| The treatment of venous insufficiency has advanced | | | | risk of sural nerve injury (due to proximity to the |
| dramatically over the last few years with the advent | | | | small saphenous vein) and risk of deep vein clot. |
| of both endovenous laser and radiofrequency ablation | | | | The poster displayed at the meeting showed that |
| techniques. Patients with venous insufficiency of the | | | | initially, all veins treated were closed at one week |
| legs now have the advantage of procedures | | | | follow up. As this is an early phase study, longer term |
| performed under local anesthesia in an office setting | | | | data will determine the durability of the ablation. |
| with immediate recovery. | | | | There were no cases of neuralgia or numbness as no |
| There have been numerous patient based studies | | | | sural nerve injuries were reported by the patients. |
| documenting the success and safety of these | | | | There was no deep vein thrombosis seen at one |
| minimally invasive techniques when treating the great | | | | week follow up, but one superficial phlebitis was seen |
| saphenous vein. This vein is the most common cause | | | | in mid calf varicosities. |
| of lower leg varicose veins and symptoms related to | | | | Keys to safe and successful treatment of the small |
| venous reflux. | | | | saphenous vein using VNUS Closure include site of |
| The small saphenous vein is another commonly | | | | access, adequate tumescent anesthesia and keeping |
| affected lower leg vein that develops reflux due to | | | | the tip of the catheter safely away from the |
| vein valve insufficiency. 6-8% of patients studies for | | | | sapheno-popliteal junction. |
| venous disease have reflux in the small saphenous | | | | The sural nerve descends the lower leg from the |
| vein. Use of endovenous ablation has not been well | | | | thigh away from the small saphenous vein in the |
| studied in this clinical population. There are a few case | | | | proximal calf. Approximately halfway down the calf, |
| series studying the use of laser to treat the small | | | | the nerve then is in close proximity to the vein, at |
| saphenous, but none detailing the use of the VNUS | | | | risk for thermal injury. Therefore, I commonly treat |
| Closure catheter. Ablation of the small saphenous vein | | | | this vein only in the proximal calf, to the level of the |
| has been used with good anecdotal reports of | | | | base of the gastrocnemius muscle. When treatment |
| success and safety, however. | | | | is kept to this level, nerve damage is minimized. |
| I recently began a prospective study looking at all | | | | Associated with catheter placement is the need for |
| patients in my practice at Capitol Vein & Laser | | | | adequate tumescent to hydrostatically separate the |
| who underwent endovenous ablation of the small | | | | nerve from the heated vein. |
| saphenous vein using the VNUS Closure catheter. This | | | | Finally, one must be attentive to the |
| study was presented in poster form at the 2009 | | | | sapheno-popliteal junction and sit the catheter tip at |
| annual meeting of the American College of | | | | least 2cm from the deep vein. This will help minimize |
| Phlebology, November 4-8. | | | | the risk of DVT. |
| Beginning January 2009, 51 patients were enrolled in a | | | | In summary, as the poster at the ACP meeting |
| prospective clinical study determining the safety, | | | | detailed, VNUS Closure of the small saphenous vein is |
| ease and efficacy of VNUS Closure of the small | | | | safe and effective in ablating reflux. |
| saphenous vein. Concerns to date have centered on | | | | |