Jefferson vascular surgeons go on web to demonstrate less invasive treatment than vein stripping for varicose veins

Typically, painful and unattractive varicose veins are dealt with by removing the vein, better known as vein stripping.

Stripping is a lengthy procedure often performed under general anesthesia and requires a surgeon to make incisions in the groin and below the knee and remove the vein with a long, surgical instrument extending inside the leg to the knee. The resulting postoperative convalescence can last two to four weeks and entail a significant amount of bruising, bleeding and postoperative pain.

But vascular surgeons at Thomas Jefferson University Hospital are offering patients a minimally invasive, less painful and shorter procedure for treating this problem and will demonstrate it on the Internet in a webcast from Jefferson University Hospital.

The webcast is scheduled for 4:30 p.m., Wednesday, June 22, at www.jeffersonhospital.org/webcast. The procedure will be performed by R. Anthony Carabasi, III, M.D., professor of Surgery, and director, Division of Vascular Surgery, Jefferson Medical College of Thomas Jefferson University.

Called the Closure system, the procedure uses radiofrequency energy to close the saphenous vein, a large vein that runs from the ankle to the groin. Problems with valves in this vein often contribute to the development of varicose veins.

“Unlike vein stripping, the Closure procedure is less invasive, requires no general anesthesia, takes approximately 45 minutes and allows most patients to leave the doctor's office within two to three hours,” said Dr. Carabasi.

With the Closure system, instead of stripping the vein, the surgeon makes a single, small needle-size incision near the knee and inserts a slender catheter into the saphenous vein that delivers bipolar radiofrequency energy directly into the vein wall, explained Dr. Carabasi.

The catheter is then positioned near the groin, energized with a radiofrequency generator and slowly withdrawn, sealing the vein shut. The passage of heat through the vein wall as the catheter is withdrawn causes resistive heating, shrinking the vessel. The catheter’s flexible electrodes then cause the vessel to collapse around the catheter, thereby closing the vein and eliminating the backward flow of blood called venous reflux. Reflux contributes to the development of varicose veins when incompetent leg vein valves let blood flow down toward the feet instead up to the heart.

“Studies have shown that patients receiving the Closure procedure exhibit less pain and bruising and return to normal activity and work significantly faster than those receiving vein stripping,” Dr. Carabasi noted.

According to the Handbook of Venous Disorders, 20 to 25 million Americans have varicose veins. Women suffer from varicose veins more than men and the incidence increases to 50 percent of people over age 50.Venous reflux, often the underlying cause of varicose veins, frequently forces people to dramatically change their lifestyle, especially when they have a standing profession and can no longer tolerate being on their feet all day.

Varicose veins may ache, and feet and ankles may swell toward day's end, especially in hot weather. They can get sore and inflamed, causing redness of the skin around them. In some cases, patients may develop venous ulcerations.

Research indicates that more than two million workdays are lost annually in the United States and $1.4 billion is spent each year on this common medical condition.

A leading cause of this unattractive medical condition is "incompetent" valves in the large saphenous vein running from groin to ankle in each leg. When those valves deteriorate, blood flows backward instead of surging toward the heart. This places increasing amounts of pressure on vein walls, which stretches them, builds up fluid in the legs and causes other veins to deteriorate.

Conditions contributing to varicose veins include genetics, obesity, pregnancy, hormonal changes at menopause, work or hobbies requiring extended standing, and past vein diseases.

The webcast is approved for AMA PRA Category 1 credit. Jefferson Medical College of Thomas Jefferson University, as a member of the Consortium for Academic Continuing Medical Education, is accredited by the ACCME to provide continuing medical education for physicians.

The webcast will air at 4:30 p.m., Wednesday, June 22, at www.jeffersonhospital.org/webcast.