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Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane
08:05

Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane

Published on: December 9, 2022

Which modality for which vein? A narrative review of strategic modality selection for chronic venous disease

Insoo Park1

  • 1Charm Vascular Clinic, Seoul, Republic of Korea.

Phlebology
|July 9, 2026
PubMed

Insights

Choosing the right chronic venous disease (CVD) treatment depends on vein anatomy. This review offers a framework to select the best endovenous technique, balancing efficacy and patient factors for optimal outcomes.

Area of Science:

  • Vascular Surgery
  • Phlebology
  • Medical Technology Assessment

Background:

  • Chronic venous disease (CVD) management has evolved, moving from traditional high ligation and stripping (HL/S) to various endovenous techniques.
  • No single endovenous modality is universally optimal for all CVD presentations, anatomical variations, or patient profiles.

Purpose of the Study:

  • To review current evidence and guidelines for CVD treatment modalities.
  • To propose an anatomy-oriented framework for selecting the most appropriate endovenous technique in clinical practice.

Main Methods:

  • A narrative review of MEDLINE and key guidelines from major vascular surgery societies.
  • Focus on comparative trials and long-term studies of HL/S, endovenous thermal ablation (TT), cyanoacrylate closure (CAC), mechanochemical ablation (MOCA), and ultrasound-guided foam sclerotherapy (UGFS).
  • Descriptive synthesis of evidence regarding anatomical indications, efficacy, and complications.

Main Results:

  • HL/S remains suitable for severely dilated, aneurysmal, or tortuous veins, and junctional disease.
  • Thermal ablation (TT) offers high occlusion rates but has limitations in very superficial or large veins.
  • Non-thermal methods (CAC, MOCA) provide comfort and avoid nerve injury, especially below the knee, but may have less durable outcomes in larger veins.
  • Ultrasound-guided foam sclerotherapy (UGFS) is versatile for complex cases but less ideal for primary truncal reflux.

Conclusions:

  • An optimal "gold-standard" endovenous modality for all CVD cases does not exist.
  • An individualized, anatomy-centered approach, potentially using hybrid techniques, is crucial for maximizing treatment success and minimizing complications in chronic venous disease management.

Keywords:
chronic venous diseasecyanoacrylate closuregreat saphenous veinmechanochemical ablationvaricose veins

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