About the same time as Dr Robert Min was pioneering the use of laser to kill veins, Mr Mark Whiteley was pioneering the use of radiofrequency to kill veins.

First used in 1999 and called “VNUS Closure”©, the procedure was performed under general anaesthetic. The device was then adapted, and called “VNUS closure FAST”© and the first procedure in the uk was performed by Mr Mark Whiteley and Mr Craig Smith.

This new device is now readily used throughout the world and is a viable alternative to laser treatment for varicose veins.

The “VNUS Closure”© technique used a radiofrequency current that was passed through electrodes positioned in contact with the vein wall, and heating it to 85⁰ Celsius. The procedure was very slow, which is why the new technique “VNUS closure FAST”© evolved to replace it. At the time laser ablation was probably a more favoured procedure, due to shorter operating times and easier use under local anaesthetic.

“VNUS closure FAST”© works by using radiofrequency to heat up a 7cm long treatment section of the catheter, heating up to 120⁰ Celsius in 20 second bursts, permanently destroying the vein; just as the old “VNUS Closure”© device did and laser fibres still do. After each 7cm treatment the catheter is pulled back and next 7cm treatment commences.

The technique for getting the “VNUS Closure”©, device into the vein is very similar to that when using a laser system: Under ultrasound guidance a needle is inserted into the vein and then a wire passed through the needle into the vein. An introducer is then placed over the guide wire and the wire removed. Under ultrasound guidance, the “VNUS Closure”© device is then guided through the introducer and into position for treatment.

During the procedure, some of the energy can dissipate into the surrounding tissue causing pain and bruising, so a dilute local anaesthetic is delivered around the vein just as in the laser ablation technique. This is called ‘tumescent anaesthesia’.

Just as with laser ablation, one of the main advantages with this technique over the conventional stripping is that, because the vein is closed in situ and not removed, there is no way in which the vein can re-grow.

The proteins in the wall of the vein are denatured using the radiofrequency energy and so the bodies own defence mechanism does not recognise the vein as being part of its own system and the white blood cells come along then eat the vein until it is completely disappeared.

“VNUS closure FAST”© was found to be a very good technique for veins that were reasonably straight with regular walls, with most cases reporting a high closure rate and very little post operative drawbacks.

Radiofrequency treatment of the vein allows patients to be treated on the NHS or in a private setting, as a walk in-walk out treatment, with the whole procedure taking about 1 hour from start to finish; and with the patient walking out with just a compression stocking on to aid healing.

However, there were some drawbacks with the device:

Clinically, the catheter itself is quite rigid making it difficult to treat some of the smaller side branches and the “VNUS closure FAST”© device has a minimum treatment area of 7cm and so treatment of veins with a smaller section is not possible

Financially, the radio-frequency catheter is more expensive than the Laser Fibres used in a laser ablation; nearly double the price when compare to the Fotona XP2 laser fibres.

Finally, veins can have clotting or scarring to the veins wall and so the energy delivered by the “VNUS closure FAST”© device is not always sufficient as to correctly treat the vein and cause 100% permanent closure.

For these reasons, most successful practices now offer a choice for patients depending on their ultrasound findings and the patient’s personal situation.

For information on removal of the visible veins that may be left after radio-frequency ablation, continue here to learn about the Phlebectomy.