The VNUS Closure procedure is an alternative to classic vein stripping. A subset of all stripping alternatives is based on controlled coagulation processes in the sense of coagulation.
In endoluminal procedures, this is done from the inside (endo = inside). Either thermally (heat) or chemically (liquid or foam-like sclerosing agents).
Both the application of heat (100-120° Celsius) and the use of sclerosing agents cause the vein walls to stick together. This prevents the blood from flowing back into the abnormally dilated vein (varicose vein).
The backflow of venous blood is caused by the venous valves no longer functioning.
This leads to the typical congestion symptoms of varicose vein disease, which are
In endoluminal procedures, doctors apply heat to the vein through a catheter. They insert this through the skin.
Endoluminal procedures include:
- VNUS Closure Fast™
- RFITT and
- ELVeS Radial™
The thermal effect of VNUS Closure Fast™ is created by radiofrequency energy, while ELVeS Radial™ is created by laser energy.
The names VNUS Closure and ELVeS come from the manufacturers of the catheters. They have patented the probes they have developed.
In the VNUS Closure Fast procedure, the vein receives radio wave energy via a seven-centimeter-long electrode. The controlled release of energy draws moisture from the pathologically altered vein until the vessel literally burns away.
The vein contracts and turns into connective tissue, which the body breaks down.
Like all endoluminal procedures, VNUS Closure does not remove the diseased vein from the tissue. The vein remains in the body and turns into a scar cord, which is gentler on the tissue. Instead of open surgery, this method is referred to as minimally invasive treatment.
Endoluminal treatment methods for varicosis have been known since 1990 and are becoming increasingly popular. After more than 1.5 million applications, VNUS Closure Fast is now a standardized procedure for treating varicose veins.
It has lower complication rates than open therapy (stripping) and also has a lower risk of recurrence. This means that the risk of varicose veins recurring after VNUS Closure Fast treatment is very low.
However, other veins can also expand over time and become varicose veins. This is generally the case with all procedures.
The risk of recurrence is 5 percent after one year.
In theVNUS Closure method, doctors insert a thin radio wave probe into the varicose vein through a small puncture on an outpatient basis @ Anastasiia /AdobeStock
VNUS Closure catheters are used to treat pronounced and extensive varicose veins. The procedure is mainly used to treat varicose veins in the trunk and straight lateral branch varicose veins.
Varicose veins are irregular, tortuous and sometimes bulging varicose veins in the superficial venous system. The application of heat using a radiofrequency catheter closes long trunk veins in particular.
The VNUS Closure method is most commonly used to treat the following varicose veins:
- Saphenous vein trunks and
- Saphenous vein trunk veins
Radio wave therapy is indicated if the patient can expect more benefits than risks from the procedure.
Contraindications include
- Severe general illnesses or
- Thrombotic blood clots within the deep vein system
In the case of varicose vein precursors such as spider veins, many doctors usually recommend a different therapy such as sclerotherapy with liquids containing alcohol. These can also be in the form of foam.
The injection of the alcohol-containing solutions(sclerotherapy) causes irritation of the vein walls.
They then stick together. However, this is primarily promising for thinner veins, which include spider veins.
In principle, larger veins, including the truncal veins, can also be treated by sclerotherapy in the form of a foam application.
However, the success of treatment is lower and the risk of recurrence is almost 20 percent after one year.
This means that every 5th patient suffers a recurrence 1 year after foam sclerotherapy.
A thorough medical history is essential before the VNUS Closure procedure. In this patient consultation, the attending physicians receive information about the problem and any previous illnesses the patient may have.
Before the procedure, the patient is informed about the surgical procedure and all risks.
Before the procedure, the patient should
- Refrain from taking anticoagulant medication such as acetylsalicylic acid
- Do not consume alcohol or only consume it in moderation so as not to jeopardize wound healing
- Limit or stop nicotine consumption
Shortly before the operation, the doctor checks the course of the affected truncal vein again using an ultrasound probe. He marks the areas while the patient is standing. This is important in order to locate the vein easily during the operation and to be able to pass it with the probe.
In the case of general anesthesia or surgery under twilight sleep, the anesthetist gives the patient painkillers, sedatives and anesthetics.
In the case of local anesthesia, the surgeon gives the patient a local anesthetic. The doctor injects this around the entire course of the vein in order to protect the surrounding tissue.
This concentrates the heat effect on the vein wall and cools and protects the surrounding soft tissue and skin. In addition, the patient requires significantly less pain medication after the operation.
The doctor then makes a small skin incision on the lower leg over the course of the damaged vein. The radiofrequency probe is inserted through this incision.
A puncture of the vein is necessary. Once the probe is correctly positioned, the doctor pushes it into the vein to just below the groin.
The electrodes make direct contact with the wall of the treated vein. When the radio probe is pulled out, the heat causes the diseased vein to contract like a zipper.
The patient's leg is in a raised position so that there is as little blood as possible in the vein. This allows the radiofrequency energy to heat the vein walls better. They stick together more easily.
VNUS Closure radio wave therapy damages the venous vascular endothelium by heating the vein wall and removes moisture from the venous protein matrix.
This causes the tissue fibers to contract. The vein wall thickens and becomes scar tissue, which the body later breaks down. Once the probe has been successfully removed, the doctor closes the small incision with a suture or wound adhesive.
VNUS Closure Fast is a modern and gentle catheter procedure for the treatment of varicose veins @ Henrie /AdobeStock
After removal of the probe and closure of the skin incision, the patient is given a pressure bandage (compression bandage).
It is recommended that the patient lies still and rests for one to two hours after the operation.
Free and unrestricted movement is then possible again. The patient can usually resume professional activities on the following day. They should take a break from sporting activities for a few days.
To prevent blood clots and the formation of bruises, it is advisable to wear medical compression stockings for about two weeks.
After around three weeks, the treated veinis checked again. The doctor will examine the wound, which should normally be well healed by this time.
Sonography is also used to check whether the treated varicose vein has closed. If smaller side branches or spider veins are visible, they can be sclerosed.
Medical compression stockings are recommended after the procedure @ tibanna79 /AdobeStock
With the minimally invasive VNUS Closure procedure, more complex vein operations to treat varicose veins can be avoided.
As with all minimally invasive procedures, the patient benefits from the fact that no skin incisions are necessary with VNUS Closure Fast.
Compared to open surgery, such as vein stripping, there are further advantages such as
- Low tissue trauma
- Minimal incision and scarring
- Short operating time
- Little downtime
- Minimal pain
- Can be performed on an outpatient basis
- Low cardiovascular stress due to local anesthesia
- Suitability for high-risk patients
Despite the advantages, there are also disadvantages associated with VNUS Closure Fast, such as
- Heat damage to the skin
- Brownish discoloration(ecchymosis)
- Temporary loss of sensation
Like any other procedure, the VNUS Closure Method is associated with risks and side effects in individual cases.
Possible complications include
- Permanent burns and skin discoloration
- Inflammation and infections
- Swelling, feelings of tension and pressure
- Numbness and sensitivity to touch
- Irreversible skin nerve damage or paralysis
- Severe pain
- Circulatory disorders or bruising (hematomas)
- Blood clots(thrombosis) or pathological vascular occlusion (embolism)
- Positional damage such as pressure damage
- Cardiovascular arrest due to anaesthetic allergy Skin rash
- sneezing
- itching
- Nausea and
- Dizziness due to hypersensitivity to anesthetics
Life-threatening complications and permanent damage are virtually impossible with standard procedures such as VNUS Closure .
Statutory health insurance companies cover the costs of the procedure if it is indicated.