Objective: Endovenous techniques have proven to be effective for treatment of incompetent truncal veins (GSV/SSV). The non-tumescent, non-thermal and non-sclerosant VenaSeal™ closure technique has become an established treatment modality, but reports focusing on long-term follow-up are rare. Methods: A multicenter review of four German outpatient surgery centers, using Cyanoacrylate Closure (CAC, VenaSeal™) for the treatment of incompetent saphenous veins over a period of eight years, was launched. Results: A total of 2982 patients with a total of 5333 incompetent truncal veins (GVS/SSV) were enrolled. Follow-up ranged from 10 days up to 98 months with a target vein closure rate of maximum 96 %. Accidental glue extension in limited amounts was observed in 0,17% of the limbs. One venous thrombosis (0,01%) occurred due to deep vein valve damage by SELDINGER guide wire. The maximum diameter of glued veins attained 19 mm. There was no need for adjunctive procedures. Miniphlebectomies were carried out in fewer numbers according to center-specific standards. If sclerotherapy was scheduled it was carried out in the first three months post intervention. Compression was not standardized in the after treatment, if necessary, then 7 to 10 days. As a typical side effect, circumscript inflammatory reddening of the skin in areas surrounding the saphenous bed in distal parts of the thigh was observed in 9,3% of patients. This occurred predominantly within the first 14 days after treatment in subdermal truncal veins and responded easily to local anti-inflammatory measures. Conclusion: Treatment with CAC was effective in achieving complete target vein closure of the GSV and SSV at long-term follow-up. CAC resulted in low postoperative discomfort, early rehabilitation and recovery even in patients who after a few days returned to work or were otherwise burdened by prolonged orthostatic charge. Chronic venous incompetence in the adult population shows an incidence of varicose veins in the range of 20% to 60% [1-5]. While conventional surgery has been unquestioned as routine approach to varicose veins throughout the past century, more recently endovascular techniques have proven both safety and efficacy for treatment of incompetent truncal veins (GSV/SSV) in an outpatient setting [6-13]. Tumescence anaesthesia is required using ELVES or RFA by the risk of thermal damage to surrounding tissues like concomitant nerves, lymphatic vessels or overlaying skin. Moreover DVT is observed upon a laser ablation in 0.5% to 7%. On this basis, the CAC technique was developed as a non-thermal and nontumescent alternative. Cyanoacrylate closure (CAC, VenaSeal™) enables to further reduce postprocedural discomfort in addition to earlier recovery even in patients who are unwilling or unable to undergo tumescent or general anaesthesia and/or mandatory postoperative compression therapy [14-19]. Recent reviews showed target vein closure rates at 12 months ranging from 87% to 97% [20,21]. The aim of this multicenter review was to evaluate whether CAC can deliver long-term effectiveness and safety.

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