Background: Minimally invasive endovascular techniques have revolutionized varicose vein treatment, with cyanoacrylate glue ablation (VenaSeal™) and microwave ablation emerging as promising alternatives to traditional thermal ablation methods.

Methods: This retrospective comparative study evaluated 66 patients with symptomatic varicose veins treated between January 2022 and December 2023. Thirty-two patients underwent cyanoacrylate glue ablation, while 34 received microwave ablation. Primary outcomes included technical success, complications, and quality of life improvements. Secondary outcomes encompassed patient satisfaction, return to work, and cost-effectiveness.

Results: Technical success was achieved in 30/32 (93.8%) patients in the cyanoacrylate group and 33/34 (97.1%) in the microwave group (p = 0.58). The cyanoacrylate group demonstrated significantly lower overall complication rates (15.6% vs 44.1%, p = 0.01), fewer recurrences (6.3% vs 26.5%, p = 0.04), and no thermal injury complications. Patients treated with cyanoacrylate glue experienced faster return to work (2.6 ± 1.0 vs 3.9 ± 1.2 days, p < 0.001) and higher satisfaction scores (4.8 ± 0.4 vs 4.3 ± 0.7, p = 0.02). However, cyanoacrylate treatment was significantly more expensive (₹112,500 ± 8,200 vs ₹44,800 ± 7,600, p < 0.001).

Conclusion: Both techniques demonstrated high efficacy in treating varicose veins. Cyanoacrylate glue ablation offers superior safety profile and patient experience but at higher cost. Treatment selection should consider patient preferences, clinical factors, and economic constraints.