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| The Closure® procedure |
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| The VNUS® Closure® procedure, an alternative treatment option to traditional vein stripping surgery, brings state-of-the-art technology to an age old disease. |
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| The Closure procedure is an outpatient (day surgery) procedure performed in doctor’s offices, surgical centers and hospitals. Local or general anesthesia can be used to insure comfort during the treatment. Using a single needle stick or a small incision, a thin catheter is inserted into the great saphenous vein. The catheter delivers radiofrequency (RF) energy to the vein wall, causing it to heat, collapse and seal shut. |
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Once the diseased vein is closed, other healthy veins take over and empty blood from your legs. As normal return flow is re-established, your symptoms should improve noticeably.
Following the procedure, the catheter is removed, a bandage is placed over the insertion site and your leg may be wrapped typically for 1 day to aid healing. Your doctor may ask you to walk, wear compression stockings, and to refrain from standing for long periods of time following the procedure to help speed your recovery. Many patients resume normal activity within 1-2 days. |
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| Highlights of the Closure procedure |
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- Relief of symptoms
- Short recovery
- Resume normal activity within 1-2 days
- Outpatient procedure
- Local anesthesia with mild sedatives
- Good cosmetic outcome with minimal or no scarring, bruising or swelling
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| The Closure procedure -- A treatment that works |
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| Clinical results indicate that the Closure procedure can be effective at closing the vein and significantly reducing patient symptoms. |
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| Patient Symptoms Reported at Follow-up1 |
| Symptom |
Pretreatment |
6 Weeks |
2 Years |
| Leg Pain |
| Leg Fatigue |
| Edema (swelling) |
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| Prior to the Closure procedure, 85% of patients reported leg pain. After the Closure procedure, 94% of patients at six weeks and 95% of patients at two years did not report residual leg pain |
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| Three randomized trials of the Closure procedure versus vein stripping, including the most recent multi-center comparative trial published August 2003 in the Journal of Vascular Surgery, show very similar results.2,3,4 In the most recent trial every statistically significant outcome was in favor of the Closure procedure, resulting in 2: |
- Return to normal activities within one day for 80.5% of Closure treated patients versus 46.9% of patients who underwent vein stripping surgery
- Less post-operative pain and limitation of physical activity
- Return to work 7.7 days sooner than vein stripping patients
- Higher quality of life scores than vein stripping
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Some of Dr. Lee’s Patients, before & after Closure Procedure
(Individual patient results may vary)5 |
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| Percent of Legs Without Varicose Veins at Follow-up |
| The Closure procedure may be as effective as vein stripping in delaying the reappearance of varicose veins. |
| Treatment |
1 Year |
2 Years |
| Closure6 |
| Vein Stripping7 |
| Ligation7 |
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| Common questions & answers about closure: |
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| How is the Closure procedure different than vein stripping? |
| During a stripping procedure, the surgeon makes an incision in your groin and ties off the veins after which it a stripper tool is threaded through the saphenous vein and used to pull the vein out of you leg through a second incision just above your calf. |
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| In the Closure procedure, there is no need for groin surgery, instead the vein remains in place and is closed using a special (Closure) catheter inserted through a small puncture. This virtually eliminates the bruising and pain often associated with vein stripping (i.e. this may result from the tearing of side branch veins while the saphenous vein is pulled out.) Vein stripping is usually performed in an operating room, under a general anesthetic, while the Closure procedure is performed on an outpatient basis typically using local anesthesia and mild sedatives. |
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| How long does the procedure take? |
| Approximately 45-60 minutes, though patients normally spend additional 30 minutes to an hour for pre and post-treatment care. |
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| Is the procedure painful? |
| Patients report feeling little, if any, pain during the Closure procedure. Dr. Lee will give you local anesthetic to numb the treatment area, in addition to some mild sedatives for relaxation. Patients typically do not require any pain medication after treatment. |
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| How quickly after treatment can I return to normal activities? |
| Most patients can resume normal activities within 1-2 days. For a few weeks following the treatment, your doctor may recommend a regular walking regimen and suggest that you refrain from very strenuous activities (heavy lifting for example) or prolonged periods of standing. |
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| How soon after treatment will my symptoms improve? |
| Most patients report a noticeable improvement in their symptoms in 1-2 weeks following the procedure. |
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| Is Closure covered by insurance? |
| Many national and regional insurance carriers have issued positive coverage policy for the Closure procedure and are covering the procedure, including Medicare and most commercial insurances. Dr. Lee can discuss cost, insurance coverage, etc in greater detail during your consultation visit. |
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| What potential risks and complications are associated with Closure? |
| Like other venous procedures, Closure involves risks and potential complications. Dr. Lee will determine if the Closure procedure is right for you and if your condition presents any special risks. Rare complications include, but are not limited to bleeding, thrombosis, pulmonary embolism, phlebitis, hematoma, infection, and minor numbness. |
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- Weiss, R, et al. Controlled Radiogrequency Endovenous Occlusion Using a Unique Radiofrequency Catheter Under Duplex Guidance to Eliminate Saphenous Varicose Vein Reflux: A 2-Year Follow-up. Dermatol Surg 2002; 28:38-42.
- Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, et al. Prospective randomized study of endovenous radiofrequency obliteration (Closure) versus ligation and stripping in a selected patient population (EVOLVES study). J Vasc Surg 2003;38:207-14.
- Stötter L. Schaaf I, Fendl R, Bockelbrink A. Randomized Study to Compare the Closure Procedure, Invagination Stripping and Cryo Stripping for Treatment of the Greater Saphenous Vein. Abstract submitted to German Society for Phlebology for presentation Sept. 2003.
- Rautio T, Ohinmaa A, Perälä J, Ohtonen P, Heikkinen T, Wiik H, et al. Endovenous obliteration versus conventional stripping operation in the treatment of primary varicose veins: A randomized controlled trial with comparison of costs. J Vasc Surg 2002;35:958-65.
- Photos Courtesy of Mimi Lee, MD
- Merchant RF, DePalma RG, Kabnick LS. Endovascular Obliteration of Saphenous Reflux: A Multicenter Study. J Vasc Surg 2002;35:1190-6.
- Jones L et al. Neovascularisation is the Principal Cause of Varicose Vein Recurrence: Results of a Randomized Trial Of Stripping The Long Saphenous Vein. Eur J Vasc Endovasc Surg 1996;12:442-445
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