Varicose Vein Treatment with VNUS Closure™ or EVLT

The Best Endovenous Ablation Systems: VNUS Closure™ Procedure and Endovenous Laser Treatment (Sciton's Pro-V EVLT)

A sometimes severe condition, called venous insufficiency syndrome or venous reflux causes large, bulging, bluish veins to appear on the legs, causing pain, leg heaviness and fatigue, swollen limbs and an unsightly appearance. This condition occurs in the largest superficial vein in the leg, causing its leaky valves to allow backflow of blood from the groin area into the lower leg. In healthy legs, valves open and close to assist the return of blood to the heart.

Endovenous Ablation Using the VNUS Closure™ and EVLT Systems

Until a few years ago, the only option for removing bulging leg varicose veins was painful stripping surgery requiring hospitalization, scarring, general anesthesia and significant post-surgery conditions. Nowadays, endovenous ablation techniques have almost put an end to these painful surgeries. Endovenous ablation refers to the minimally invasive Ultrasound guided procedure, whereby varicose veins are entered into and shut down from inside the veins by means of a heat generating radiofrequency catheter or laser fiber. Currently, the VNUS™ closure procedure and Endovenous Laser Treatment (EVLT) are the only two systems that are approved by the FDA for endovenous ablation procedures. The former uses a radiofrequency generating electrode, whereas the latter uses a laser fiber to thermally ablate the veins. The success rate for varicose vein treatment using both systems ranges from 93-95 percent with minimal side-effects or complications. It should be pointed out that in our experience with the more current VNUS™ system, the success rate runs at higher than 95 percent (Compare it with 85 percent for the older surgical ligation or stripping methods). Moreover, according to most recent clinical studies, patients who have undergone endovenous ablation have reported superior quality of life compared to vein stripping patients two years following treatment.

Interestingly, the veins that are the root cause of the venous insufficiency and therefore targeted for endovenous ablation may not be the same bulging veins for which patients may have originally sought medical attention. Patients are often surprised to learn that a huge bulging vein network on a calf may have its origin at the groin level or back of the knee, where the largest superficial veins communicate directly with the deep vein system. The endovenous ablation procedures target these main superficial veins rather than the visible branch varicosities that are most obvious to the patient. Once treated with an endovenous ablation procedure successfully, these main superficial veins stop the source of back flow of blood to the bulging varicose branches, resulting in dramatic visible improvement within a few weeks, as these veins adjust back to normal pressure conditions. Some of these residual veins may need additional treatments for the best cosmetic outcome, with either sclerotherapy or foam sclerotherapy.

The two most important main superficial veins that are treated with the endovenous ablation procedure are the Great Saphenous Vein (GSV) and the Small Saphenous Vein (SSV). The GSV is by far the most commonly treated one. It extends from the inside of the ankle to the level of the groin, where it joins the deep vein system. The SSV is much shorter and runs in the back of the calf area. It should be noted that shorter communicating veins called perforators, may present as additional and secondary sources of venous reflux. These have to be identified and treated separately.

Nu Vela Esthetica has chosen the VNUS Closure™ and Sciton's Pro-V EVLT for endovenous ablation systems because compared to other systems, they tend to be superior in outcome due to their gentler nature and more precise control of heat delivery. In fact, until recently, clinical studies had consistently shown that the VNUS Closure™ treatment system was superior to most endovenous laser systems in producing less pain, bruising, and complications. The Sciton Pro-V laser used at Nu Vela is a newer generation laser that uses a wavelength of 1319 nm. This wavelength is ideal in terms of targeting the vein wall itself and not the blood content of the vein, unlike some of the older laser systems used for EVLT. The result is a fast and comfortable endovenous laser ablation with smooth recovery experience.

Dr. Dishakjian, a phlebologist, is a highly skilled physician in venous system treatments, including the innovative VNUS Closure™ procedure and Endovenous Laser Treatment. Phlebologist are the experts in minimally invasive varicose vein treatment procedures, which require expertise in ultrasound and noninvasive needle and catheter techniques.

VNUS CLOSURE™ OF THE SAPHENOUS VEIN

BEFORE & AFTER GALLERY. click here...

VNUS Closure™ - The Procedure

The VNUS Closure™ procedure is a clinically proven, minimally invasive procedure that treats varicose veins and the underlying cause, venous reflux, on an outpatient basis with little or no pain. The VNUS™ closure is an endovenous procedure; meaning, diseased veins are accessed and treated from inside the veins. Using a careful duplex ultrasound guidance, your physician accurately positions the VNUS ClosureFAST™ Radiofrequency (RF) Catheter tip, and injects a numbing solution around the target vein that acts like an insulating sleeve while RF energy is delivered to the vein wall. As the RF energy is delivered and the catheter is withdrawn, the vein wall is heated causing the collagen in the wall to shrink and the vein to close. Once the diseased vein is closed, blood is re-routed to other healthy veins. The procedure is performed on an outpatient basis.

