THE CLOSUREŽ
PROCEDURE
(SAPHENOUS VEIN OCCLUSION)
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.
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.
DISCLAIMER
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 |
