The VNUS Closure procedure is an alternative to traditional vein stripping. A subset of all stripping alternatives relies on controlled coagulation processes.
In endoluminal procedures, this is done from the inside (endo = inside), either thermally (heat) or chemically (liquid or foam sclerosing agents).
Both the application of heat (100–120° Celsius) and the use of sclerosing agents cause the vein walls to adhere to one another. This prevents blood from flowing back into the pathologically dilated vein (varicose vein).
The reflux of venous blood is caused by venous valves that no longer function properly.
This leads to the typical symptoms of venous congestion associated with varicose veins, which include:
In endoluminal procedures, doctors apply heat to the vein through a catheter, which they insert through the skin.
Endoluminal procedures include:
- VNUS Closure Fast™
- RFITT and
- ELVeS Radial™
The thermal effect in VNUS Closure Fast™ is generated by radiofrequency energy, while in ELVeS Radial™ it is generated by laser energy.
The names VNUS Closure and ELVeS come from the manufacturers of the catheters. They have patented the probes they developed.
In the VNUS Closure Fast procedure, the vein receives radiofrequency energy via a seven-centimeter-long electrode. The controlled energy delivery gradually removes moisture from the diseased vein until the vessel effectively shrinks.
The vein contracts and transforms into connective tissue, which the body then breaks down.
Like all endoluminal procedures, VNUS Closure does not remove the diseased vein from the tissue. The vein remains in the body and transforms into a scar tissue strand, which is gentler on the tissue. Instead of open surgery, this method is referred to as a minimally invasive treatment.
Endoluminal treatment methods for varicose veins have been in use since 1990 and are growing in popularity. After more than 1.5 million procedures, VNUS Closure Fast has now become a standardized treatment for trunk varicose veins.
It has lower complication rates than open surgery (stripping) and also carries a lower risk of recurrence. This means that the risk of varicose veins forming again after VNUS Closure Fast treatment is very low.
However, over time, other veins may also dilate and develop into varicose veins. This is generally the case with all procedures.
The so-called recurrence rate is 5 percent after one year.
With the VNUS Closure method, doctors insert a thin radiofrequency probe into the varicose vein through a small puncture during an outpatient procedure @ Anastasiia /AdobeStock
VNUS Closure catheters are used to treat pronounced and extensive varicose veins. The procedure is primarily used to treat trunk varicosities and straight-running side-branch varicose veins.
Varicose veins are characterized by irregularly meandering and sometimes bulging veins in the superficial venous system. Long trunk veins, in particular, are closed off using heat applied via a radiofrequency catheter.
The VNUS Closure method is most commonly used to treat the following varicose veins:
- Trunk veins: Vena saphena magna and
- Trunk veins: Vena saphena parva
Radiofrequency therapy is indicated when the patient can expect more benefits than risks from the procedure.
Contraindications include:
- Severe systemic diseases or
- Thrombotic blood clots within the deep venous system
For early-stage varicose veins, such as spider veins, many doctors usually recommend a different treatment, such as sclerotherapy using alcohol-based solutions. These solutions may also be in foam form.
Injecting the alcohol-based solutions (sclerotherapy) causes irritation of the vein walls.
They then stick together. However, this method is primarily effective for thinner veins, which include spider veins.
In principle, larger veins—including the saphenous veins—can also be treated with sclerotherapy using a foam solution.
However, the success rate is lower, and the risk of recurrence is nearly 20 percent after one year.
This means that one in five patients experiences a recurrence one year after foam sclerotherapy.
A thorough medical history is absolutely essential before the VNUS Closure procedure. During this consultation, the treating physicians gather information about the patient’s condition and any pre-existing medical conditions.
Before the procedure, the patient is informed about the surgical process and all associated risks.
Before the procedure, the patient should:
- Avoid taking anticoagulant medications such as acetylsalicylic acid
- Avoid alcohol or consume it only in moderation so as not to compromise wound healing
- Limit or stop nicotine use
Shortly before the surgery, the doctor will use an ultrasound probe to re-examine the course of the affected saphenous vein. He will mark the relevant areas while the patient is standing. This is important to ensure that the vein can be easily located during the procedure and that the probe can pass through it.
If the procedure is performed under general anesthesia or twilight sedation, the anesthesiologist administers pain medication, sedatives, and anesthetics to the patient.
If local anesthesia is used, the surgeon administers a local anesthetic to the patient. The doctor injects this along the entire length of the vein to protect the surrounding tissue.
This concentrates the heat on the vein wall while cooling and protecting the surrounding soft tissue and skin. In addition, the patient requires significantly fewer pain medications after the procedure.
The doctor then makes a small skin incision on the lower leg along the course of the damaged vein. Through this incision, the doctor inserts the radiofrequency probe.
This requires puncturing the vein. Once the probe is correctly positioned, the doctor advances it into the vein until it reaches just below the groin.
The electrodes make direct contact with the wall of the treated vein. As the radiofrequency probe is withdrawn, the diseased vein contracts like a zipper due to the heat.
The patient’s leg is elevated during the procedure to minimize the amount of blood in the vein. This allows the radiofrequency energy to heat the vein walls more effectively, causing them to seal together more easily.
VNUS Closure radiofrequency therapy damages the venous 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 turns into scar tissue, which the body later breaks down. After successfully removing the probe, the doctor closes the small incision with a suture or surgical adhesive.
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VNUS Closure Fast is a modern and gentle catheter procedure for treating varicose veins @ Henrie /AdobeStock
After the probe is removed and the skin incision is closed, the patient is fitted with a compression bandage.
It is recommended that the patient lie still for one to two hours after the procedure and take it easy.
Afterward, the patient can move freely and without restriction. The patient can usually resume work the following day. However, they should refrain from physical activities for a few days.
To prevent blood clots and bruising, wearing medical compression stockings for about two weeks is recommended.
A follow-up examination of the treated vein takes place after about three weeks. During this visit, the doctor examines the wound, which should normally have healed well by this time.
In addition, an ultrasound is used to check whether the treated varicose vein has closed off. If smaller side branches or spider veins are visible, sclerotherapy may be performed.
Medical compression stockings are recommended after the procedure @ tibanna79 /AdobeStock
The minimally invasive VNUS Closure procedure helps avoid more complex vein surgeries for the treatment of varicose veins.
As with all minimally invasive procedures, patients also benefit from the fact that no skin incisions are necessary with VNUS Closure Fast.
Compared to open surgeries, such as vein stripping, there are additional advantages, including:
- Minimal tissue trauma
- Minimal incisions and scarring
- Short procedure time
- Minimal downtime
- Minimal pain
- Can be performed on an outpatient basis
- Minimal cardiovascular strain due to local anesthesia
- Suitable for high-risk patients
Despite its advantages, VNUS Closure Fast also has some disadvantages, such as:
- Heat damage to the skin
- Brownish discoloration (ecchymoses)
- Temporary sensory disturbances
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, tightness, and pressure
- Numbness and sensitivity to touch
- Irreversible skin or nerve damage or paralysis
- Severe pain
- Circulatory disorders or bruising (hematomas)
- Blood clots (thrombosis) or pathological vascular occlusion (embolism)
- Pressure-related injuries, such as pressure sores
- Cardiac arrest due to an allergy to anesthetics 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 plans cover the cost of the procedure when it is medically indicated.
