Minimally invasive vein surgery is a ‘quite remarkable’ advance

There is a remarkable new minimally invasive surgical treatment available

By: Lorraine Seabrook with Kenneth A. Goldman, M.D.
   Approximately 25 million people in the United States suffer the swelling and discomfort of varicose veins. While this is not a life-threatening condition, it can be quite painful and unsightly. Fortunately, there is a remarkable new minimally invasive surgical treatment available.
   There are two parallel systems of veins — one deep, the other superficial —that run through the legs. The deep venous system is responsible for returning the majority of blood from the legs to the heart. The superficial veins (saphenous venous system) lie closer to the skin’s surface and may be visible. The two systems are connected by short perforating vessels.
   Blood normally flows from the superficial veins to the deep veins and from the foot towards the groin. One-way valves in the veins and perforators prevent the backflow of blood and keep blood flowing in the proper direction. When these valves fail — a condition known as superficial venous reflux — blood can flow backwards and may pool in the legs, causing pain, swelling, leg heaviness and fatigue and varicose veins.
   Varicose veins are most common in women and typically occur as a result of vein injury, blood clots in the veins of the leg, or the hormonal influences, weight gain and increased blood volume that mark a pregnancy.
   Kenneth A. Goldman, M.D., R.V.T., F.A.C.S., a board-certified vascular surgeon at University Medical Center at Princeton, explains that in the past, patients suffering from superficial venous reflux would be treated by having the troublesome vein stripped out or removed from the leg and the blood flow re-routed through healthy veins. This surgery resulted in extensive bruising and a long recovery.
   Today’s minimally invasive procedure — the VNUS closure technique —offers a highly effective alternative to vein stripping.
   "The VNUS closure technique is quite remarkable," Dr. Goldman notes. "Instead of stripping the veins as we have done in the past, we can simply close the vein using a radiofrequency catheter."
   VNUS closure is performed as an outpatient procedure. Local or regional anesthesia is used to numb the treatment area. A special catheter is then inserted into the vein through a small opening, usually a single needle puncture. The closure delivers radiofrequency energy to the vein wall, causing it to heat, collapse and seal shut. Once the diseased vein is sealed, blood flow becomes rerouted to healthy veins. The catheter is removed, a bandage is placed over the insertion site and the leg is wrapped for a day or so to aid in the healing process. Patients return home the same day within several hours of having the procedure.
   The VNUS closure procedure is much less painful and invasive than vein stripping. With vein stripping, the surgeon makes an incision in the groin and ties off the veins. A stripper tool is then used to pull the diseased vein out of the leg through a second incision made just above the calf.
   "One of the most exciting aspects of the VNUS closure technique is that it is outpatient surgery with a short recovery period for the patient," explains Dr. Goldman. "There is minimal if any bruising, swelling or scarring, and patients are usually up and about resuming their normal activities within a day or two. The closure technique offers great cosmetic results that are as effective as vein stripping in preventing the reappearance of varicose veins."
   For patient Amy Kramer, a school teacher who spends a good part of her day on her feet, VNUS closure has changed her life. Ms. Kramer, who suffered from varicose veins for many years, grew accustomed to the throbbing, heavy, itchy feeling ever present in her legs. When she learned of this new procedure, she knew that having it done would greatly affect her quality of life.
   "I feel great. My legs feel so much better. I didn’t realize how much they were bothering me until I had this procedure done. I can walk long distances, and I don’t have any discomfort at all," said Ms. Kramer. "I have not been able to wear shorts for years, and finally, I’m not embarrassed to wear them in public. I tell everyone about it, because I’m so proud of the results. They were incredible."
   If you suffer the pain and discomfort of varicose veins, learn more about VNUS closure at a free community education event hosted by Princeton HealthCare System Community Education & Outreach Program. Dr. Goldman will present the program, "Varicose Veins — Now You See Them, Now You Don’t," on Tuesday from 6 to 6:30 p.m. at Princeton Fitness & Wellness Center in the Princeton North Shopping Center at 1225 State Road, Montgomery. From 6:30 to 9 p.m., Dr. Goldman and his nurse will do screenings. If you would like a screening, please wear or bring shorts to change into.
   Pre-registration is required. Call (609) 497-4480 or visit www.princetonhcs.org for more information.