Comparison Of Treatment Options
VNUS RF Ablation
VNUS Closure BrochureVNUS® RF (radiofrequency) Ablation system (also called the Closure® procedure) is a minimally invasive treatment alternative with less pain and less bruising when compared to traditional vein stripping surgery and laser treatment. Using the Closure system, physicians close the diseased veins by inserting the Closure catheter into a vein and heating the vein wall using temperature-controlled RF energy. Heating the vein wall causes collagen in the wall to shrink and the vein to close. After the vein is sealed shut, blood then naturally reroutes to healthy veins.
Venous reflux or venous insufficiency develops when the valves that usually keep blood flowing out of your legs become damaged or diseased.
The Closure procedure provides the following benefits for patients and physicians:
- -Minimally Invasive Outpatient Procedure: Closure catheters are inserted into the vein via a tiny incision in the lower leg, eliminating the need for groin surgery and general anesthesia. The Closure procedure can be performed using local anesthesia in a physician’s office, as well as in an outpatient hospital setting or surgicenter.
- -Clinically Proven Less Post-Operative Pain: The Closure procedure does not involve pulling the diseased vein from the thigh as with vein stripping surgery, or using 700° C laser energy which boils blood to occlude a vein as with endovenous laser (EVL). In the RECOVERY Trial, a multi-center head-to-head comparative randomized trial comparing the Closure procedure with EVL, the Closure procedure was found to have less patient pain and less patient bruising than EVL for the best patient recovery experience available from a minimally invasive vein treatment.10 Additionally, in other randomized comparative studies have shown that patients receiving the Closure procedure return to normal activity and work significantly faster than those receiving vein stripping.
- -Excellent Clinical Outcomes:The ClosureFAST catheter, which represents the latest advancement in the Closure procedure, has been shown in a multi-center study to have a 97.4 efficacy rate at one-year. This shows that the treatment is highly effective and, as proven in the RECOVERY trial, is gentle on the patient.
- -Cosmetically Appealing: Because treatment with Closure is minimally invasive and is catheter-based, it results in little to no scarring. As with any medical procedure, you are encouraged to review all safety information associated with the procedure by consulting your physician.
Endovenous Laser Treatment
Endovenous Laser Treatment for the elimination of varicose veins is quickly becoming the gold-standard in the treatment of varicose veins. Endovenous Laser Treatment uses laser energy, which is simply a highly concentrated beam of light. Medical lasers work by delivering this light energy to the targeted tissue with extreme precision, so as not to affect the surrounding tissue. Lasers have proven their safety and effectiveness through years of use in all types of medical procedures, from eye surgery to dermatology. In the hands of a skilled physician, lasers offer far less risk for complications than conventional surgery.
In endovenous laser treatment, a thin fiber is inserted into the damaged vein through a very small entry point in the skin. A laser light is emitted through the fiber, as the fiber is pulled back through the vein, it delivers just the right amount of energy. The targeted tissue reacts with the light energy, causing the vein to close and seal shut. The veins that are closed are superficial veins that handle less than five percent of the body's blood flow. The blood is automatically routed to other, healthy veins.
Some physicians are now using a jacketed fiber, which prevents any contact between the fiber and the vein wall. This prevents much of the pain and bruising that is often associated with the more conventional method of ligation and stripping. Some patients may experience temporary soreness or some slight swelling, which can be treated effectively with over-the-counter, non-aspirin pain relievers and typically subsides within the first five days.
The procedure is minimally invasive and requires no general anesthesia. Only local anesthetic is used to numb the area where the physician is working. Patients are encouraged to walk immediately after the procedure and can resume normal activities the same day. The VenaCure EVLT™ system utilizes this technology and method to eliminate varicose veins.
Learn more about VenaCure EVLT http://www.vnus.com/physician-info/radiofrequency-ablation.aspx
http://www.vein-treatment.com/vnus-closure.php
http://www.phlebology.org/patientinfo/treatment.html
http://www.evlt.com/content/patients/varicose-vein-removal/ablation.jsp
VNUS and Closure are registered trademarks of VNUS.
Surgical Stripping Of Varicose Veins
The traditional technique for surgical stripping is ligation and stripping of the great saphenous vein (GSV), the long vein that extends from the anklebone along the inside of the leg and thigh and empties into the femoral vein in the groin. Ligation and stripping involves tying off the abnormal vein (ligation) and physically removing it (stripping).
Ligation and stripping are performed in a hospital setting or outpatient surgical center under local, spinal, or general anesthesia. The surgeon makes a small incision in the groin to expose the diseased GSV, which is tied off. The surgeon then makes a series of incisions along the leg from the thigh to a point just below the knee. Using a specialized stripping tool that is inserted and threaded through the incisions, the surgeon strips out the diseased vein.
