VNUS Closure radiofrequency ablation of varicose veins

Abstract

SummaryEndovenous procedures are increasingly being used to eliminate epifascial variose veins. The radiofrequency therapies VNUS Closure and VNUS Closure FAST Catheter have established themselves and boast very good results compared to other endovenous procedures with regard to closure rates and postoperative quality of life. Equipment and method: Between February 2005 and December 2009, a total of 2413 patients comprising 3366 great and small saphenous veins were operated upon at the Vascular and Venous Diseases Department of DERMATOLOGIKUM HAMBURG. 2241 great and small saphenous veins were treated with the VNUS Closure FAST catheter, 1125 great and small saphenous veins were treated with the Closure PLUS catheter system. Additionally, 264 recurrent varicose veins were treated with the Closure FAST system. Ultrasound examinations were conducted 7 days after the treatment, again 6 weeks after the treatment, and at the follow-up examination one year after treatment. Any recanalisations were treated immediately. Between January 2007 and January 2009, 57 patients were also treated for perforant veins between stages C-4 and C-6. Gender and age distributions, as well as CEAP classifications corresponded to standard distributions. Compression stockings were only administered in the case of advanced chronic venous insufficiency (C-4 to C-6). The patients were anticoagulated before treatment by means of a low molecular weight heparin as a single shot prophylactic. Anticoagulation through thrombocyte aggregation inhibitors or dicumarin was continued. Results: 1089 great and small saphenous veins were examined after removal with Closure PLUS radiofrequency therapy. The primary closure rate after 6 weeks was 98.9%; after one year, 91.2%; after two years 99.0%; after three years, 98.2%; and after four years, 100%. 2241 great and small saphenous veins were treated with the VNUS Closure FAST Radiofrequency System. 2096 great and small saphenous veins were examined after treatment. The primary closure rate after 7 days was 99.7%; after 6 weeks, 99.6%; after one year, 98.8%; and after two years, 100%. The rate of minor complications after Closure FAST Radiofrequency catheter treatment of the great saphenous vein was 5.3%; after treatment of the small saphenous vein, 5.9% in total. No major complications – such as deep vein thromboses or pulmonary embolisms – were caused, and neither was burning of the skin. The closure rate one week after RFS treatment was 84.6%; after 6 weeks, 86.2%; and after one year, 78.3%. In all of the recurring varicose veins, the recirculation was successfully eliminated. Conclusion: The VNUS Closure FAST Radiofrequency catheter represents a standardised, established procedure for treating epifascial varicose veins to ensure the certain elimination of recirculation. The development of Closure PLUS 6-French and 8-French catheter into Closure FAST Radiofrequency catheter has led not only to a reduced operation duration but also a safe and high closure rate after follow-up. With the new concept of segmental ablation the Closure FAST system eliminates the catheter pullback variability and standardises and simplifies the procedure. The success of the treatment is shown by the complete decomposition of the vein underneath the inflow of the superficial epigastric vein or the inflow of the gastrocnemic veins. However, the long term results for the Closure FAST system are awaited eagerly. The current high closure rates and high patient satisfaction rates give us cause to look ahead with hope.