VARICOSE VEIN ABLATION WITH THE VNUS™ CATHETER

Endovenous Laser Treatment (EVLT)

Nu Vela Esthetica has chosen Sciton's Pro-V endovenous laser treatment system for endovenous ablation because it has the optimal wavelength to make the procedure fast and comfortable. Absorption of this wavelenth occurs in water within the vein and vein wall, and the the heat generated by the absorption process contracts and collapses the vein wall. The procedure for endovenous laser treatment of saphenous veins is very similar to that of the VNUS closure, except that the laser fiber replaces the radiofrequency generating catheter.

VNUS CLOSURE PROCEDURE - PATIENT EDUCATION

The VNUS ClosureRFS™ Stylet - Perforator Vein Reflux Treatment

Recent studies have indicated that there is a clear correlation between having incompetent perforator veins (veins that take blood from the superficial veins into the deep veins) and the recurrence of varicose veins. Accordingly, when incompetent perforator veins are present, ablation of the large superficial saphenous veins with the VNUS ClosureFAST™ catheter alone will not correct venous insufficiency, and the incompetent perforating veins should also be treated.

To this end, VNUS™ Medical Technologies has extended the Closure procedure, and introduced the VNUS ClosureRFS™ stylet. The ClosureRFS™ stylet with its smaller catheter is intended to treat several other smaller veins, including anatomically suitable refluxing perforator veins.

Currently, the VNUS ClosureRFS™ stylet is the only endovenous ablation device specifically cleared by FDA for the treatment of incompetent refluxing perforating veins. These veins are the most common origin of hyperpigmentation and venous stasis ulcers that occur along the inner aspect of the leg around the ankle. Conventional treatments for venous ulcer patients with antibiotics, salves, and compression therapy are often not effective in treating the condition.

Dr. Dishakjian, the phlebologist at the Vein Clinic, will use Duplex Ultrasound imaging to detect the presence of any refluxing perforator veins and accordingly suggest a treatment plan. Perforator vein treatment with the ClosureRFS™ stylet is an outpatient procedure, which can be either the primary treatment, or it can be performed in addition to the saphenous vein ablation with the VNUS ClosureFAST™ catheter.

VNUS CLOSURE STYLET TREATING PERFORATOR VEINS

Endovenous Ablation (VNUS™ or EVLT) - Recovery and Aftercare

Following the Endovenous ablation procedure (VNUS™ or EVLT), the treated leg is wrapped and compression stockings applied in the doctor's office. Although patients are able to walk immediately, and typically return to normal activity the next day, they are advised to arrange for transportation back home as the treated leg may be partially numb. Mild bruising and swelling may occur, typically resolving within a few weeks. After-procedure pain level is expected to be minimal and can be mostly managed with over-the-counter medications, such as Advil. Tenderness to direct manual pressure over the vein, however, may persist for several weeks. Wraps will come off during the next-day follow up visit, but compression stockings should be worn for two weeks following the procedure.

As for activities, patients are encouraged to engage in moderate exercises that involve the legs, like walking, hiking, biking, or treadmill workouts. Activities to avoid include heavy weight lifting, extreme sports, abdominal crunches, and any activity that increase core body pressure. Patients should also avoid extreme hot environments, like sauna and bathtub. After the first 24 hours, the compression stockings can be taken off during sleep and while taking shower. During the healing period, direct sun exposure and tanning should also be avoided in order to prevent skin discoloration.

VNUS CLOSURE AT NU VELA ESTHETICA

Who is Not a Good Candidate for Endovenous Ablation (VNUS™ and EVLT)?

Endovenous ablation should not be performed on candidates who are either immunocompromised, pregnant, unable to ambulate freely, and patients with

• bleeding abnormalities
• clots in the deep vein system or in the vein to be treated
• disease in the arteries of the legs
• localized or general infections
• rare arterial-venous communication in the segment to be treated

What Are the Complications Associated with Endovenous Ablation?

Complications are very rare, but there are reported incidents involving thrombophlebitis, deep venous thrombosis (DVT), and pulmonary embolism (PE).

Are the VNUS Closure™ and EVLT Procedures Covered by Insurance?

Among minimally invasive varicose vein treatment procedures, the VNUS™ Closure procedure and EVLT have the broadest and most complete insurance coverage available. Eligibility of reimbursement is based on established medical necessity. It is estimated that more than 98% of EVLT and VNUS Closure™ procedures performed in the U.S. have involved payments from insurance plans, such as Aetna, Cigna, BCBS Plans, Humana, Health Net, United Healthcare, Medicare, and Coventry.

Questions About Cost or the Treatment?

You may reach our Los Angeles medical spa and vein clinic by clicking the "Contact us" button at the top of the page, or by calling 818-832-4500. Our receptionist will be delighted to assist you with any enquiries regarding cost, additional information, or scheduling a free consultation session with Dr. Dishakjian, a cosmetic surgeon and phlebologist.

Click spider and varicose vein treatment Los Angeles to read about other treatment options available at the Center.