VNUS® Closure®

VNUS® Closure® is a clinically proven, minimally invasive procedure that treats varicose veins and their underlying cause, venous reflux, with little or no pain. Closure patients can walk away from the procedure and be back to everyday activities – either at home or at work – typically within a day.

Finally. A solution to leg pain and varicose veins. If you experience discomfort, swelling and varicose veins in your legs, you may be suffering from superficial venous reflux disease. Approximately 25 million people in the United States suffer from this condition. Traditionally patients diagnosed with venous reflux would undergo vein stripping surgery. Now, patients can be treated with the Closure procedure -- a minimally invasive alternative to painful vein stripping surgery.

Venous reflux or venous insufficiency develops when the valves that usually keep blood flowing out of your legs become damaged or diseased. The main treatment 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. Closure provides a less-invasive alternative to vein stripping by closing the diseased vein instead.

Experience the Closure Procedure

The Closure procedure can be performed on an outpatient basis using either local or general anesthesia in which the physician numbs the leg before treatment. Currently, it is predominantly performed in a hospital setting, though it may also be performed in a physician’s office. The procedure consists of four principal steps.

Map the Saphenous Vein. A typical procedure begins with noninvasive ultrasound imaging of the diseased vein to trace its location. This allows the physician to determine the site where the Closure catheter will be inserted and to mark the desired position of the catheter tip to begin treatment.

Insert the Closure Catheter. After the physician accesses the saphenous vein, the Closure catheter is inserted into the vein and advanced to the uppermost segment of the vein. The physician then typically injects a volume of dilute anesthetic fluid into the area surrounding the vein. This numbs the leg, helps squeeze blood out of the vein and provides a fluid layer outside the vein to protect surrounding tissue from heat once the catheter starts delivering RF energy. Saline is then slowly infused into the vein from the tip of the catheter to further create a near-bloodless field inside the vein, allowing the catheter to preferentially heat the vein wall, rather than the blood.

Deliver RF Energy and Withdraw Catheter. Noninvasive ultrasound is used to confirm the catheter tip position and the physician then activates the RF generator, causing the electrodes at the tip of the catheter to heat the vein wall to a target temperature of typically 85 degrees Centigrade or 185 degrees Fahrenheit. As the vein wall is heated, the vein shrinks and the catheter is gradually withdrawn. During catheter pullback, which typically occurs over 15 to 18 minutes, the RF generator regularly adjusts the power level to maintain target temperature to effectively shrink collagen in the vein wall and close the vein over an extended length.

Confirm Closing of Vein. After treatment, ultrasound imaging is used to confirm closing of the vein. If a portion of the vein is not closed, the catheter can be reinserted and energy reapplied. After the procedure, the narrowed vein gradually becomes fibrous, sealing the interior of the vein walls and naturally redirecting blood flow to healthy veins. Experienced physicians often complete the procedure in 45 to 60 minutes.

98% of patients who have undergone the Closure procedure are willing to recommend it to a friend or family member.

Dr. Weston will instruct you to walk regularly for several days after the Closure procedure and return within 72 hours for an ultrasound examination. You may be prescribed compression stockings to be worn for several days or weeks after the procedure. Compression stockings are prescribed as a routine item for vein procedures with the goal of enhancing patient comfort in the initial days after treatment.

Patients who undergo the Closure procedure typically resume normal activities within a day.

Closure Procedure Highlights

• Relief of symptoms
• Outpatient procedure
• Resume activities typically within a day
• Good cosmetic outcome with minimal or no scarring, bruising, or swelling

VNUS® Closure® FAQs

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.

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.

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.

Will the procedure require any anesthesia?

The 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.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.

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.

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. Click here to review additional insurance information. Your physician 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.

Interested in VNUS® Closure® Procedure for Varicose Vein Treatment call Azura Medical Spa at 980-297-7733 or contact us to learn more.