Treatment for Varicose Veins - The Closure System

The Problem: Leaky Valves

A single saphenous vein runs down each leg, from the groin to the ankle. Its job is to help return oxygen-depleted blood to the heart. In most people they work fine.

However, if the valves which are designed to prevent blood from flowing backwards don’t function properly, a condition called superficial venous reflux, numerous problems occur. Symptoms include swelling, pain, fatigue and varicose veins.

Varicose veins are known for their distinctive blue color and bulging appearance on the skin. Resembling large, elongated worms, they afflict an estimated 10%-20% of the adult population. In the United States that translates into 20-25 million people, the majority of whom are women.

Whether the initial cause was genetics, pregnancy, excess weight or inadequate exercise, the physiology of varicose veins is always the same. The valves are damaged—physicians call them incompetent—and the vein is stretched and distorted from increased pressure caused by blood flowing in the wrong direction. Although the condition is rarely life threatening, it is painful and unattractive.

Treatment Options

Historically, patients have had several choices for treating varicose veins, depending on the severity. They could make lifestyle changes, such as eating less, exercising more and wearing support hose. That regimen has proven helpful in reducing leg pain and further deterioration, particularly in mild cases. But sooner or later most patients returns to their previous lifestyles.

Patient could also have the visible, varicose veins removed in a phlebectomy. This surgical technique was developed in the 1950s. A specially trained physician removes diseased veins through a series of very small punctures or incisions with a variety of specialized hooks. However, phlebectomy along does not address the incompetent valves in the saphenous vein which created the problem and can cause varicose veins to recur.

Some physicians thus advocate stripping the saphenous vein. This involves making an incision in the groin region and surgically tying off the top of the saphenous vein. An instrument resembling a thin rod with a bulbous end is then inserted into the saphenous vein and passes through to the upper calf. Another incision is made at the upper calf. The stripping device is then tied to the vein which is them pulled out through the second incision. This typically causes significant bruising and can create post-operative pain, nerve damage and poor cosmetic outcomes. However, by removing the saphenous vein, blood is diverted to other veins with competent valves. This generally eliminates the pain associated with varicose veins and greatly reduces their potential for recurring.

Closure

Closure was developed to provide the benefits of stripping without its potential drawbacks, e.g. invasive surgical procedure, general anesthesia, post-operative pain, bruising and prolonged recovery period. This unique, patented, technology uses a very small catheter and radiofrequency energy to occlude, or seal shut, the saphenous vein. Since receiving commercial clearance from the FDA in March 1999, studies have shown that 95% of all Closure patients who underwent six-month follow-up visits rated themselves "symptom free" or "substantially improved" and "they would recommend the procedure to a friend."

A physician typically makes a single, small incision near the knee and inserts the slender Closure catheter into the saphenous vein. The catheter is then positioned near the groin, energized and slowly withdrawn, sealing the vein shut. There are no stitches and most patients return to normal activity within a day or two.

Disclaimer

Like other venous procedures, Closure involves risks and potential complications. Each patient should consult their doctor to determine whether or not they are a candidate for this procedure, and if their condition presents any special risks. Potential complications include numbness or tingling (parathesia), skin burns, blood clots and temporary tenderness in the treated limb.

NWH offers the Closure procedure through its Interventional Radiology Service.

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