Endovenous Laser Treatment

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Endovenous Laser Treatment
Radiofrequency Occlusion
Other Vein Treatment Options

Endovenous Laser Treatment
Endovenous Laser Treatment is an alternative to traditional surgical excision or “stripping” of specific underlying veins that are the source of varicose veins and venous insufficiency. Endovenous laser treatment, also known as Venacure® (AngioDynamics, Inc., Queensbury, N.Y.) has become a widely accepted procedure with an excellent success and low complication rate. It is performed in an “office” setting under local anesthesia and works by heating the inside of the valve-incompetent vein, which causes it to seal shut and disappear. The entire procedure, including preparation, takes only about 30 minutes.

During this technique a very thin laser fiber is inserted into the damaged underlying vein with incompetent valves. The fiber is then advanced under duplex ultrasound guidance to the upper end of the abnormal vein. Local anesthesia is then delivered to the entire vein and the fiber with an 810 or 980 wavelength diode laser heats the inside of the vein as it is slowly withdrawn back down the vein. The only visible site on the surface of the skin is a small puncture site about the size of an IV catheter.

After endovenous laser treatment, the venous blood re-routes through the remaining normal (valve-competent) veins to more efficiently circulate blood back to the heart and reduce the abnormal high venous pressure in the legs. Because they are no longer under high sustained pressure, patients quickly experience significant improvement in their leg discomfort and varicose veins generally decompress and disappear spontaneously. Any prominent veins that persist can easily be treated by minimally invasive phlebectomy techniques or sclerotherapy. Possible side effects of endovenous laser treatments include skin numbness, blood clots and phlebitis and vein inflammation.

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Radiofrequency Occlusion
Radiofrequency Occlusion is similar to endovenous laser treatment as alternative to traditional surgical excision or “stripping” of specific underlying veins that are the source of varicose veins and venous insufficiency. This patented technique known as the Closure Procedure® (VNUS, San Jose, CA) directly heats the inner lining of the diseased vein using a radiofrequency (RF) catheter instead of a laser filament. The decision to use a radiofrequency versus a laser catheter in treating superficial venous insufficiency depends on the leg vein anatomy and the caliber of the vein to be treated.

During this technique a thin radiofrequency catheter is inserted into the damaged underlying vein with incompetent valves. The catheter is then advanced under duplex ultrasound guidance to the upper end of the abnormal vein. Local anesthesia is then delivered to the entire vein and the radiofrequency catheter is then opened so that the “prongs” contact the inner surface of the vein wall. The RF catheter is then slowly withdrawn back through the vein while delivering RF energy along the entire length of the abnormal vessel. This heats the vein causing it to contract, fibrose and eventually completely close.

The results and potential side-effects following the Closure Procedure® are similar to those following the endovenous laser treatment. Again, radiofrequency occlusion is thought to yield superior cosmetic results than traditional venous reconstructive surgery because it leaves only a tiny puncture site as opposed to multiple incisions. Also, there is less bruising and pain than associated with venous “stripping” techniques thereby allowing quicker return to normal activities.

Both catheter-based techniques (Venacure® and Closure Procedure®) have multiple national and regional medical policies with insurers. Most major health plans including Medicare, have positive coverage policies with these techniques. As with any vein procedure, medical necessity must be established and documented to obtain coverage.

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Other Minimally Invasive Techniques

Transilluminated Powered Phlebectomy

Transilluminated Powered Phlebectomy is a minimally invasive technique to directly remove varicose veins. This outpatient procedure also known as the TriVex® System (Smith & Nephew, Andover, MA) has become a widely accepted method used as an alternative to the traditional hook phlebectomy approaches which may require dozens of incisions for complete varicose vein treatment. The TriVex System uses two small cannulas inserted through a minimal number of 1-2mm puncture sites to localize and directly visualize varicosities and assist in their complete removal. Tri-Vex is a useful technique for patients who are not candidates for endovenous catheter therapies because of venous anatomy or other factors.

Ambulatory Phlebectomy

Ambulatory Phlebectomy is a minimally invasive technique to remove abnormal varicosities through a tiny incision or incisions. The procedure is performed in an office-setting using a special set of instruments. Recovery is rapid, and most patients do not need to interrupt regular activity after ambulatory phlebectomy.

Sclerotherapy

Sclerotherapy is the treatment most commonly used to treat spider and reticular veins of the legs. It is an office procedure that involves a tiny needle to inject a sclerosing solution into the small, prominent veins. This causes the lining of the vein walls to swell, stick together and eventually seal shut accompanied by a fading of the visual appearance of the treated vein. Sclerotherapy can enhance your appearance and your self confidence. Two or more sclerotherapy sessions lasting about 30 minutes are generally required to achieve optimal results. A cotton ball and compression tape along with an external compression garment is applied to your leg when the session is completed. This procedure only affects those veins that are visible and does nothing to permanently alter the venous system or prevent new spider veins from emerging in the future.