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Get a leg up on pain

Relief from aching associated with varicose veins might come from catheterization procedure

Relief from aching associated with varicose veins might come from catheterization procedure

August 20, 2007|By JULIE E. GREENE

Strangers would come up to Tammy Shoemaker and ask her about the "knot" on the back of her left calf.

But worse than the awkwardness of these incidents was the constant pain, and aching of her legs - swollen with varicose veins from having four children in a short amount of time and inheriting a likelihood for the condition.

To say Shoemaker, 44, of Frederick, Md., was hesitant to get treatment was an understatement. She underwent treatment about 10 years ago, getting varicose veins "stripped" from her legs during a procedure that required general anesthesia and left both legs looking as if she'd been bitten by a shark, she says. She had 30-some 1-inch incisions on one leg and 40 on the other.

With prodding from her husband and a referral from her primary doctor, Shoemaker learned of an updated treatment for varicose veins that would require only local anesthesia, take less time and have her back on her feet immediately.

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She had procedures on each leg in June through Capitol Vein & Laser Center in Frederick.

"It was unbelievable," she says. "I got up, got my stuff together and drove myself home" afterward.

The procedure, VNUS ClosureFast catheterization, is the second generation of a method that uses radio-frequency energy to produce heat that causes the vein's walls to shrink and close, says Dr. Paul McNeill. McNeill, along with fellow vascular surgeon Dr. Garth Rosenberg, offers the treatment at Capitol Vein & Laser Center.

When the main internal leg veins, such as the great saphenous vein, are healthy, valves keep the blood moving from the feet up to the heart. A failed valve allows gravity to pull the blood down to the foot, creating pressure that transfers to smaller branching veins.

The smaller veins become enlarged, becoming visible varicose veins as blood pools in the veins.

According to information from the National Heart, Lung and Blood Institute, varicose veins usually don't cause medical problems. Occasionally, treatment is needed for pain, skin problems, blood clots, or other complications.

With VNUS ClosureFast, an intravenous tube is inserted in the larger main vein with the leaky valve, usually near the knee, and the ClosureFast catheter - about the diameter of pencil lead - is slid into the vein and up to the groin using ultrasound as a guide, McNeill and Rosenberg say. Then the catheter uses heat created by radio-frequency energy to close or shrink the damaged vein as the catheter is withdrawn.

The latest generation of VNUS ClosureFast, with a catheter design that allows for speedier treatment, became available in the U.S. in March, McNeill says.

McNeill says "stripping" veins is an obsolete practice and "barbaric" when compared to more modern procedures. With stripping, incisions are made to dissect and free the vein from surrounding tissue, forcibly removing it from the leg, McNeill says.

Common treatment for varicose veins in recent years has included laser treatment, which accomplishes the same thing as the VNUS ClosureFast catheter, but with a laser instead of radio-frequency heat.

McNeill says ClosureFast is virtually pain-free, almost never requires pain medication; usually does not result in bruising; and allows people to return to work the next day and return to exercise in two to three days.

The same is true with laser treatment, also known as endovenous laser treatment and endovenous thermal ablation, says Dr. Itsuro Uchino, a phlebology specialist at the Center for Vein Medicine in Hagerstown.

Uchino says the end result of both laser and VNUS ClosureFast procedures is the same. Some patients might experience leg pain on the third or fourth day, he says.

Bruising can occur if the vein into which laser or catheter is inserted is not completely devoid of blood, Uchino says. The blood can leak out as the vein is destroyed, causing bruising.

Both procedures involve about three to five minutes of heat, either with ClosureFast or a laser, and take about 30 minutes total.

Varicose veins should be treated to prevent blood clots and venous stasis ulcers, doctors say.

A follow-up procedure called microphlebectomy is sometimes done to remove the smaller varicose veins that are no longer of use to the body, McNeill says. The body has plenty of other veins to take care of circulation. An incision about 2 millimeters long - about 1/16 inch - is made. A special instrument is used to grab the vein, which is cut and wiggled out. No stitches are required and the incision heals in a day or so.

A procedure known as ultrasound-guided or image-guided sclerotherapy can be done to close small leaky veins or valves, Uchino says.

This nonsurgical procedure is used with smaller veins, injecting sotradecyl, a slimy detergent agent, into the leaking vein so it sticks shut, he says.

Sclerotherapy has been around for decades, but ultrasound sclerotherapy has been around for seven or eight years, Uchino says.

He says some insurance companies have started covering sclerotherapy, whereas most insurance companies cover laser or VNUS ClosureFast procedures.

McNeill says insurance coverage for sclerotherapy is spotty because the procedure is usually used for cosmetic problems, such as spider veins.

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