The closurefast catheter attached to the VNUS radiofrequency generator.
Ultrasound imaging uses high frequency sound waves to produce pictures of the inside of the body. In vein treatment, it is used to map out the veins and to detect venous reflux or blockages to blood flow (such as blood clots). The machine is also used as an aid in the placement of a needle, a catheter, or a laser fiber during foam Sclerotherapy or endovenous ablation, such as Venefit™ or EVLT procedures.
Varicose Vein Radiofrequency Treatment (Venefit™ or VNUS™ Closure Procedure)
Venefit™ - Best Endovenous Thermal Ablation Procedure Performed by Dr. R. Dishakjian, M.D., Phlebologist
Nu Vela Esthetica has been one of the first Vein Centers in the San Fernando Valley region of Southern California to offer the Venefit™ Targeted Endovenous Therapy (previously called VNUS Closure procedure). The Venefit™ Targeted Endovenous Therapy is a minimally invasive, non-surgical procedure intended for the treatment of symptomatic bulging leg varicose veins and other conditions associated with venous reflux, such as leg pain, discomfort, itching, burning, cramping, restless legs, and occasionally, more serious conditions, such as leg edema and venous ulcers. Venous reflux is a medical term that describes pooling of blood in the legs due to the improper bumping of blood in the veins towards the heart. The presence of incompetent vein valves is the main reason for developing venous reflux and varicose veins.
Venefit™ Targeted Endovenous Therapy for Varicose Vein Treatment
Venefit™, the targeted endovenous therapy procedure, is a clinically proven, minimally invasive procedure that treats varicose veins and the underlying cause, venous reflux, on an outpatient basis, with minimal discomfort. The Venefit™ procedure is described as endovenous, because a varicose vein is thermally ablated from within the vein. Thermal ablation of the vein is achieved by means of a catheter equipped with radiofrequency (RF) generating electrode. The Venefit™ Targeted Endovenous Therapy is also known as Endovenous Radiofrequency Ablation (RFA) therapy and VNUS™ closure procedure (former name).
VNUS CLOSURE™ OF THE SAPHENOUS VEIN
Currently, the Venefit™ Targeted Endovenous Therapy is one of the two FDA-approved endovenous modalities for the comprehensive treatment of varicose veins; the other being Endovenous Varicose Veins Laser Treatment (EVLT). According to most recent clinical studies and our own experience, patients who undergo varicose vein treatment with the Venefit™ Targeted Endovenous Therapy report superior quality of life compared to vein stripping patients two years following treatment. However, to be a suitable candidate for varicose vein treatment with this procedure, your vein doctor has to make sure that you are not immunocompromised, pregnant, or unable to ambulate freely. Besides, your physician has to confirm that you do not suffer from any bleeding abnormalities, clots are not present in your deep vein system or in the vein to be treated, and your arteries are healthy.
At present, the RFA catheters supplied by Venefit come in two sizes: a large catheter, 7 cm long (Covidien ClosureFast™ Catheter) intended for the ablation of the Greater saphenous vein, and a small catheter, ClosureRFS™ stylet, 3 cm long, which can be used for the ablation of the smaller saphenous vein, tributary veins and perforator veins.
The Venefit™ Procedure
During a varicose vein treatment session, your physician uses duplex ultrasound guidance to locate the trouble causing vein and then accurately positions the Venefit™ Radiofrequency (RF) catheter tip into the diseased vein through a small tube he/she has inserted into the vein through a tiny incision. The vein doctor then injects a large amount of numbing solution around the vein that has to be treated. A second role of the numbing solution, besides its numbing action, is to serve like an insulating sleeve and protect the surruonding tissues from heat damage. As the RF energy is delivered and the catheter is withdrawn, the heat applied to the vein wall destroys its regenerative capacity and shrinks its collagen, leading to its permanent closure. The treated leg is then wrapped, and compression stockings applied in the doctor's office. Although patients are able to walk immediately, and usually return to normal activity the next day, they are advised to arrange for transportation back home as the treated leg may be partially numb.
How Does the Venefit™ System Treat Varicose Veins?