A more recent variation on this technique is PIN (Perforate Invaginate) stripping. This technique involves inserting an instrument called a PIN stripper through a small incision in the leg. The stripper is advanced through the vein, its tip is sewn to the end of the vein, and the vein is pulled in on itself as it is stripped out of the leg. PIN stripping is performed in a hospital operating room or outpatient surgical center under general anesthesia or local anesthesia with IV sedation.
During stripping, branch veins attached to the GSV are broken, causing blood to leak into surrounding tissues. This causes the postoperative pain, soreness and bruising experienced by ligation and stripping patients. Other potential complications include numbness from damage to surrounding nerves, chronic leg swelling from damaged lymphatic tissue, incision scars and allergic reaction to anesthesia. Although the patient is usually able to return home the same day, recovery from vein stripping surgery typically takes up to four weeks, with patients sidelined for several days in the beginning.
Surgical vein stripping is far more invasive than the VenaCure EVLT™ procedure. Additionally, a study published in the Journal of Vascular Surgery in 1999 revealed that vein stripping surgery was 71% effective in eliminating varicose vein, compared to a success rate of up to 98% for the VenaCure EVLT™ procedure. Endovenous laser vein therapy also causes less bruising and numbness and leaves minimal to no scars as compared to surgical ligation and vein stripping.
Sources:
http://www.vnus.com/vascular-disease/varicose-veins/vein-stripping-treatment.aspx
http://www.phlebology.org/patientinfo/treatment.html
Phlebectomy
Phlebectomy is a minimally-invasive surgical procedure that removes surface varicose veins. There are two basic types of phlebectomy: Ambulatory and Transilluminated Powered Phlebectomy (TIPP).
-Ambulatory Phlebectomy
An ambulatory phlebectomy is usually performed in a doctor’s office using local anesthesia. First, a local anesthetic fluid is injected into the area of varicose vein clusters to be treated. The doctor then uses a small scalpel or needle to puncture the skin next to the varicose vein, inserts a small hook into the hole, grasps the vein and removes it. The area is covered with a compression bandage and/or compression stockings. No stitches are required and the scars are nearly imperceptible. The patient is able to walk immediately following the procedure, which is often performed following the VenaCure EVLT™ procedure to remove any large surface veins left behind after the procedure. The possible risks of ambulatory phlebectomy include an allergic reaction to the anesthetic and localized numbness.
-Transilluminated Powered Phlebectomy
Transilluminated Powered Phlebectomy (TIPP) is similar to ambulatory phlebectomy but slightly more invasive. It is performed on an outpatient basis in an operating room under light anesthesia. After making two small incisions near the varicose vein, the surgeon inserts a tumescent canula illuminator (TCI) that contains a fiber optic light that makes the veins easily visible. Fluid containing a local anesthetic is infused under the skin, loosening the vein from the surrounding tissue. A vein remover instrument is guided to the vein, which is suctioned into the instrument where it is cut into small pieces and removed. Thanks to the large amount of local anesthetic used, patients usually awake without any pain and are able to return home in about an hour. They can return to their normal activities immediately and to work within a few days. Strenuous activity should be limited for up to two weeks. As with any surgery, there are some potential complications including a risk of infection and hyperpigmentation (skin discoloration).
Sources:
http://www.phlebology.org/patientinfo/treatment.html
http://www.radiologyinfo.org/en/pdf/phlebectomy.pdf
Compression Stockings
Compression therapy is frequently the first and most conservative step in the management of varicose veins. In fact, insurers often require that patients undergo conservative compression therapy prior to becoming eligible for reimbursement for the VenaCure EVLT™ system or other more aggressive varicose vein treatments. Compression stockings are also often used following those same treatments to promote healing by lessening pain, swelling and bruising.
It is important to recognize that compression stockings can alleviate some symptoms of varicose veins but they cannot treat their underlying cause, failed valves (also called venous reflux). Even with faithful use of compression stockings, the disease may progress to the point that more advanced treatment is necessary.
Gradient compression stockings and hosiery provided pressure that is strongest around the foot and ankle and looser as it moves up the leg. The steady pressure provided by compression stockings assists the leg muscles and veins in moving blood more efficiently and quickly up the leg to the heart. They also prevent the superficial veins directly beneath the stockings from over expanding with pooled blood. For best results, compression stocking should be worn throughout the day.
Compression stockings and hosiery are available in varying degrees of compression that are expressed in units called “mmHg”, or millimeters of mercury. The range is from 10 mmHg to over 50 mmHg. Compression stockings at the lower end of the scale are used for milder cases of vein disease and can be purchased over the counter. Higher compression stockings require a prescription from your physician.
Compression stockings and hosiery come in a variety of types and brands and in styles and colors to suit both women and men. They are readily available online as well as at most pharmacies and medical supply stores.
The main potential complication linked to graduated compression stockings is that a poor fit may obstruct venous or arterial blood flow. When trying on compression stockings, choose a comfortably supportive fit over one that’s overly tight.
Sources: