New technique used to shrink varicose veins

ORLANDO, Fla. — In the time it would have taken Jeff Sorensen to go out to lunch, the discomfort and swelling caused by his varicose veins was safely and painlessly treated at a Maitland, Fla., outpatient clinic.

The 34-year-old pharmaceutical salesman was among the estimated 25 million Americans who have varicose veins — enlarged, unsightly veins that get filled with an abnormal collection of blood.

"It felt like a throbbing in my leg," said Sorensen, of Winter Park, Fla. "My leg felt tired, and full."

The problem usually occurs in veins of the legs. Walking or standing for long periods of time can make the condition worse because they increase pressure in the veins of the lower body. Other risk factors can include family history, pregnancy, obesity and lack of movement.

"We get a lot of nurses, police officers, and teachers," said Dr. Kendrix Adcock, who along with his medical partner, Dr. Manuel Perez-Izquierdo, are among the original users of an FDA-approved catheter procedure that uses radio frequency to melt the vein away in a matter of minutes.

Using ultrasound technology, the doctors position a catheter into the diseased vein through a small incision in the skin. The tiny catheter, powered by radio-frequency energy, delivers heat to the vein wall. As the thermal energy is delivered, the vein wall shrinks and the vein is sealed. Once the diseased vein is closed, blood is rerouted to other healthy veins. Recovery time is 24 to 48 hours.

The old way of treating serious varicose veins involved vein stripping, a gruesome general surgery that involves making incisions in the groin and calf. A stripper tool is threaded through the diseased vein to pull it out of the leg.

"Traditional vein stripping is done in an operating room under general anesthesia. It takes over an hour to perform, and involves three to four weeks recovery," said Perez-Izquierdo. "You expose the vein and pull it out, like pulling the chain on a lawnmower. You end up ripping out the vein along with all the branches attached to it."

The Maitland practice, which also trains other physicians in the procedure — doctors who practice at Florida Hospital and Orlando Health are among them — has performed more than 1,000 operations using the VNUS Closure, a trademark name for the ablation therapy that uses radio frequency to destroy diseased veins. Perez-Izquierdo said the procedure has been available since 2002.

In normal veins, valves keep blood moving forward toward the heart. With varicose veins, malfunctioning valves allow blood to remain in the vein, causing it to enlarge and turn its distinctive bluish-purple color. Sorensen's veins had grown 7 millimeters in diameter, three times the size of normal veins.

As Sorensen lay on an adjustable bed, Adcock slid the catheter into his patient's swollen vein.

"The first one is the worst one," Adcock said.

"You mean it's already in?" Sorensen asked.

Adcock said that in addition to being safer and less invasive, if the VNUS procedure addresses a serious medical condition and is not considered cosmetic surgery, it's covered by Medicare and health insurance.

For most people with varicose veins and its milder form, spider veins, the condition is simply a cosmetic concern. But besides causing pain, varicose veins can lead to more serious problems. They may also a signal a higher risk for other circulatory problems. Complications can include formation of ulcers and rupture of a varicose vein.

Surgery is not usually the first choice in treating varicose veins. Rather, doctors begin treatment by asking patients to avoid excessive standing, keeping legs raised when resting or sleeping, and wearing support hose. While the most common surgical approach used to be vein stripping and removal of varicose veins, more and more doctors are using ablation therapy.

Another form of ablation therapy uses a laser beam. Like the VNUS procedure, laser therapy uses heat to cauterize and close enlarged veins.

"Both ablation therapy approaches are effective in treating varicose veins; it's really up to a physician's preference" said Dr. Kathleen Ozsvath, a vascular surgeon in Albany, N.Y., and a board-certified member of the Society for Vascular Surgery. "Both ultimately have the same goal: to shut the vein off."

Sclerotherapy is another approach that involves the injection of medicine into the veins, which makes them shrink. Ozsvath said sclerotherapy works best on spider veins, which are smaller.

Ozsvath said vein stripping, which is a procedure that has been in use since the 1950s, is still performed on patients who have severe varicose veins, or who want to have both legs treated at the same time and want to be under general anesthesia.

For more information on the VNUS closure surgery and to locate a local physician who specializes in the procedure, visit www.vnus.com.