Safe introduction of the VNUS Closure procedure: a multidisciplinary approach

Abstract

Objectives: The National Institute for Health and Clinical Excellence supports the use of radiofrequency ablation (VNUS Closure) of the long saphenous vein (LSV) as an alternative to stripping. An increase in interest in the procedure is anticipated. The technique can produce serious complications not commonly associated with conventional surgery, and safety is a major concern with its introduction. The aim was to introduce the new technique into a district hospital, without major complications or failures. Methods: A multidisciplinary team was developed consisting of consultant surgeon, vascular technologist and theatre nurse, who received intensive training and mentoring from a group with considerable experience. All members attended operating theatre and duplex imaging sessions over a period of six months. Approval for the introduction of the technique into our institution was sought from the Medical Director and Clinical Governance Directorate. The results of VNUS Closure surgery were included in the monthly clinical governance and audit meetings. During the consent process, the first patient was informed that the team had not yet undertaken the procedure, but had taken all necessary measures to ensure its competence. Subsequently, patients were advised of our experience and the results. Results: Of the 18 patients who consented for the study, 13 (72%) were found on duplex scanning to have saphenofemoral reflux suitable for VNUS Closure. VNUS Closure was attempted in 22 LSVs in 13 patients; 21 LSVs (95%) in 12 patients were closed at surgery and 19 (86%) remained completely closed at a median of 12 months (range 3–24 months). There were no deaths and no major complications. Conclusion: The safe introduction of VNUS Closure in a district hospital can be accomplished through intensive training and a process of mentoring from experienced practitioners, a multidisciplinary approach with a vascular technologist in theatre and attention to governance issues, in particular audit and consent.