Patient guide
VenaSeal and Varithena are two nonthermal treatments for selected unhealthy superficial veins. They work differently, have different risks and aftercare, and neither is right for everyone.
By Saphena Vein Clinic Editorial Team Updated July 2026
VenaSeal places a cyanoacrylate medical adhesive inside a selected superficial truncal vein in the leg, such as the great saphenous vein, when it has backward blood flow, called reflux. In this context, truncal veins are the leg’s main superficial veins rather than visible branch veins. Varithena uses a prescription polidocanol microfoam to treat the vein lining so the vein closes and is gradually replaced by fibrous tissue.
A clinician should compare these and other options after reviewing your symptoms, health history, exam, duplex ultrasound, which is a blood-flow scan, anatomy, allergy and clot risks, mobility, prior treatment, pregnancy status, goals, and preferences.
Both options avoid heat and surgical stripping, but nonthermal does not mean risk-free or appropriate for every patient.
A catheter places small amounts of cyanoacrylate adhesive inside a selected superficial truncal vein in the leg, such as the great saphenous vein, when reflux, or backward blood flow, is present. The adhesive closes the treated segment and remains in place. The current device instructions, vein anatomy, allergies, clot risk, and infection status matter.
Polidocanol microfoam is administered under ultrasound guidance. It displaces blood and treats the vein lining, causing the vein to close and later become fibrous tissue. The labeled veins, dose limits, clot risk, allergy history, and aftercare matter.
This table summarizes current labeling and guideline-informed planning. It is not a candidacy checklist. Product labeling can change, so the treating clinician should use the current instructions and prescribing information.
| Factor | VenaSeal | Varithena |
|---|---|---|
| Material and mechanism | A cyanoacrylate medical adhesive is placed through a catheter. It closes the vein and remains in the treated segment, where it becomes surrounded by fibrous tissue. | Polidocanol prescription microfoam treats the vein lining. The vein closes and is gradually replaced by fibrous tissue. |
| FDA-labeled use | Adults with symptoms and backward blood flow, called reflux, in selected superficial truncal veins in the leg, such as the great saphenous vein, when reflux is diagnosed by duplex ultrasound. | Great saphenous and accessory saphenous veins that do not move blood normally, plus visible varicose veins in the great saphenous vein system. |
| Heat and numbing medicine | Nonthermal. It does not require tumescent anesthesia, a larger volume of numbing fluid placed around a vein, but local numbing medicine may be used at the access site. | Nonthermal. It does not require tumescent anesthesia, but local numbing medicine may be used for vein access. |
| Compression and aftercare | Current Medtronic patient information says compression stockings are not required after VenaSeal, although a doctor may recommend them after the procedure. A clinician may tailor aftercare for an individual plan. | The prescribing information calls for compression for two weeks, plus procedure-specific walking, activity, and follow-up instructions. |
| Key reasons it may not fit | Certain cyanoacrylate allergies, acute superficial thrombophlebitis, moving areas of vein inflammation called thrombophlebitis migrans, or acute sepsis. Pregnancy, prior clots, infection, and other health factors require discussion. | Polidocanol allergy or an active blood-clot condition called acute thromboembolic disease. Pregnancy, clot risk, mobility, prior treatment, and other health factors require discussion. |
| Possible risks | Inflammation or phlebitis, pain, access-site bleeding or infection, blood clots, and allergic or hypersensitivity reactions to cyanoacrylate. Other complications are possible. | Pain, trapped clotted blood, bruising, superficial thrombophlebitis, blood clots, medicine leaking outside the vein, and allergic reaction. Accidental injection into an artery or leakage outside the vein can cause severe tissue injury, including necrosis, ischemia, or gangrene. |
| Additional treatment | The procedure primarily treats selected superficial truncal veins in the leg, such as the great saphenous vein. Visible branch veins may require another treatment. | Some people need another session or treatment for additional involved veins. Product dosing limits and timing apply. |
| Other reasonable paths | Thermal ablation, foam or liquid sclerotherapy, compression or other conservative care, monitoring, or another medical evaluation may be appropriate. | Thermal ablation, adhesive closure, other sclerotherapy, compression or other conservative care, monitoring, or another medical evaluation may be appropriate. |
| Evidence limits | Clinical evidence supports labeled use, but results from separate VenaSeal and Varithena studies do not establish a head-to-head winner. | Clinical evidence supports labeled use, but results from separate studies cannot be compared as though they came from one trial. |
| Insurance | Coverage depends on the plan and documented criteria. Verification is not a guarantee of coverage or payment. | Coverage depends on the plan and documented criteria. Verification is not a guarantee of coverage or payment. |
Symptoms alone do not identify which vein is responsible or whether a procedure is appropriate. Duplex ultrasound is the diagnostic test of choice for venous reflux and helps map the superficial source and relevant deep veins. The clinician then considers:
Reflux on ultrasound does not make treatment mandatory. Monitoring, conservative care, another procedure, or a different medical evaluation may be more appropriate.
Ask which risks apply to you, how the team reduces them, and whom to contact after the procedure. Possible complications vary by treatment and can include inflammation or phlebitis, pain, bruising, bleeding, infection, allergic reaction, blood clots, vascular or tissue injury, and the need for additional care.
Seek prompt medical guidance for new or worsening one-sided swelling, pain or tenderness, warmth, or redness or discoloration. Call 911 or seek emergency care for trouble breathing, chest pain, coughing up blood, a fast or irregular heartbeat, lightheadedness, or fainting.
Catherine Youssef, MD
Dr. Catherine Youssef holds active Florida medical license ME159975. The Florida Department of Health license record lists an Altamonte Springs practice address. A product comparison cannot replace an individual medical evaluation. Ask who will interpret your ultrasound, recommend an option, perform any procedure, and provide follow-up.
Read more about vein treatment options and insurance and your visit.
No treatment is better for every patient. VenaSeal and Varithena have different FDA-labeled uses, materials, risks, reasons they should not be used, and aftercare. A clinician should compare all reasonable options using your history, exam, duplex ultrasound, anatomy, and preferences.
Duplex ultrasound identifies where reflux starts and which superficial and deep veins are involved. It provides important information, but it does not make the decision by itself. The recommendation also considers symptoms, medical history, clot and allergy risks, mobility, prior treatment, and your goals.
Both treatments avoid heat and tumescent anesthesia, which is a larger volume of numbing fluid placed around a vein. VenaSeal patient information describes numbing the access site before catheter placement, and Varithena labeling says local anesthetic may be used before vein access. Your clinical team should explain the planned anesthesia and what you may feel during the procedure.
Varithena prescribing information calls for compression for two weeks. Current Medtronic patient information says compression stockings are not required after VenaSeal, although a doctor may recommend them after the procedure. Your clinician may tailor aftercare based on your anatomy, any additional procedures, and your treatment plan.
Coverage varies by plan. An insurer may review symptoms, duplex findings, medical necessity, prior authorization, and conservative-care documentation. Benefit verification does not guarantee coverage or payment. Confirm the requirements with both the clinic and your insurer.
Follow the procedure team’s instructions. Seek prompt medical guidance for new or worsening one-sided swelling, pain or tenderness, warmth, or discoloration. Call 911 or seek emergency care for trouble breathing, chest pain, coughing up blood, a fast or irregular heartbeat, lightheadedness, or fainting.
Call Saphena Vein Clinic or request an evaluation in Altamonte Springs. For sudden or severe symptoms, use the urgent-care guidance above.
Review the treatment categories Saphena currently describes and the role of clinical evaluation.
See what to bring and which coverage questions to ask before treatment.
Learn how symptoms, evaluation, and treatment options fit together locally.
