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Frequently Asked Questions

How will my varicose veins be treated?

Each patient will meet with Dr. Frasca individually, with a comprehensive plan developed and presented to you prior to any treatment. Your physical examination, an ultrasound duplex study and your personal lifestyle all will be considered. Every attempt will be made to ensure that your care experience is as comprehensive as possible, while being mindful of your busy schedule.

IF RECOMMENDED, WHAT ARE RADIOFREQUENCY ENDOVENOUS ABLATION and VENASEAL CLOSURE THERAPY?

Radiofrequency endovenous ablation and Venaseal Closure are two different minimally invasive options to effectively treat patients suffering from varicose veins or chronic venous insufficiency (CVI). Both treatment options utilize a treatment catheter which is inserted into the diseased vein. Radiofrequency Ablation utilizes uniform heat to contract the collagen in the vein walls, causing them to shrink and seal close. Venaseal Closure utilizes the placement of medical adhesive inside the vein to seal it shut. This type of medical adhesive has been used successfully to treat other medical conditions for decades and has now been shown effective in treating varicose veins. Once the diseased vein has been closed by either procedure, blood will re-route itself to other healthy veins.

I HAVE HEARD OF THE VENEFIT AND VNUS PROCEDURES BEFORE. HOW ARE THEY DIFFERENT FROM RADIOFREQUENCY ABLATION?

They are all the same procedure. Venefit was the name of the marketing campaign previously used by Medtronic. VNUS was the name of the company which originally developed the radiofrequency process. Medtronic, the current license holder, bought out the VNUS company, so the procedure name was changed.

HOW ARE RADIOFREQUENCY ABLATION AND VENASEAL CLOSURE DIFFERENT FROM VEIN STRIPPING?

During vein stripping, incisions are made in the groin and calf, and a tool is threaded through the diseased vein to pull it out of the leg. With endovenous ablation or Venaseal closure, only one small incision is made at the catheter insertion site and the vein is treated and left in place. These two minimally invasive procedures both reduce the likelihood of pain and bruising.1,2,6

HOW IS RADIOFREQUENCY ENDOVENOUS ABLATION DIFFERENT FROM ENDOVENOUS LASER?

Although radiofrequency and laser are both minimally invasive procedures using heat as the treatment modality, a comparative multi-center study showed that the radiofrequency endovenous procedure was associated with statistically significant lower rates of pain, bruising, and complications. Patients undergoing the radiofrequency endovenous procedure also reported improvements in quality of life measures up to four times faster than patients treated with endovenous laser ablation (the study was conducted with a 980nm laser).3

HOW LONG DO THE RADIOFREQUENCY ENDOVENOUS ABLATION AND VENASEAL PROCEDURES TAKE?

They are very similar in the time that they take, about 45-60 minutes. Individual time in the office may vary depending on the extent of other procedures which might be performed at the same time.

ARE EITHER OF THE PROCEDURES PAINFUL OR CAUSE BRUISING?

No. Most patients report feeling little, if any, pain or bruising during or after either type of procedure.3,6  Dr. Frasca will give you local anesthetic to numb the treatment area.

DO EITHER OF THE PROCEDURES REQUIRES ANESTHESIA?

No. Both procedures are performed under local anesthesia in Dr. Frasca’s office.

HOW QUICKLY CAN I RETURN TO NORMAL ACTIVITIES AFTER TREATMENT?

Patients treated with either Radiofrequency Endovenous Ablation or Venaseal Closure may resume normal activities more quickly than patients who undergo surgical vein stripping or endovenous laser ablation. Normal daily activities, can be resumed within 24 hours with both procedures. Aerobic and full weight lifting activities can be resumed within 24 hours after Venaseal closure and after 7 days after radiofrequency endovenous ablation. Job functions can be resumed within 24 hours after Venaseal closure and for most patients undergoing radiofrequency endovenous ablation. Dr. Frasca may make a 7 day return to work recommendation post-radiofrequency endovenous ablation for jobs with heavy physical requirements, or if additional procedures are performed at the same time as either the of the procedures.