Venous reflux in the main superficial veins (saphenous veins) of the leg and the connecting perforator veins is the most important cause for the appearance of superficial varicose veins and other complications associated with vein disease. The Venefit™ system targets these incompetent saphenous and perforator veins. Once a diseased vein is closed under the influence of the heat delivered by the radiofrequency generating electrode of the Venefit™ system, the blood-flow in the deep veins reverts to its normal pattern towards the heart. As a consequence, branch varicosities; that is, large and very superficial veins that are most obvious to the patient, adjust back to normal pressure conditions and dramatic visible improvement in the appearance of the legs is observed within a few weeks. Some of the residual veins may need additional treatments, such as microphlebectomy (ambulatory phlebectomy), foam sclerotherapy (for branch varicosities), or sclerotherapy (for reticular and spider veins). Dr. Dishakjian, the phlebologist (vein doctor) of the center, will follow the progress of your recovery and accordingly recommend the procedure that will produce the best cosmetic outcome with the least discomfort.
ENDOVENOUS THERMAL ABLATION RESTORES THE NORMAL BLOOD FLOW TOWARDS THE DEEP SYSTEM
Preparing Yourself for Endovenous Thermal Ablation Therapy
Tell your doctor if you are or could be pregnant or have been drinking a lot of alcohol. Mention any medications, supplements, or herbs you are taking. Do not take aspirin about a week prior to the treatment. Stop any blood thinning medications, and wait for any skin infections to heal. Do not tan in the few weeks prior to your treatment, and make sure you do not travel far, as you should avoid sitting for long periods. You may eat prior to the procedure. Also, before coming to the office for treatment, you are advised to wear comfortable clothing, and bring under clothes change, as the ones you are wearing may get stained with betadine.
Recovery and Aftercare Following Endovenous Thermal Ablation Therapy
After varicose vein treatment with thermal ablation, whether Endovenous Varicose Veins Laser Treatment (EVLT) or Venefit™ Targeted Endovenous Therapy, you may feel a tightness in the treated leg. This is normal and should be temporary. Mild bruising and swelling are also common. These should not be of concern, however, since they typically resolve 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. Go to compression therapy and watch the video on how to wear compression stockings.
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 immediately on the days following varicose vein treatment with endovenous ablation techniques, whether Endovenous Laser Therapy or Venefit™, 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.
VENEFIT (VNUS) PROCEDURE AT NU VELA ESTHETICA
When Will the Results of Thermal Ablation Therapy be Seen?
It takes about 10-14 days for the treated veins to dry and shrivel up. The final results will be obvious after a few months.
What Are the Advantages of Endovenous Thermal Ablation Therapy?
Only an experienced vein specialist can tell you if an endovenous thermal ablation procedure is a viable option for your vein problem. The physician will usually take the decision after a complete ultrasound examination. The advantages of endovenous thermal ablation Procedures for varicose vein treatment are as follows:
Compared to stripping surgery, endovenous thermal ablation procedures cause less bruising, eliminate the need for hospitalization, and general anesthesia.
Other than the brief "stick and burn" during the injection of local anesthetia, most patients report feeling little, if any, discomfort during the procedure.
They are covered by Medicare, and most health insurance plans in the United States and in several countries in Europe.
Excellent cosmetic outcome. Do not result in permanent scarring, like the ones left behind following surgical vein removal.
According to international multi-center studies, endovenous thermal ablation procedures are more than 90% effective at a 5-year follow-up.
Endovenous thermal ablation procedures take less than an hour, followed by quick recovery and a return to normal activities.
What Are the Complications Associated With Endovenous Thermal Ablation Therapy?
Complications associated with endovenous ablation are rare and may include skin burns and temporary superficial nerve injury resulting in limited skin numbness in the lower legs. Thrombophlebitis, deep venous thrombosis (DVT), and pulmonary embolism (PE) are other rare complications reported in the medical literature. Note that the incidence of these complications compares very favorably with that reported for surgical ligation/stripping.
Is Varicose Veins Treatment With the Venefit™ Procedure Covered by Insurance?
Among minimally invasive varicose veins treatment procedures, the Venefit™procedure has one of the broadest and most complete insurance coverage available. Eligibility of reimbursement is based on established medical necessity as defined by the presence of symptomatic venous reflux non-responsive to conservative treatment methods. Moreover, at our vein center, three quarters of what you pay for the diagnostic Ultrasound test is reimbursed as payment towards varicose vein treatment.
The VNUS ClosureRFS™ Stylet for Endovenous Ablation of Perforator Veins
Recent studies have indicated that there is a clear correlation between having incompetent perforator veins (short communicating veins between the superficial and deep vein systems along the leg) 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 may only partially correct venous insufficiency, requiring the treatment of the incompetent perforating veins for optimal outcome.
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 (re-named Venefit 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 venous stasis ulcers that occur despite the successful closure of saphenous veins. These ulcers commonly occur along the inner aspect of the leg around the ankle and poorly respond to conventional treatments with antibiotics, wound care, and compression therapy.
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 Venefit™ catheter.