QUESTIONS & ANSWERS: The Vnus Closure® procedure 


What are Varicose Veins? 
Varicose veins are veins that have lost their useful purpose of returning the blood in your legs to the heart.  They are usually rendered ineffective because tiny valves in the veins are ruptured and the veins are under increased pressure.  The increased pressure causes these veins to enlarge and become unsightly and painful. 

What is Venous Insufficiency? 
Venous insufficiency is the underlying pressure problem created in the veins of the legs that give rise to varicose veins and symptoms of swelling, heaviness, fatigue and achiness in the legs..  Saphenous vein reflux, or reverse flow, is usually the root of the cause and may be accompanied by reflux of other veins also.  It is estimated that 25 million people suffer from venous insufficiency in its most severe form, venous insufficiency can cause profound swelling and skin breakdown or ulceration. 

Who should treat your veins? 
Veins of any size should be treated by a physician who specializes in vein care.  One needs to consider underlying venous physiology before beginning treatment of any kind.  Significant venous reflux can be the cause of superficial veins and needs to be corrected first.  This includes spider veins.  You should be treated by someone who understands venous physiology and who can offer all modalities of treatment.  As Board Certified Vascular Surgeons, Dr. Reynolds understands the underlying disease process and can choose among all techniques available to decide your best treatment course.  Many “vein specialists” cannot offer a full complement of treatment options and are biased towards the procedures they do perform.  Be an educated consumer! 

How do I know I have Venous Insufficiency? 
Sometimes it is easy to tell just by a physical examination.  In our practice, however we use the venous ultrasound and Doppler study to completely evaluate the entire venous system.  Only after we understand each patient’s venous anatomy and physiology do we make treatment recommendations. 

What can be done to correct Venous Insufficiency? 
Saphenous Vein Closure:  Recent technology has enabled the treatment of vein and saphenous vein reflux to be treated without surgery.  Using only needle access to the vein, a catheter is advanced the entire length of the vein to searl the vein using radio frequency energy.  When the vein is sealed,  the pressure problem is resolved and symptoms improve.  Since the root of the problem is eliminated, most varicose veins will subsequently become smaller or resolve.  The procedure is well tolerated using local anesthesia and can be preformed in the office or in an ambulatory centre.  There are no incisions to heal and no scarring as a result.  Patients return to daily activities within 24-48 hours and notice symptom improvement within 1 week following treatment. 

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

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

How does it 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 your 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 your legs. 

How is the VNUS® Closure® procedure different from vein stripping?  
During a stripping procedure, the surgeon makes an incision in your groin and ties off the vein, after which a stripper tool is threaded through the saphenous vein and used to pull the vein out of your leg through a second incision just above your 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 (VNUS® Closure®) catheter inserted through a small puncture. This may eliminate the bruising and pain often associated with vein stripping (i.e., that may result from the tearing of side branch veins while the saphenous vein is pulled out). Vein stripping is usually performed in an operating room, under a general anesthetic, while the VNUS® Closure® procedure is performed on an outpatient basis, typically using local or regional anesthesia.  
 
Three randomized trials of the VNUS® Closure® procedure vs. vein stripping, including the most recent multi-center comparative trial, show very similar results. In the multi-center comparative trial, the VNUS® Closure® procedure was superior to vein stripping in every statistically significant outcome. In the study, 80.5% of patients treated with the VNUS® Closure® procedure returned to normal activities within one day, versus 46.9% of patients who underwent vein stripping. Also, VNUS® Closure® patients returned to work 7.7 days sooner than surgical patients. Patients treated with the VNUS® Closure® procedure had less postoperative pain, less bruising, faster recovery and fewer overall adverse events. 

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 VNUS® Closure® procedure painful? 
Patients report feeling little, if any, pain during the VNUS® Closure® procedure. Your physician will give you a local or regional anesthetic to numb the treatment area. 

Will the procedure require any anesthesia? 
The VNUS® Closure® procedure can be performed under local, regional, or general anesthesia. 

How quickly after treatment can I return to normal activities?  
Many patients can resume normal activities immediately.  For a few weeks following the treatment, your doctor may recommend a regular walking regimen and suggest you refrain from very strenuous activities (heavy lifting, for example) or prolonged periods of standing. 

How soon after treatment will my 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 following the Vnus Closure procedure. 


Are there any potential risks and complications associated with the VNUS® Closure® procedure?  
As with any medical intervention, potential risks and complications exist with the VNUS® Closure® procedure. All patients should consult their doctors to determine if their conditions present any special risks. Your physician will review potential complications of the VNUS® Closure® procedure at the consultation, and can be reviewed in the safety summary. Potential complications can include: vessel perforation, thrombosis, pulmonary embolism, phlebitis, hematoma, infection, paresthesia (numbness or tingling) and/or skin burn. 

Is the VNUS® Closure® procedure suitable for everyone?  
Only a physician call tell you if the VNUS® Closure® procedure is a viable option for your vein problem. Experience has shown that many patients with superficial venous reflux disease can be treated with the VNUS® Closure® procedure. 

Is age an important consideration for the VNUS® Closure® procedure?  
The most important step in determining whether or not the VNUS® Closure® procedure is appropriate for you is a complete ultrasound examination by your physician or qualified clinician. Age alone is not a factor in determining whether or not the VNUS® Closure® procedure is appropriate for you. The VNUS® Closure® procedure has been used to treat patients across a wide range of ages. 

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. 

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

Is the VNUS® Closure® treatment covered by my insurance?  
Many insurance companies are paying for the VNUS® Closure® procedure in part or in full. Most insurance companies determine coverage for all treatments, including the VNUS® Closure® procedure, based on medical necessity. The VNUS® Closure® procedure has positive coverage policies with most major health insurers. Your physician’s insurance staff can discuss your insurance coverage further at the time of consultation. 

What are patients saying about the VNUS® Closure® procedure?  
98% of patients who have undergone the Vnus Closure procedure are willing to recommend it to a friend or family member with similar leg vein problems.