Frequently Asked Questions
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 Closure® procedure?
The 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 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 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 Closure procedure, there is no need for groin surgery. Instead, the vein remains in place and is closed using a special (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 Closure procedure is performed on an outpatient basis, typically using local or regional anesthesia.
Three randomized trials of the Closure procedure vs. vein stripping, including the most recent multi-center comparative trial, show very similar results. In the multi-center comparative trial, the Closure procedure was superior to vein stripping in every statistically significant outcome. In the study, 80.5% of patients treated with the Closure procedure returned to normal activities within one day, versus 46.9% of patients who underwent vein stripping. Also, Closure patients returned to work 7.7 days sooner than surgical patients. Patients treated with the Closure procedure had less postoperative pain, less bruising, faster recovery and fewer overall adverse events.1
How long does the Closure procedure take?
The 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.
Will the procedure require any anesthesia?
We perform the Closure procedure under local anesthesia.
Is the Closure procedure painful?
Patients report feeling little, if any, pain during the Closure procedure. Your physician will give you a local or regional anesthetic to numb the treatment area.
How quickly after treatment can I return to normal activities?
Many patients can resume normal activities immediately.2 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 Closure procedure?
Patients report minimal to no scarring, bruising, or swelling following the Closure procedure.
Are there any potential risks and complications associated with the Closure procedure?
As with any medical intervention, potential risks and complications exist with the 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 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 Closure procedure suitable for everyone?
Only a physician call tell you if the 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 Closure procedure.
Is age an important consideration for the Closure procedure?
The most important step in determining whether or not the 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 Closure procedure is appropriate for you. The Closure procedure has been used to treat patients across a wide range of ages.
How effective is the 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.3,4,5
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 Closure procedure was performed.6
Is the Closure treatment covered by my insurance?
Many insurance companies are paying for the Closure procedure in part or in full. Most insurance companies determine coverage for all treatments, including the Closure procedure, based on medical necessity. The VNUS® Closure procedure has positive coverage policies with most major health insurers. We can discuss your insurance coverage further at the time of consultation.
What are patients saying about the Closure procedure?
98% of patients who have undergone the Closure procedure are willing to recommend it to a friend or family member with similar leg vein problems.7
What is sclerotherapy?
Sclerotherapy is a microinjection procedure to treat spider veins. The procedure involves the injection of a sclerosing solution into the small veins using a very fine, thin needle. This solution irritates the vein lining causing fibrosis and the eventual disappearance of the vein. Multiple veins can be injected at each session.
What are spider veins?
Spider veins are most common in women age 30-50. Spider veins look like a network pattern in a circular fashion. These light purple veins are completely harmless.
Where is the procedure done?
It is usually done in the doctor's office. It generally does not require any type of anesthesia. The patient is asked to come to the clinic in loose fitting clothing and the spider veins are identified. With a very fine needle, these spider veins are injected with a chemical that will destroy the vein. There is minimal pain. For those who are unable to tolerate the pain, a topical local anesthetic can be applied to the skin prior to the procedure.
Can sclerotherapy be used to treat large varicose veins?
Sclerotherapy is generally used for the very small superficial veins next to the skin. Sclerotherapy is not effective for large veins and requires large amounts of the sclerosants with the potential to be absorbed. When large veins are treated with sclerotherapy, a stronger solution and a higher volume is required. Following the treatment for larger veins, compression hose stockings are often recommended to be worn for a number of weeks. It is best to have spider veins treated in the winter months as one can easily wear stockings.
How many sclerotherapy treatments are required?
It varies but typically 2-4 treatments are required for the best results. In patients with milder cases, 1-2 will suffice. More treatments are required when there are more veins or slightly larger veins.
Do I have to limit any activity after the treatment?
Walking is highly recommended soon after the procedure. But any high activity sports should be avoided for the first 2-3 days.
Does sclerotherapy hurt?
There is a little sting associated with each injection. The burning sensation last a few seconds. Most individuals are able to tolerate the procedure and do not require any type of anesthesia. The majority of patients claim that the procedure is much less painful than what they anticipated.
