Endovenous Radiofrequency Ablation (VNUS Closure®) procedure
The endovenous radiofrequency ablation (or VNUS Closure) procedure is a minimally-invasive vein treatment used to treat the great saphenous vein (GSV), small saphenous vein (SSV) and other superficial veins. It uses a patented radiofrequency catheter inserted into the vein, which applies RF energy to heat the vein. This causes the vein to collapse and seal shut. The VNUS Closure procedure has been FDA-approved since 1999 and over 250,000 procedures have been performed worldwide. The VNUS Closure procedure can be performed in an office, ambulatory surgical center or hospital, generally under local anesthesia.
Steps of the endovenous radiofrequency ablation procedure are:
- Physician (or ultrasound technologist) uses ultrasound to map the course of your vein
- Radiofrequency (Closure) catheter is inserted (through a small puncture or incision usually at the knee) into your vein
- Local anesthetic solution is 'infiltrated' (infused) into the area around your vein
- Radiofrequency energy is applied to heat the vein and collapse the vein shut
- Patients usually are asked to walk immediately after the procedure. Walking is encouraged to stimulate reduced pressure on the veins and minimize the risk of complications.
- Compression stockings are usually prescribed for one to two weeks following the procedure
The endovenous radiofrequency ablation procedure has shown success rates (reflux-free) of 90% with up to 2 year follow-up1. Patients are walking after the procedure and generally resume normal activity within a day or so. A VNUS multi-center registry shows results of the Closure procedure to be highly stable and effective at 5-year follow-up; of patients showing absence of reflux at 1 year, 92% remain reflux-free at follow-ups out to 5 years1. A number of comparative clinical trials versus vein stripping have shown similar results with a faster and improved recovery2.
Possible side effects of the Closure procedure include bruising, swelling and numbness, but these are generally only temporary. Some more recent studies indicate the VNUS Closure procedure may have slightly reduced post-operative pain and bruising as compared with EVLT1. Deep vein thrombosis (DVT) is a rare complication.
Endovenous radiofrequency ablation (VNUS Closure) is usually covered by most insurers (e.g., Medicare and private insurers). Eligibility generally requires proof of medical necessity and previous conservative therapy (like compression stockings). Patients should consult their physician or individual insurance carrier to determine their specific coverage criteria.
1 VNUS Website: http://www.vnus.com/navigation/clinicalevidence.htm and http://www.vnus.com/navigation/patient_recovery.htm
2 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.
Closure is a registered trademark of VNUS Medical Technologies, Inc. (San Jose, CA).