in the leg in a completely painless way without having to inject any anaesthetic. At present, our current techniques of laser and VNUS closure work very well but the patient has to have some injections, which makes the experience like going to the dentist.

The Clarivein and Sapheon systems are designed to close the vein without needing to make as many injections into the leg. The Sapheon system uses a tissue glue which is a bit like ‘superglue’ to stick the vein together. The Clarivein system uses a chemical called ‘fibrovein’ and a rotating device to damage the inside lining of the vein.

So far it is pretty clear that both Clarivein and Sapheon glue are both safe to use and in the early stages both work quite well to close the vein. They are also more or less painless for the patient. In my personal experience of Clarivein (now about 250 cases over 2 years) the vein stays closed in about 85% of cases. This makes it less successful than the laser, where one can expect the vein to stay closed in about 95% of cases, but more successful than other techniques such as foam sclerotherapy or open surgery.

For Sapheon glue, we are still in the early stages of assessing the technique. So far there have been only a handful of cases done in the UK and the longest follow up to date is about one year. The other main issue with the glue is the cost – each consumable kit is about £1,300 as compared to about £250 for a laser fibre, so the price of treatment per leg is high (about £4,000 – £4,500 per leg).

Having said that it is certainly an interesting development and one which we will be offering to patients in the near future.

Eddie Chaloner