VNUS Closure Radiofrequency Therapy

VNUS-Closure radiofrequency therapy is also known as endovascular radiofrequency ablation and is a modern procedure for the treatment of truncal varicose veins and straight running side branch varicose veins. Varicosis is understood as the extensive occurrence of varices. Varicose veins (lat. varix – varicose vein) are irregularly tortuous, superficial veins that may be enlarged in a nodular fashion in some areas. The principle is based on a strong application of heat, which is caused by a catheter endovascularly (inside the vein) and leads via a strong constriction (contraction of the vein) to the closure of the varicose vein. Thus, it is an alternative to vein stripping.

Indications (areas of application)

Before surgery

Before surgery, an intensive medical history discussion should be conducted that includes the patient’s medical history and motivation for the procedure. The procedure, any side effects, and the consequences of the surgery should be discussed in detail. Note: The requirements of the explanation are stricter than usual, since courts in the field of aesthetic surgery demand a “relentless” explanation. Furthermore, you should not take acetylsalicylic acid (ASA), sleeping pills or alcohol for a period of seven to ten days before the operation. Both acetylsalicylic acid and other painkillers delay blood clotting and can lead to unwanted bleeding.Smokers should severely limit their nicotine consumption as early as four weeks before the procedure so as not to jeopardize wound healing.

The surgical procedure

First, with the patient standing, the course of the truncal vein to be treated (great saphenous vein or parietal saphenous vein) is traced and marked with an ultrasound probe. The surgeon then locates the distal point of insufficiency (the damaged section furthest toward the foot). At this point, the vein is punctured through a 3 mm incision (“cut”) and the radiosonde is inserted. The probe is then advanced to the groin and the leg is elevated to the level of the foot. Under ultrasound control, the electrodes of the radiosonde are now heated to approx. 85 °C. The electrodes must be in direct contact with the vein. The electrodes must be in direct contact with the wall of the vein for the vein occlusion to be successful. The probe is now slowly withdrawn while the vein contracts like a zipper. VNUS-Closure radiofrequency therapy produces the following effects:

  • Vein migration heating with damage to the endothelium – the top layer of cells inside the vein is severely damaged by the heat exposure.
  • Denaturation of the collagen protein matrix – proteins (protein) and collagens lose their structure due to the heat and are thus destroyed
  • Collagen shrinking – the collagenous fibers contract.
  • Venous occlusion – the vein wall thickens and fibrosis (connective tissue remodeling or scarring of the tissue).

After removal of the radiosonde, a compression bandage (pressure bandage) is applied in the course of the vessel. The procedure takes place either under local anesthesia, tumescent anesthesia (form of local anesthesia in which a highly diluted local anesthetic is injected in large quantities into the subcutaneous fat tissue until a reservoir is present) or general anesthesia.

After surgery

The patient can carefully move freely again as early as 1-2 hours after the procedure and can perform light occupational activities the very next day. As the procedure progresses, the patient should wear class II compression stockings for two to three weeks.

Possible complications

  • Small surgical incisions that usually do not form noticeable scars; keloids (bulging scars) and/or skin discoloration may occur here, if necessary, in cases of wound healing disorders or predisposition (rare)
  • Infections (rare)
  • Temporary minor swelling, tightness and feeling of pressure in the legs usually occurs between the third and fifth day. This is due to the shrinkage of the treated veins with the radio waves.
  • Paresthesias (numbness) and/or increased sensitivity to touch due to damaged skin nerves from radio waves.
  • Strength pain, as a sign of circulatory disturbance (here, an immediate control examination is required).
  • Superficial hematomas (bruises) in the area of the former varicose veins.The patient should therefore wear a compression bandage for about 2 weeks postoperatively.
  • As after any surgical procedure, thrombosis (formation of a blood clot) may occur, with the possible consequence of embolism (occlusion of a blood vessel) and thus pulmonary embolism (danger to life) (rare) Thrombosis prophylaxis leads to a reduction in risk.
  • Due to the storage on the operating table, it can come to storage damage (eg, pressure damage to soft tissues or even nerves, with the consequence of sensory disturbances; in rare cases thereby also to paralysis of the affected limb).
  • In case of hypersensitivity or allergies (e.g. anesthetics/anesthetics, drugs, etc.), the following symptoms may temporarily occur: Swelling, rash, itching, sneezing, watery eyes, dizziness or vomiting.