Nashville General Surgeons

Get Rid of Varicose Veins

what's the best varicose vein removal procedure?

In general, for those large, ropey veins there will usually be an identifiable cause. The causes are usually from the superficial venous system and the perforator system. The only minimally invasive endovenous ablation technique that can directly take care of both systems successfully is VNUS Closure (RF or radiofrequency abltion). It takes 30 minutes or less, no incisions, local anesthetic with iv sedation, and when you leave the office no restrictions and no down time. The VNUS Closure FAST catheter has a less than 1% failure rate. The RFS catheter in experienced hands has a less than 10% failure rate. There are no well designed studies in the literature for the RFS catheter and the results are physician dependent (experience with the technique). Approximately 60-70 % of the time the ropey, bulging veins will shrink on ther own once the venous pressure is reduced.

The endovenous laser technique soon will undoubtedly prove in the literature to have a higher complication rate than RF (bruising, pain, numbness, etc...) as we often see at our own vein clinics in patients who refuse to complete there varicose vein treatment with endovenous laser (even in experienced hands). The endovenous laser technique uses too high a temperature to be safe for direct perforator vein ablation. For these reasons, we do not offer endovenous laser ablation. Too many patients don't like it. Very few patients complain about VNUS Closure.

For those residual bulging varicose veins there are other percutaneous, no incision techniques that can be used to shrink the varicose veins. If these tecniques are unsuccessful, ultrasound guided sclerotherapy or sclerotherapy can be used. As a last resort, more invasive phlebectomy techniques are available and may be necessary in up to 10% of patients.

Steven Roth, MD

Nashville General Surgeon