What happens if spider veins are not treated?
Absolutely nothing. Spider veins are small veins which are entirely a cosmetic nuisance. They do not form blood clots, they do not ache, and they do not cause swollen feet or pain.
Can sclerotherapy be done on the arms or face?
Absolutely not. Sclerotherapy should never be done on the face and hands. The hand veins may not look pretty at times, but they should never be treated. Even though veins on the face are being done with sclerotherapy, the injections can be painful and the results are variable. If the facial veins are very conspicuous, laser treatment is a better option than sclerotherapy.
Is there any harm in removing spider veins?
Spider veins have no function and removing them does no harm. The only reason they are removed is because of their unsightly cosmetic appearance.
Can anyone undergo sclerotherapy?
Almost anyone with unwanted spider veins can be treated, except women who are pregnant or nursing. Other relative contraindications include those patients with skin infections, uncontrolled diabetes, fever, history of deep vein thrombosis, anticoagulant therapy, and those patients taking corticosteroids.
Is there any preparation required before sclerotherapy?
No preparation is required before the procedure. It is recommended that one stop smoking and stop taking aspirin a few days before the procedure. Any patient on a blood thinner is not a candidate for sclerotherapy.
What happens after sclerotherapy treatment?
There is some mild pain which can easily be overcome with Tylenol. The injected site will appear bruised and swollen for a few days. Continual wearing of the ace bandage will relieve the swelling and pain. The bruising usually disappears in 2-3 weeks. Patients will not experience any problem walking. After the first 2 days, most patients can resume their normal activities.
How long is each sclerotherapy session?
Each treatment session lasts up to 30 minutes. After the treatment, sterile dressings are placed over the injection site and the entire leg is covered with an ace bandage. The ace bandage is left on for 2-3 weeks until the patient returns to see the doctor.
What are side effects of sclerotherapy?
Besides some stinging pain, sclerotherapy rarely causes side effects. Allergic reactions are rare. A few individuals may develop intense itching at the site of injection. If the chemical is injected outside the vein, profound discoloration and pain can occur.
Does insurance cover sclerotherapy?
Spider veins and sclerotherapy are considered cosmetic in nature and the cost of treatment is not covered by any insurance companies.
References
1 Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, et al. Prospective randomized study of endovenous radiofrequency obliteration (Closure) versus ligation and stripping in a selected patient population (EVOLVES study). J Vasc Surg 2003;38:207-14.
2 Goldman, H. Closure of the greater saphenous vein with endo radiofrequency thermal heating of the vein wall in combination with ambulatory phlebectomy: preliminary 6-month follow-up. Dermatol Surg 2000; 26:452-456.
3 Merchant RF, DePalma RG, Kabnick LS. Endovascular obliteration of saphenous reflux: a multicenter study. J Vasc Surg 2002;35:1190-6.
4 Weiss RA, et al. Controlled Radiofrequency Endovenous Occlusion Using a Unique Radiofrequency Catheter Under Duplex Guidance to Eliminate Saphenous Varicose Vein Reflux: A 2-Year Follow-up, Dermatologic Surgery, Jan 2002; 28:1: 38-42
5 Whiteley, MS, Holstock JM, Price BA, Scott MJ, Gallagher TM. Radiofrequency Ablation of Refluxing Great Saphenous Systems, Giacomini Veins, and Incompetent Perforating Veins using VNUS Closure and TRLOP technique. Abstract from Journal of Endovascular Therapy 2003; 10:I-46.
6 Pichot O, Sessa C, Chandler JG, Nuta M, Perrin M. Role of duplex imaging in endovenous obliteration for primary venous insufficiency. J. Endovasc Ther 2000;7:451-9.
7 Weiss RA, Weiss MA. Controlled radiofrequency endovenous occlusion using a unique radiofrequency catheter under duplex guidance to eliminate saphenous varicose vein reflux: A 2-year follow-up. Dermatol Surg 2002;28:38-42.