Patients have a clinical and ultrasound examination prior to treatment planning. Insured patients may have the ultrasound investigation at no additional charge if their insurance company covers the cost of the test (Code 5940), however insurance plans may vary. At the preliminary evaluation all patients will be informed about the most effective treatment, have all their questions answered, and have a management plan developed.
Vein Treatment Options include
ClosureFast Procedure (Venefit)
Endovenous Laser Therapy (EVLT)
Sclerotherapy – either by injection or laser
VenaSeal Closure System (Sapheon)
Treatment of Venous Ulcers (Treating Perforating Veins)
ClosureFast Procedure (Venefit)
The ClosureFast procedure (Venefit or VNUS Closure formerly) gives results which are identical to the more commonly used surgical process of vein stripping; however it avoids cutting, stripping, sewing and general anaesthesia. It combats this persistent venous disorder with the latest technological advances.
Outpatient admission or walk-in walk-out (meaning ‘ambulatory care’ in which extensive post-surgery hospital stays are unnecessary) is the norm for the Closure procedure. Under ultrasound guidance, the surgeon places a Closure catheter into the incompetent vein by means of a small incision. A radiofrequency energy emits from this slim instrument, which works to heat the vein walls, after which the catheter can be extracted. The collagen in the venous tissue will contract and the vein will close. These incompetent veins can be quite safely obliterated as other healthy veins are present through which the blood can flow.
After the procedure a bandage is applied, and subsequently an elastic stocking. The wound is small, and there are no sutures or stitches to be removed. In most cases, patients who undergo the closure procedure may fully resume the activity of their daily lives within 24 hours of receiving treatment and resume driving at 48 hours, when they can make an emergency stop.
Click opposite to view a short video about the ClosureFast procedure
Endovenous Laser Therapy (EVLT)
Endovenous Laser Therapy (EVLT) involves passing a small laser fibre up through an incompetent major vein to obliterate it using heat energy. It is the original and most validated endovenous treatment having been introduced in 1991. It is suitable for ambulatory patients, and obliterates incompetent veins permanently, by collagen coagulation. Again patients have a bandage applied after the procedure, much like the Venefit treatment. Patients are advised to subsequently wear elastic stockings during the day.
Highlights of the Closure and EVLT procedures
- Less adverse effects than open surgery
- Ability to return to regular pursuits within 24 hours time
- Walk-in, walk-out or outpatient procedure
- Can be done under Local Anaesthesia
- Positive cosmetic results: negligible scars, bruises, or burns – no stitches
The ambulatory phlebectomy procedure involves removal of superficial or surface veins. The incisions made during this process are tiny, meaning that they neither require stitches nor lead to cosmetic problems like noticeable scarring. This procedure is conducted while using local anaesthesia, meaning there will be no painful sensation during the treatment, and the pain experienced after treatment will likewise be negligible or very tolerable. Post-extraction treatment will involve the use of elastic compression stockings and bandaging for a brief while. This procedure is often combined with Venefit (VNUS) closure or Endovenous Laser therapy.
Sclerotherapy, involving the injection of a solution (that is a sclerosant) with a miniscule needle, is a treatment designed to alleviate or eliminate cosmetically undesirable spider veins and varicose veins. The sclerosing solution serves to aggravate the veins’ inner wall until this lining expands and hardens. Eventually, the treated area will be absorbed into the surrounding bodily tissue. A slight amount of irritation may be felt during the procedure, along with a feeling of pressure for minutes upon the injection of the more prominent veins. The number of veins to be injected will vary, and will be contingent upon the severity of each patient’s condition, also taking into account factors such as the positioning and size of the veins. There is also no standardised number of therapy sessions, with multiple sessions (up to three) being required for a given venous area. Elastic stockings (which exert a pressure of 30 to 40mmHg) will be worn afterwards, to reduce the risk of bruising.
Venaseal Closure System (Sapheon)
VenaSeal Sapheon Closure System is a minimally invasive treatment which uses a medical glue or adhesive to eliminate varicose veins and venous reflux. This system is passed under ultrasound guidance, and a tiny catheter is placed in the diseased vein. The VenaSeal dispenser then delivers a very small amount of medical glue or adhesive which permanently closes the diseased vein. With the affected vein closed, blood re-routes through other healthy veins in the leg.
Uniquely, in contrast with most other treatments, VenaSeal does not require tumescent anaesthesia (i.e. local anaesthetic injected into the leg via multiple needle sticks), and patients can return to normal activities right after the treatment. Unlike thermally-based procedures, with VenaSeal there is no risk of skin burns, and nerve damage is very unlikely. VenaSeal usually does not require any post-treatment pain medication or uncomfortable compression/elastic stockings. This is a new procedure, and consequently, in Ireland, the Venaseal™ system is not currently covered by any private medical insurance. It can only be offered to those patients who are paying for their treatment. If you wish to undergo Venaseal™ treatment, please come for a consultation and venous duplex ultrasound assessment.
More about Venaseal http://www.venaseal.com/how-venaseal
Treating the Venous Ulcer (Treating Perforating Veins)
Recent medical research indicates that roughly 0.5% of the population suffer from venous ulcers – these wounds being the most advanced or chronic phase of venous disorder.1,2 Over 50% of the ulcers are recurrences of previously healed wounds. Though several conventional treatments do exist to alleviate the pain associated with these ulcers and to heal them, they are not particularly successful in preventing recurrences. The more common treatments involve application of ointments or antibiotics, or compression therapy. Moreover, therapies that focus on healing the damaged skin without addressing the abnormal venous blood flow will also slow the healing process and contribute to a recurrence of ulcers.1,3,4,5
Sclerotherapy, compression therapy, VNUS Closure and Endovenous laser therapy among other treatments provide an opportunity to offer venous ulcer patients an alternative to more invasive surgery. Importantly these treatments can be provided without the need for general anaesthesia, hospitalisation, or stopping routine patient medications.
Click opposite to see a quick animation of the ClosureRFS.
1 Barwell JR, Davies CE, Deacon J, et al: Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): Randomised controlled trial. Lancet. 2004;363(9424):1854–1859.
2 Poblete H, Elias S: Venous ulcers: new options in treatment: minimally invasive vein surgery. Journal of the American College of Certified Wound Specialists (2009) 1, 12–19
3 Obermayer A, Gostl K, Walli G, et al. Chronic venous leg ulcers benefit from surgery: long term results from 173 legs. J Vasc Surg 2006;44:572-79
4 Nelzen O, Fransson I. True long-term healing and recurrence of venous leg ulcers following SEPS combined with superficial venous surgery: a prospective study. Eur J Vasc Endovasc Surg 2007;34:605-12.
5 Zamboni P, Cisno F. et al. Minimally invasive surgical management of primary venous ulcers vs. compression treatment: A randomized clinical trial. Eur J Vasc Endovasc Surg 2003;25:313-18.