Integrating Evidence and Expert Insights for Safe and Effective Use of Cyanoacrylate in Management of Varicose Veins

Abstract Chronic venous insufficiency and varicose vein disease are common, progressive conditions associated with significant morbidity and impaired quality of life. Endovenous thermal ablation techniques have largely replaced surgical stripping; however, their reliance on tumescent anesthesia and thermal energy is associated with procedure-related discomfort and specific complications. Cyanoacrylate closure (CAC) has emerged as a nonthermal, nontumescent alternative that addresses several limitations of thermal techniques while eliminating the need for compression stockings postprocedure. While randomized controlled trials and real-world studies have demonstrated high vein closure rates and favorable safety profiles with CAC, data from India remain limited and largely observational. This manuscript summarizes the deliberations of a multidisciplinary Indian expert panel convened to integrate available evidence with real-world clinical experience and provide practical guidance for the safe and effective use of CAC in the management of varicose veins. Key areas addressed include optimal patient selection, procedural refinements, follow-up strategies, and the recognition and management of adverse reactions, particularly hypersensitivity reactions and phlebitis-like abnormal reactions. The panel emphasizes the importance of careful anatomical assessment, adherence to device instructions for use, and differentiation between immune-mediated reactions and inflammatory phlebitis to guide appropriate management. By contextualizing international evidence within Indian practice realities, these expert recommendations aim to support standardized adoption of CAC, optimize clinical outcomes, and enhance patient safety in the management of varicose veins.