VNUS Closure for varicose veins: your questions answered

What is the VNUS Closure procedure?
The procedure is a minimally invasive treatment for superficial venous reflux. A thin catheter is inserted into the vein through a small opening, through which radiofrequency (RF) energy is delivered to the vein wall, causing it to heat, collapse and seal shut.

What is superficial venous reflux?
Superficial venous reflux is a condition that develops when the valves that usually keep blood flowing out of the legs become damaged or diseased. This causes blood to pool in the legs. Common symptoms of superficial venous reflux include pain, swelling, leg heaviness and fatigue, as well as varicose veins in the legs

How does VNUS Closure work to treat superficial venous reflux?
Since valves can’t be repaired, the only alternative is to re-route blood flow through healthy veins. Traditionally, this has been done by surgically removing (stripping) the troublesome vein from the leg. The VNUS Closure procedure provides a less invasive alternative to vein stripping by simply closing the problem vein instead. Once the diseased vein is closed, other healthy veins take over and empty blood from the legs.

What happens to the treated vein left behind in the leg?
The vein simply becomes fibrous tissue after treatment and will gradually be incorporated into surrounding tissue. One study reported that 89% of treated veins are indistinguishable from other body tissue one year after the Closure procedure was performed

How is the VNUS Closure procedure different from vein stripping?
During a stripping procedure, an incision in the groin is made and the vein tied off, after which a stripper tool is threaded through the saphenous vein and used to pull the vein out of the leg through a second incision just above the calf.

In the VNUS Closure procedure, there is no need for groin surgery. Instead, the vein remains in place and is closed using a special (Closure) catheter inserted through a small puncture hole. This may eliminate the bruising and pain often associated with vein stripping. Vein stripping is usually performed in an operating room, under a general anaesthetic, while the VNUS Closure procedure is performed on a day-case basis, typically using local or regional anesthesia.

How long does the VNUS Closure procedure take?
The VNUS Closure procedure takes approximately 45-60 minutes, though patients normally spend 2-3 hours at the medical facility due to normal pre and post treatment procedures.

Is the procedure painful?
Patients report feeling little, if any, pain. Local or regional anaesthetic can be used to numb the treatment area.

How quickly after treatment can one return to normal activities?
Many patients can resume normal activities immediately. For a few weeks following treatment, patients are advised to wear a stocking and regular walking is recommended. Patients are also advised to refrain from very strenuous activities (eg: heavy lifting) or prolonged periods of standing.

How soon after treatment will the symptoms improve?
Most patients report a noticeable improvement in their symptoms within 1-2 weeks following the procedure.

Is there any scarring, bruising, or swelling after the VNUS Closure procedure?
Patients report minimal to no scarring, bruising or swelling compared to vein stripping and laser treatment.

Are there any potential risks and complications associated with the VNUS Closure procedure?
As with any medical intervention, potential risks and complications exist with this procedure. All patients should consult their doctors to determine if their conditions present any special risks. Potential complications can include phlebitis, haematoma, infection, numbness or tingling and/or skin burn.

Is age an important consideration for the VNUS Closure procedure?
The most important step in determining whether or not the Closure procedure is appropriate is a complete ultrasound examination. Age alone is not a factor. The procedure has been used to treat patients across a wide range of ages. It is particularly beneficial in the elderly as it can be safely performed under a local anaesthetic thereby avoiding the potential risks of a general anaesthetic in this group of patients.

How effective is the VNUS Closure procedure?
Published data suggests that two years after treatment, 90% of the treated veins remain closed and free from reflux, the underlying cause of varicose veins.


References

  1. Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, et al. Prospective randomized study of endovenous radiofrequency obliteration (Closure) versus ligation and stripping in a selected patient population (EVOLVES study). J Vasc Surg 2003;38:207-14.
  2. Goldman, H. Closure of the greater saphenous vein with endo radiofrequency thermal heating of the vein wall in combination with ambulatory phlebectomy: preliminary 6-month follow-up. Dermatol Surg 2000; 26:452-456.
  3. Dietzek A, Two-Year Follow-Up Data From A Prospective, Multicenter Study Of The Efficacy Of The ClosureFAST Catheter, 35th Annual Veith Symposium. November 19, 2008. New York.
  4. Pichot O, Sessa C, Chandler JG, Nuta M, Perrin M. Role of duplex imaging in endovenous obliteration for primary venous insufficiency. J. Endovasc Ther 2000;7:451-9.
  5. Weiss RA, Weiss MA. Controlled radiofrequency endovenous occlusion using a unique radiofrequency catheter under duplex guidance to eliminate saphenous varicose vein reflux: A 2-year follow-up. Dermatol Surg 2002;28:38-42.

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