Treatment Options for Varicose Veins:  Explaining VNUS Closure, EVAT - Endo Venous Ablation Therapy,  Ambulatory Phlebectomy, and Injection Sclerotherapy

By:  Hope Waltman

Superficial Venous Insufficiency is a condition that causes varicose veins and other painful symptoms.  Approximately 25 million people suffer from this condition, which is also known as superficial venous reflux.

I interviewed Dr. Robert Worthington-Kirsch, an Interventional Radiologist, about the VNUS Closure, Ambulatory Phlebectomy, and Injection Sclerotherapy varicose vein procedures, which he performs at Roxborough Memorial Hospital, Philadelphia, Pennsylvania.  

What are varicose veins? 

Healthy veins have valves that open and close to assist the return of blood to the heart.  Varicose veins are caused when the valves are diseased or damaged.  The damaged valves do not work properly and cause a backward flow of blood in the legs, which causes the veins to bulge and swell.  This condition is referred to as venous reflux, venous incompetence, or venous insufficiency.  

Can you describe what a spider vein looks like? 

Spider veins are small veins that are located near the surface of the skin.  These veins are often referred to as broken capillaries and may appear as small red, blue, or purple veins. 

How will the doctor examine my varicose veins? 

The doctor will review the patient’s history and symptoms and a physical examination of the legs will be performed.  A non-invasive examination will consist of a Doppler and color Duplex ultrasound.  The ultrasound results will help the doctor to identify the specific areas of reflux and map out the unique way in which each patient’s venous insufficiency has developed. 

A customized treatment plan will be defined for each patient.  The treatment plan could be one or more of the following:  VNUS Closure Procedure, Ambulatory Phlebectomy, and Injection Sclerotherapy. 

What is the difference between the VNUS Closure and the Vein Stripping procedure? 

The vein stripping procedure is a surgical procedure for varicose veins.  It is usually performed in an operating room under a general anesthetic.  A physician makes an incision in the groin and ties off the veins after which a stripper tool is threaded through the abnormal vein and used to pull the vein out of the leg through a second incision just above the knee.   

The Closure procedure is performed on an outpatient basis (day surgery), under local anesthesia with light sedation. The veins remain in place and are closed using a special catheter inserted through a small puncture.  The catheter delivers radiofrequency (RF) energy to the vein wall causing it to collapse and seal shut.  Once the diseased vein is closed, other healthy veins take over and carry blood from the leg to re-establish normal blood flow.

Many patients resume normal activities within 1-2 days, and report noticeable improvement in their symptoms in 1-2 weeks after the Closure procedure. After stripping, most patients do not resume normal activities for 2-3 weeks. There is minimal to no scarring, bruising, or swelling after Closure.  VNUS Closure provides durable relief from symptoms in about 90 percent of patients.  

The VNUS Closure procedure does not require groin surgery.  The Closure procedure eliminates the usual bruising and pain often associated with vein stripping, which results from the tearing of side branch veins while the vein is pulled out of the leg. 

Can you explain the Ambulatory Phlebectomy procedure? 

This is a minimally invasive surgical technique for mid-size varicose veins.  A tiny incision or incisions are made and the abnormal vein is removed through the incision using a special set of tools.  Local anesthesia is used and the procedure typically takes under an hour.  Recovery is rapid and most patients do not need to change their activities after this procedure. 

How is Injection Sclerotherapy used to treat damaged veins? 

Injection Sclerotherapy treatment is used for the smallest veins, such as spider veins.  An extremely fine needle is used to inject the diseased vein with a special solution, which destroys the vein wall. 

The results from VNUS Closure, Ambulatory Phlebectomy, and Injection Sclerotherapy are impressive over the existing surgical varicose vein treatments.  

What is the EVAT Procedure? (2005) 

EndoVenous Ablation Therapy (EVAT), an alternative treatment option to traditional vein stripping surgery, brings state-of-the-art technology to an age-old disease.

It is an out-patient procedure (day surgery).  Local anesthesia is used to numb the treatment area.  A thin catheter is inserted into the vein through a small opening, usually only a single need stick.  A laser fiber is used to destroy the vein wall, causing it to seal shut. 

Once the diseased vein is closed, other healthy veins take over and carry blood from the leg, re-establishing normal flow.  Symptoms should improve noticeably after the procedure.

For the "Treatment of Varicose Veins and Superficial Venous Insufficiency" brochure, contact Robert Worthington-Kirsch, M.D., FSCVIR, Image Guided Surgery Associates, PC, e-mail kirsch@igsapc.com, website www.IGSAPC.com. 

 www.sirweb.org has a "Find an Interventional Radiologist (Search - Varicose Veins)".

Reprinted by permission of WE magazine and Hope For Fibroids Organization.