Patients who have large varicose veins generally have what is known as reflux disease. This means the valves in the great saphenous vein or small saphenous vein are damaged, and consequently blood is allowed to flow in the wrong direction in these veins. Until 2001 the only effective treatment for this condition was a varicose vein stripping. This was a somewhat painful and disfiguring operation that required general anesthesia and several weeks recuperation before it was possible to return to normal activities. In 2001 the technique of venous thermal ablation was developed, which has proven to be a marked improvement over vein stripping in every conceivable area. It is less painful, quicker, leaves virtually no scars, allows an almost immediate return to normal activity, can be done with local anesthesia, and is less expensive. It can be used in almost all patients who have either great saphenous vein or small saphenous vein reflux. It has also been found that the long term (>5 years) effectiveness of the treatment is just as good as for varicose vein stripping.
Venefit / VNUS Closure™ thermal ablation
There are several different techniques that can be used for venous ablation treatment. The first technique is a variation of a procedure that was first used in the 1930’s for the treatment of hemorrhoids, and is known as radiofrequency ablation or Venefit/VNUS Closure™. With this technique a catheter is inserted into the offending vein, and an electrical current is used to slowly heat the vein. The term radiofrequency is used because the frequency of the current that is used is just below the frequency of an AM radio station. Typically, the treatment takes a few minutes per vein, and the set of wires are slowly withdrawn during this time to ensure treatment of the entire course of the vein.
Endovenous laser treatment thermal ablation
The second technique makes use of a more recent technical development—that of the laser. This procedure, which is known as Endovenous Laser Treatment (EVLT) or Endovenous Laser Ablation Treatment (EVLAT), involves passing a laser optic fiber into the vein and heating the vein with laser energy. This technique also damages the vein, with the actual treatment taking about a minute.
Steam thermal ablation
The third technique is still considered investigational and involves a very old technology—steam. With this approach a catheter is placed in the vein and the vein is heated by injecting hot steam into the catheter, or by injecting water that is then converted to steam by a small heating element in the tip of the catheter. It appears that this technique, while being just as safe and effective as both Endovenous Laser and Venefit/VNUS Closure™ ablation, offers no particular advantage over these two procedures.
FDA EVLT study
Willamette Vein Centré was one of ten research sites selected by the FDA for the clinical investigation of endovenous laser treatment in 2001. Since then over 900 offices, clinics and hospitals have joined us in using endovenous laser treatment for venous reflux disease. More recently, we have added Venefit/VNUS Closure™ to our vein treatment repertoire, thus giving our patients the option of choosing from one of two excellent ablation techniques.