ETA was associated with more adjunctive procedures and unscheduled care, while CAC achieved similar clinical improvement with fewer concurrent procedures and unplanned follow up, though total expenditures converged with CAC having higher upfront charges and ETA accruing more downstream costs.
Concurrent adjunctive phlebectomy was significantly more frequent in ETA-treated limbs than CAC-treated limbs.
Concurrent adjunctive sclerotherapy was significantly more frequent in ETA-treated limbs than CAC-treated limbs.
Clinical improvement as measured by rVCSS was comparable between ETA and CAC treatment groups.
ETA patients had significantly more unscheduled visits and unscheduled ultrasounds compared to CAC patients.
Initial CAC treatment costs were higher than ETA, but overall total costs were also higher for CAC.
Adverse events significantly increased costs in ETA patients but not in CAC patients.
This research compared two minimally invasive treatments for varicose veins — cyanoacrylate closure (CAC), which uses a medical glue to seal the faulty vein, and endothermal ablation (ETA), which uses heat energy — focusing on how often patients needed additional procedures, unexpected follow-up care, and total costs. The study looked back at records from 654 legs (327 treated with each method) over a six-month period. Both treatments produced similar improvements in patients' vein disease symptoms, but the path to those results was quite different between the two approaches. Patients treated with ETA were far more likely to need additional procedures done at the same time as their main treatment: nearly half needed phlebectomy (surgical removal of surface varicose veins) and 40% needed sclerotherapy (injection treatment), compared to only about 6–7% of CAC patients needing these concurrent procedures. ETA patients also had more unscheduled follow-up visits and ultrasound scans, and adverse events in ETA patients led to meaningfully higher costs, while adverse events in CAC patients did not significantly change total costs. Although CAC had higher upfront procedure costs, ETA accumulated more expenses over time through additional treatments and unplanned care, so that total costs ended up being modestly higher for CAC overall (+$210). This research suggests that while CAC costs more at the initial procedure, ETA tends to generate more activity — and associated costs — downstream through concurrent add-on procedures, unscheduled visits, and adverse events. Patients and healthcare providers may find it useful to consider not just the upfront cost of a vein treatment but the likelihood of needing additional procedures and follow-up care when choosing between these two approaches, since both achieved similar symptom improvement at the end of six months.
Gibson K, Glorieux K, Minjarez R, Foster E, Neradilek M, Polissar N. (2026). Adjunctive procedure utilization and cost comparison of cyanoacrylate versus endothermal ablation for saphenous vein reflux.. Vascular medicine (London, England). https://doi.org/10.1177/1358863X261434818