We have been using the vein glue VenaSeal® since August 2012. In the last 98 months we have ablated 2836 varicose veins in 1474 patients with the vein glue. In 26 ablated veins (0.9%) we saw a postoperative lymphatic fistula, in 4 cases a granuloma (glue pimple) had to be removed after 10 months-12 months [1-3]. All catheter-based procedures for the treatment of varicose veins can result in injuries to the lymphatic system when the vessel is punctured and the catheter is inserted. This leads to the development of a lymphatic fistula in approx. 2%-4% of the therapeutic cases. Lymphatic water is pressed through a small opening in the wound to the surface of the skin. We also saw lymph fistulas in the vein glue VenaSeal® after puncturing the vessel. These were additionally promoted by glue granulomas residues remaining in the tissue. It is therefore important, particularly when using the vein glue, to ensure that the puncture site is worked properly and that the sealing maneuver is individually defined for the patient.
Lymphatic fistulas and granulomas in vein glue: The lymphatic fistula The lymphatic fistula mostly occurs as a complication after surgery. The frequency is around 2%-4%. A lymph fistula can form, especially during operations in body regions with many lymphatic vessels. Lymphatic fluid is increasingly secreted via the injured lymphatic system, which can then escape through the wound. Lymphatic fluid emerges from the fistula. The amount of liquid can increase, especially in the warm season. Germs can enter the body through the lymph fistula, causing erysipelas-a bacterial infection of the lymphatic system-to form. Disinfection and sterile covering of the lymph fistula is therefore very important as a first measure. Since protein is also lost through the lymphatic fistula the primary goal is to close the fistula [4-6]. The escaping lymph is difficult to handle for the patient in many cases and is associated with a loss of quality of life. Wound healing is also delayed. The treatment options for a lymph fistula in vein glue and other catheter procedures are versatile. They range from a tight compression bandage to prophylactic adhesive bonding and surgical refurbishment to radiation therapy (especially for lymph fistulas in the groin region). Also, the glue granuloma must be removed in any case, since it is often the cause of the wound healing disorder.

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Journal of Phlebology and Lymphology
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