Dec. 27, 2004 Dec. 9, 2004 — Some 41 percent of American women may have varicose vein disease by the time they reach their 40s and 50s. Now Washington University in St. Louis dermatologic surgeons are among a growing group of physicians offering a procedure that uses heat to treat the problem.
Donna Kurowski has battled pain, swelling and pressure from varicose veins in her legs since she was in her early twenties. A staff nurse at Washington University's Pain Management Center, Kurowski works with chronic pain patients. She also has a 10-year-old son who keeps her busy. Prolonged standing would trigger intense pressure and pain, but Kurowski never let the condition interfere with her life.
"I didn't let it limit my activities," she says. "I learned to make adjustments and find ways to elevate or reposition my legs. Or, I'd just deal with the pain."
Jeffrey Petersen, M.D., assistant professor of medicine at the Washington University School of Medicine wanted to help Kurowski improve her quality of life and suggested that she undergo the VNUS Closure procedure to treat her varicose veins.
The innovative procedure is a minimally invasive treatment for superficial venous reflux. Genetics, age, pregnancy or injury can contribute to the problem, which occurs mainly in people with professions — nurses, chefs, waitresses, hairstylists — that require prolonged standing. Symptoms include pain, fullness, heaviness, aching, visibly enlarged veins, swelling, skin discoloration and ulcers around the ankles.
Normally, Peterson says, veins carry blood from the extremities toward the heart. With varicose veins, the blood flows backward, pooling impure and acidic blood in the legs.
"People mistakenly think that treating varicose veins is cosmetic, but many patients are very unhappy due to the pain and discomfort," Petersen says. "Many don't realize it's a medical problem and that treatment usually is covered by insurance."
The VNUS Closure procedure became available in the United States in 1999 as an alternative to traditional vein stripping, the surgical removal of veins from the leg. Vein stripping usually required general anesthesia, an extended hospital stay and a long recovery. It also caused significant swelling, bruising and pain. A fan-shaped catheter delivers radiofrequency energy to the vein wall during the minimally invasive procedure. A fan-shaped catheter delivers radiofrequency energy to the vein wall during the minimally invasive procedure.
The Closure procedure uses radiofrequency or laser heat placed directly into the wall of the saphenous vein, which runs from the ankle to the groin. Over time, faulty valves in the saphenous vein can result in unattractive, bulging and painful varicose veins. The radiofrequency or heat causes the vein wall to collapse, cutting off the source of blood.
Petersen performs the procedure at Washington University's Center for Dermatologic and Cosmetic Surgery. During the procedure, a mixture of intravenous saline solution, lidocaine (a local anesthetic) and epinephrine (a drug that contracts blood vessels) helps reduce blood loss and postoperative bruising while providing anesthesia.
First, Petersen inserts a thin catheter into the damaged vein through a small incision. Using an ultrasonic guide, the catheter is manipulated up the vein, and radiofrequency energy is delivered to the vein wall, causing it to heat, collapse and seal shut.
Once the diseased vein is closed, healthy veins take over, and normal blood flow returns to the leg, allowing the swelling, pain and discoloration to improve noticeably.
After the procedure, a compression garment is worn for several weeks to aid healing. Patients can resume normal activities in one to two days but must refrain from strenuous activities, prolonged standing and heavy lifting for a few weeks.
Kurowski had vein-stripping surgery in 2001. "Recovery from the procedure was really painful, and I was very bruised," she says. "By nighttime I was exhausted from the pain and pressure, and I couldn't go back to work for two weeks."
Recently, she was treated again, but this time Petersen used the Closure procedure. Just days later, Kurowski says she felt considerably less pressure and pain in her leg. And although she didn't have the procedure for cosmetic reasons, she was happy to see bulgy veins and pigment discoloration disappear.
"There's a dramatic difference," Kurowski says. "A week after the closure procedure most of my bruising was gone, and the pain and pressure in my leg was considerably better."
Last year, a study in the Journal of Vascular Surgery compared vein stripping to the VNUS Closure procedure by evaluating procedure-related complications, overall patient recuperation and quality-of-life issues. In every measurable category, patients who underwent the closure procedure had better outcomes.
"There is little, if any, pain — most patients don't even require oral sedation for relaxation," Petersen says. "They can even get up and walk out of the office after the procedure."
Petersen says European studies have shown that more than 91 percent of legs treated with the procedure were free of venous reflux, the underlying cause of varicose veins, two years later.
Washington University School of Medicine's full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked second in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.
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