General, Vascular and Minimally Invasive Surgery





A single saphenous vein runs down each leg, from the groin to the ankle. Its job is to help return oxygen-depleted blood to the heart. In most people they work fine.
Saphenous Vein
However, if the valves which are designed to prevent blood from flowing backwards don't function properly---a condition called superficial venous reflux---numerous problems occur. Symptoms include swelling, pain, fatigue and varicose veins.

Whether the initial cause was genetics, pregnancy, prolonged standing (such as for occupations), excess weight, or inadequate exercise; the physiology of varicose veins is always the same. The valves are damaged--- physicians call them incompetent and the vein is stretched and distorted from increased pressure caused by blood flowing in the wrong direction.

Nonsurgical treatment (compression, elevation, lifestyle changes) have proven helpful in reducing leg pain and further vein deterioration, particularly in mild cases but are temporary "band-aids," and do not cure the problem. Sooner or later most patients require more definitive therapy or surgery.

The simplest of surgical procedures involves removing the visible surface varicose veins in a procedure known as Segmental excision, or phlebectomy. This technique was developed in the 1950s. A surgeon excises diseased varicose veins through a series of very small incisions. However, phlebectomy alone does not address the incompetent valves in the saphenous vein which created the problem in the first place. Therefore, the varicose veins tend to recur within a year or two. Due to this tendency toward recurrence, many physicians advocate stripping the saphenous vein.

Saphenous vein stripping involves making an incision in the groin and surgically tying off the top of the saphenous vein. An instrument resembling a thin wire with a button on the end of it is inserted into the saphenous vein and passed down to the lower leg. Another incision is then made in the lower leg and the wire is retrieved. The stripping device is then pulled out through the second incision tearing out the saphenous vein, and in the process avulsing every branch that comes off of the vein in the thigh and upper calf. This stripping process typically causes significant bruising due to bleeding from the avulsed branches. Stripping contributes to post-operative pain, can cause nerve damage and may result in poor cosmetic outcomes. Recovery rates commonly are four to six weeks. More positively, stripping removes the saphenous vein, diverting surface blood flow to other veins with competent valves and to the deep venous systen which can tolerate the pressure and flow. This generally eliminates the pain associated with varicose veins and greatly reduces their potential for recurrence.

ClosureŽ has been developed and refined over the past fifteen years in an effort to provide the benefits of stripping without its drawbacks, e.g. invasive surgical procedure, post-operative pain, excessive bruising and prolonged recovery period. This unique, patented, technology uses a very small catheter and computer controlled radiofrequency energy to occlude, or seal shut, the saphenous vein. The procedure is usually done through a single incision five millimeters long, (about a quarter of an inch), which is covered with a band-aid upon completion of the operation. ClosureŽ is commonly done in conjunction with segmental excision of a few of the largest visible varicose veins so that they are immediately eliminated following the procedure. The entire operation is done in the operating room under ultrasound so that the veins and the catheter can be clearly seen at all times. This minimizes the risk of complications. The combination of phlebectomy and ClosureŽ results in cure of the varicosities and of their underlying cause. Data published in Vascular Surgery (May 2000) has shown that 94% of all ClosureŽ patients who underwent six and twelve month follow-up visits rated themselves as "symptom free" or "substantially improved" and "they would recommend the procedure to a friend." Post-operatively, most patients return to normal activity within a couple of days.

Like any operation, the ClosureŽ procedure does still involve risks and potential complications. Each patient should consult with me to determine whether or not they are a candidate for this procedure, and if their condition presents any special risks. Complications reported in medical literature include numbness or tingling (paresthesia), skin burns (very rare), blood clots (very rare), and temporary tenderness in the treated limb.

ClosureŽ is a Registered Trademark of VNUS Medical Technologies