Endovenous closure was introduced in 2000, and since then has been the gold standard for the treatment of symptomatic superficial venous insufficiency since 2002. Despite its long track record of safety and efficacy, endovenous ablation for the treatment of superficial venous insufficiency still remains somewhat of an unknown among the general patient population as well as some primary care and specialty physicians. This procedure uses either radiofrequency energy (Venefit™) or LASER energy delivered through a thin catheter to seal the culprit vein(s) which are the underlying cause of the varicose veins, swelling or skin changes. Performed with ultrasound guidance and under local anesthesia, this process is a gentle, minimally invasive approach to the treatment of the leaking or insufficient veins causing the myriad of venous insufficiency presentations such as varicose veins, swelling, aching, leg cramps, night time urination, skin discoloration, bleeding or ulceration. Endovenous closure or endovenous ablation allows treatment of leaking veins by sealing them with heat, rather than stripping the veins out of the leg. With endovenous closure, there are no incisions, minimal to no pain, minimal scarring and little downtime. The bulging varicose veins often decompress completely after sealing of the underlying veins making surgical excision of varicose veins necessary in only 50% of those who initially present with varicose veins. Other signs and symptoms of venous insufficiency also rapidly improve following sealing of the veins. Edema and pain may start resolving within 24-48 hours, chronic ulcers may start showing signs of healing within a few days and the roughness and thickness of chronic stasis dermatitis often regresses over the weeks to months following endovenous ablation.
Endovenous closure involves the placement of a thin catheter into the faulty or leaky vein through a small needle hole, under local anesthesia, in an outpatient setting. Once the leaking vein is closed, the tortuous varicose veins will often depressurize and shrink. Some varicosities will completely disappear. In other cases it may be necessary to remove the residual bulging veins either in conjunction with the endovenous closure procedure or at a subsequent procedure. This can easily be accomplished through tiny incisions, again under local anesthesia, in an outpatient, office setting. The sealed vein is permanently closed off to any future blood flow, and the body will naturally use other healthy veins to return blood to the heart. In fact, the body’s “circulation” will be improved after a severely leaky vein is sealed since normal veins will not be overwhelmed with the job of returning the extra pooling blood from the leaky vein. The majority of patients with advanced venous disease can be treated with endovenous closure alone and can return to normal activity almost immediately. Endovenous closure can be performed in a physician’s office under local anesthesia, with long-term success exceeding 95%. The decision to use radiofrequency (Venefit™) versus LASER energy to perform the endovenous ablation is based a number of factors. Personal preference is probably the most subjective factor as many vein specialists choose one or the other method as their sole method. A balanced practice approach enables the specialist to use the best technique for the individual patient based on objective anatomic factors such as size of vein to be sealed, length of vein to be sealed and proximity to surrounding nerves.
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