WHAT HAPPENS TO THE VENASEAL ADHESIVE?

Only a very small amount of Venaseal adhesive is used to close the vein. Your body will naturally absorb the adhesive over time.

HOW SOON AFTER TREATMENT WILL MY SYMPTOMS IMPROVE?

Symptoms are caused by the diseased superficial vein. Thus, symptoms may improve as soon as the diseased vein is closed. Almost all patients report a noticeable improvement in at least 1-2 weeks following the procedure. 3

WHAT POTENTIAL RISKS AND COMPLICATIONS ARE ASSOCIATED WITH THE RADIOFREQUENCY ENDOVENOUS ABLATION OR VENASEAL CLOSURE PROCEDURES?

Adverse reactions or complications are extremely rare for all patients undergoing any varicose vein treatment by Dr. Frasca. On an overall basis, his performance statistics indicate that fewer than 0.5% (one half of one percent) of all patients have any issues post treatment. The most common is a mild skin inflammation in the treated area. However, prior to all treatments, Dr. Frasca discusses all potential risks with everyone. Patient questions are encouraged and he will spend as much time as necessary to ensure everyone is comfortable with the suggested treatment plan. All medical treatments have the potential for complications. It is important that all patients understand the risks and benefits of any and all medical treatment.

HOW DO I DETERMINE WHICH PROCEDURE TO CHOOSE?

Dr. Frasca will discuss both procedures with you and will make a specific recommendation based upon your current and past medical history, duplex ultrasound results, and lifestyle needs. Experience has shown that many patients with varicose veins or chronic venous insufficiency can be treated very successfully with either procedure.

IS AGE AN IMPORTANT CONSIDERATION FOR EITHER TYPE OF PROCEDURE?

Age alone is not a factor in determining whether or not either radiofrequency endovenous ablation or Venaseal closure is recommended. Both procedures have been used to treat both women and men across a wide range of ages. Current and past medical history, duplex ultrasound results and lifestyle considerations will be used to determine which procedure would be best for you.

HOW EFFECTIVE ARE THE PROCEDURES?

Both procedures have been shown in large international, multi-center studies to be at least 93% effective over three years.  5

ARE THE PROCEDURES COVERED BY INSURANCE?

Most insurance companies will pay for your medically recommended vein treatment plan. Dr. Frasca’s office will confer with your insurance company and obtain authorization prior to all vein care. You will be made award of any authorization issues ahead of time. Please feel free to discuss any questions you have about coverage with the office staff.

References:

  1. LurieF, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, et al. Prospective randomized study of endovenous radiofrequency obliteration. (Closure procedure) versus ligation and stripping in a selected patient population (EVOLVeS Study). J Vasc Surg 2003;38;2:207-14
  2. Hinchliffe RJ, et al. A prospective randomized controlled trial of VNUS Closure versus Surgery for the treatment of recurrent long saphenous varicose veins. Eur J Vasc Endovasc Surg 2006 Feb;31;2:212-218
  3. Almeida JI, Kaufman J, Göckeritz O, et al. Radiofrequency endovenous ClosureFast versus laser ablation for the treatment of great saphenous reflux: a multicenter, single-blinded, randomized study (RECOVERY Study). J Vasc Interv Radiol. 2009;20:752-759.
  4. L. H. Rasmussen, M. Lawaetz, L. Bjoern, B. Vennits, A. Blemings and B. Eklof, Randomized Clinical Trial Comparing Endovenous Laser Ablation, Radiofrequency Ablation, Foam Sclerotherapy and Surgical Stripping for Great Saphenous Varicose Veins. British Journal of Surgery Society Ltd., Wiley Online Library, www.bjs.co.uk, March 15, 2011.
  5. Proebstle T. et al. Three-year European follow-up of endovenous radiofrequency-powered segmental thermal ablation of the great saphenous vein with or without treatment of calf varicosities. JVS; July2011.
  6. Morrison, N et al. Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous veins (VeClose). Journal of Vascular Surgery. 2105.