By Dr. Saurabh Joshi
In my practice at Vein Center, one question comes up constantly. A patient will walk in with large, twisted bunches of veins—perhaps even a non-healing leg ulcer—and ask:
“Dr. Joshi, you are going to treat this with VenaSeal (Glue), right? Will that one injection fix everything?”
It is a valid question. We often market VenaSeal as a revolutionary, single-prick solution. But the clinical reality for severe cases (C4, C5, and C6) is a bit more nuanced.
Today, I want to explain why VenaSeal is excellent, but why it is often just the start of your treatment, not the whole treatment.
The “Complete Meal” Analogy
To understand vein treatment, think of a full dinner.
If you came to my house for a meal, would I serve you just a bowl of plain rice or roti? No. That is incomplete. You need the vegetables, the dal, the salad, and maybe even a dessert to make it a “complete meal.”
Vein treatment is exactly the same:
- The Main Course (VenaSeal): This treats the “Truncal Vein”—the long, straight highway vein that causes the reflux. VenaSeal is the best tool for this because it seals the vein shut without heat or multiple injections.
- The Side Dishes (Secondary Procedures): This is where we treat the visible “mess.” The twisted bunches, the spider veins, and the veins feeding an ulcer.
If I only give you the main course (VenaSeal), I have fixed the root cause, but I haven’t cleaned up the visible problem. You would leave my clinic with the main vein closed, but those ugly bunches might still be there.
Why Can’t VenaSeal Do It All?
The VenaSeal device is designed for straight veins. It is like a catheter that needs a straight path.
However, when you have advanced varicose veins, you often have:
- Tortuous Bunches: Twisted, knotty veins where a straight catheter simply cannot pass.
- Perforators: “Connector” veins that pop straight out from the deep system.
- Ulcer Beds: A complex network of veins directly under a wound.
For these specific problems, “Glue” isn’t the right tool. The right tool is Sclerotherapy.
The Power of Combination Therapy
For my patients with severe swelling or ulcers, I almost always perform a Combination Procedure.
We use VenaSeal to shut down the main leak (the underlying pressure). Then, in the same sitting or a follow-up, we use Foam Sclerotherapy or direct glue injections to treat the branches.
- For Bunches: We inject a foamed medicine that irritates the vessel walls and causes them to collapse and fade away.
- For Ulcers: We specifically target the veins under the ulcer bed. VenaSeal cannot reach here, but a direct injection can. This is critical for healing the wound.
The Verdict
So, is VenaSeal enough?
If you have early-stage veins that are straight and simple? Yes. But if you have “big bunches,” skin darkening, or ulcers? No. You need the full meal.
At Vein Center, my goal isn’t just to do a procedure; it is to give you a result. And sometimes, that means combining the best technology (VenaSeal) with the gold standard for clean-up (Sclerotherapy).
