New ultrasound-based treatment for varicose veins

Rowena Cheng, RN, has spent most of her 34-year career on her feet. Standing for long periods of time comes with the job of being a nurse. For Cheng, however, it exacted a physical toll: knotted, swollen blood vessels in the calf of her left leg.

“For patients who don't get good relief from wearing compression stockings alone, the VNUS catheter is a new ultrasound-based treatment modality”

"By the end of a shift, it would be very painful," said Cheng, who was a nurse in Stanford Hospital's North Intensive Care Unit for 27 years. "I would get home and have to put my feet up for about an hour."

Like Cheng, some 25 million Americans suffer from varicose veins. Normally, one-way valves in the veins of your legs keep blood flowing toward the heart. But venous reflux, as the condition is also known, occurs when those valves become faulty or weakened, allowing blood to pool and distend the veins.

The unsightly and often painful condition is thought to be hereditary, but it can be exacerbated if you have a job that requires you to stand a lot. Pregnancy, obesity and old age are other risk factors. According to Ronald Dalman, MD, chief of vascular surgery at Stanford Hospital & Clinics, an estimated 40 percent of women will have chronically significant varicose veins by the time they reach 50.

Some patients find relief by wearing graduated compression stockings, but the progressive condition cannot be cured. In the past, surgeons treated varicose veins by a procedure known as saphenous vein stripping. Operating in a surgical suite on a patient under general anesthesia, a surgeon made an incision at each end of a troublesome vein, threaded a flexible wire through it and pulled it out. But this surgery can produce scarring and has a relatively high risk of infection.

With the development of minimally invasive procedures over the past decade, surgeons now have a new option for treating varicose veins. "For patients who don't get good relief from wearing compression stockings alone, the VNUS catheter is a new ultrasound-based treatment modality," Dalman said.

During the past five years, the VNUS catheter has been fine-tuned, resulting in a faster, improved procedure. "It's all done through a needle puncture at the knee," Dalman said. "The catheter is inserted, guided by ultrasound all the way up a vein, then heated with radiofrequency energy and slowly pulled back out. As the catheter is withdrawn, it cauterizes the vein from the inside and collapses it completely."

Local anesthesia is used during the procedure, which takes about an hour. "We've transitioned the procedure out of the operating room, into the clinic," Dalman said. "Patients need a ride home afterward, but they can return to work the next day." That contrasts with a roughly two-week recovery required after vein stripping.

"With VNUS catheterization, there are no incisions, typically no post-op pain medication and the procedural risks are very low," Dalman said.

VNUS closure is not right for every patient. It cannot be used if there has been previous clotting in the veins and may not be appropriate for advanced cases, Dalman said. "VNUS is ideal for early treatment of varicosities," he said.

After trying the compression stockings, which Cheng likened to pulling on the bottom half of a wetsuit every morning, she opted for the VNUS procedure. "I had to take it easy for about three days afterward, but I could still stand up and walk around," she said. "Overall, it was a very easy experience."

The pain and fatigue in her leg disappeared, said Cheng, now a nurse coordinator in Stanford Hospital's Heart Center. "Cosmetically, it's also back to normal," she said. "You can only see the puncture site if you're looking for it."