Nerves left untouched, veins 'stuck' shut ... Varicose veins treated with adhesive [Health Check]

[Financial News] Varicose veins bulging below the knee have long been considered difficult to treat. Because nerves run right alongside the veins, using conventional procedures that seal veins with heat carried a risk of nerve damage. A Korean research team has reported findings showing that this area can be treated without nerve damage using a sclerosant or medical adhesive instead of heat.
A research team led by Professor Min Ji-young of the Department of Radiology at Konkuk University Medical Center (first author) and Professor Park Sang-woo (corresponding author) said that after performing nonthermal, non-tumescent closure on 50 patients (73 legs) with reflux confined to the below-knee great saphenous vein, the vein was completely occluded in every leg immediately after the procedure, with no recurrence during follow-up. The findings were published in the international journal Journal of Vascular Surgery: Venous and Lymphatic Disorders.
Varicose veins develop when valves in the leg veins fail to function properly, causing blood to flow backward instead of toward the heart; the veins then enlarge and bulge. The legs may swell and feel heavy, and over time the skin may change color or ulcers may develop. The key to treatment is to block the vein where reflux occurs. Once the affected vein is blocked, blood returns to the heart through nearby healthy veins.
The below-knee section of the great saphenous vein, a large vein that runs along the inside of the leg, lies close to the saphenous nerve. For this reason, the 2022 guidelines of the European Society for Vascular Surgery (ESVS) do not recommend thermal ablation in this section, while 2023 guidelines from three U.S. societies, including the Society for Vascular Surgery (SVS), also noted the need for alternative strategies. Previous studies reported nerve damage after thermal treatment in this section in 3.4% of cases, and in as many as 7%. In effect, this was an area where patients had symptoms but no suitable treatment options.
The nonthermal, non-tumescent closure used in this study does not burn the vein with heat or use tumescent anesthesia, in which anesthetic fluid is injected around the vein to make the area swell. The research team performed mechanochemical ablation, which uses a rotating catheter and a sclerosant to irritate the vein wall and close the vein, on 51 legs. They performed cyanoacrylate adhesive closure, which seals the vein using medical adhesive, on 22 legs.
This was a multicenter retrospective study involving clinicians from the radiology and cardiothoracic surgery departments at Konkuk University Medical Center, as well as radiologists from two other hospitals or clinics. The researchers analyzed records of patients who underwent the procedure between October 2020 and April 2025. The patients' average age was 60, and 72% were women. The procedure was performed under local anesthesia through a blood vessel on the inner side of the ankle.
Ultrasound scans immediately after the procedure showed complete occlusion of the vein in all 73 legs (100%). Follow-up ultrasound scans at one week and at 1, 3, 6 and 12 months showed no recanalization, or reopening of the blocked vein. There were no serious adverse events such as deep vein thrombosis or pulmonary embolism, nor any permanent sensory changes suggestive of saphenous nerve damage.
Symptoms also improved markedly. The median Venous Clinical Severity Score (VCSS) fell from 4 before the procedure to 0 one week later and remained at 0 through 12 months; it was significantly lower than the pre-procedure score at every follow-up point. Both procedures were found to be effective. A total of 43 legs were assessed at 12 months.
There were some mild adverse events. Superficial phlebitis occurred in 6 legs (8%), bruising at the procedure site in 5 legs (7%), and skin rashes related to bandages or compression stockings in 5 legs (7%). All resolved with conservative treatment within two weeks.
The research team cited several limitations: the retrospective design leaves open the possibility of selection bias; the procedure was chosen according to the operator's preference rather than at random; the sample was small; and follow-up lasted only 12 months. They said prospective randomized studies are needed to confirm the long-term effects.
Professor Min Ji-young said, “The study is significant because it presents a way to safely treat the below-knee great saphenous vein, where treatment options have been limited, without complications such as nerve damage. We will work to ease the burden of procedures on patients and provide safer treatment.”



[email protected] Jeong Myeong-jin, Medical Affairs Writer Reporter