Mr Sabu Jacob, MBBS, FRCS (Gen)

General and Vascular Surgeon

Treatment for varicose veins

Healthy leg veins contain valves that open and close to assist the return of blood back to the heart. Superficial venous reflux is a condition that develops when the valves that usually keep blood flowing out of the legs and back to the heart become damaged or diseased. This causes blood to pool in the legs.

Mr Jacob offers fast access to effective treatment for varicose veins

Common symptoms of superficial venous reflux include pain, swelling, leg heaviness and fatigue, as well as varicose veins in the legs. Superficial venous reflux disease is progressive – symptoms can worsen over time if left untreated.

As a Vascular Surgeon, one of Mr Jacob’s specialties is a treatment called VNUS Closure, which can offer sufferers a solution to leg pain and varicose veins.

What is the VNUS procedure?
VNUS is a minimally invasive treatment for superficial venous reflux. A heated probe attached to a generator is used to obliterate (close) the faulty vein, as a result redirecting blood through nearby healthy veins, which take over and empty blood from the legs.

What happens during the treatment?
An ultrasound scan will be done on your leg to mark the position of the veins. A local anaesthetic injection will numb your skin and a small flexible guide wire will be passed into the vein. A fine sheath is passed over this wire and then the VNUS Catheter is threaded through the sheath. The position of the catheter will be confirmed by ultrasound. The generator then creates radiofrequency energy (heat) to seal the vein along the length being treated in just a few minutes. You should not feel anything during the treatment. Once the vein has been closed up, the probe is removed and a bandage is applied to the leg(s).


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

What is the recovery period like?
The bandage that is applied immediately after VNUS treatment should be kept on day and night for 1 week.

After this, a support stocking should be worn during the day only, and removed during bathing and at bedtime. Normal activities, including work, can be resumed as soon as you like. However, contact sports, heavy exercise and swimming should be avoided for up to 2 weeks.

Following a week after the bandage is removed you may occasionally see minimal bruising or hardness under the skin. This is quite normal and will settle down gradually. Patients are also advised to refrain from very strenuous activities (e.g.; heavy lifting) or prolonged periods of standing.

Most patients report a noticeable improvement in their symptoms within 1 - 2 weeks following the procedure. If any small varicose veins remain, these can be removed by an injection given in outpatients.

What are the advantages of VNUS?
VNUS is performed as a day case procedure under local anaesthetic. Patients report feeling little, if any, pain. Local or regional anaesthetic can be used to numb the treatment area.

As well as a quick return to normal activities, VNUS requires fewer incisions to the skin, so leaves fewer scars and less potential for complications such as wound infection or pain following surgery. Approximately 5% of patients who have conventional vein stripping surgery are left with patches of numbness on the leg. This occurs even less with VNUS.

Are there any potential complications?
There is a small chance of around 3% that the vein may not be fully obliterated (closed) by the procedure. If this happens, the treatment can always be repeated, or the veins can be treated by conventional surgery or by liquid injection. There may be a few visible varicose veins left after the VNUS treatment, but these do not cause symptoms and become less prominent with time.

Most people do not require additional injections for residual veins. About 1% of patients experience some numbness in the leg following the VNUS procedure, but this is almost always temporary.

As with any surgical procedure, there is a small risk of blood clots forming in the main leg veins (DVT), although this is probably less common after VNUS than conventional vein surgery. Patients are not advised to undertake long haul air travel within 3 weeks of the procedure. Short flights may be acceptable, but this must be discussed with Mr Jacob before undergoing treatment.

How do the results of VNUS compare with traditional ‘vein stripping’ treatment?
Three randomized trials of VNUS versus vein stripping showed very similar results, with the closure procedure being superior to vein stripping in every statistically significant outcome. In one study, 80.5% of patients treated with the VNUS procedure returned to normal activities within 1 day, versus 46.9% of patients who underwent vein stripping.

Also, VNUS patients returned to work 7.7 days sooner than surgical patients*. Patients treated with the VNUS procedure had less post-operative pain, less bruising, faster recovery and fewer overall adverse events.

* Figures courtesy of

How do I know if VNUS Closure is suitable for me?
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 local anaesthetic thereby avoiding the potential risks of a general anaesthetic in this group of patients.

Mr Sabu Jacob, Consultant General and Vascular Surgeon

Mr Jacob's clinic times at Spire Roding Hospital

  • Mondays: 6.30pm - 8.30pm
  • Thursdays: 2.00pm - 5.30pm
  • Saturdays: 9.00am - 11.00am
020 8709 7878