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What differentiates VNUS closure from vein stripping?

This question was asked in Kempton, North Dakota and has 6 answer(s) as of 05/10/2013.
Are there major differences between VNUS closure and vein stripping? Is one more painful, or more effective, than the other? How so?


Doctors Answers (6)

There is a MAJOR difference between the two. Vein stripping is when an incision is made usually in the groin and at the ankle to disconnect the vein and the vein is pulled out of the body through the incision. Vein stripping can cause a lot of post operative pain, bruising, bleeding, and is done under general anesthesia. VNUS closure and endovenous laser treatment has basically replaced vein stripping. They are both very effective in shutting down veins. With VNUS closure specifically (now known as Venefit) a radio-frequency catheter is inserted into the vein after local anesthesia is injected. The catheter heats up the vein and closes it down from the inside. The vein ultimately shrivels up and your body absorbs it. The procedure takes about 20 minutes and is done in the office again under local anesthesia. There is minor post operative bruising and discomfort and little to no scarring.

Yes "stripping" is more painful. VNUS can be done in office, under local anesthesia, and is just as effective.

Vein stripping consists of removing the (greater saphenous/small saphenous) veins surgically. A small incision is made at the knee or at the ankle, and another at the groin. All the connecting branches are tied off and divided at the groin and then a guide wire is then threaded through the lumen (bottom up) and a metal cone is screwed into the end of the wire. The cone is then imbedded below the skin and the wire is pulled from the ankle area, thus stripping the vein from all its branches. The patient requires General or Spinal anesthesia. This operation is still being done 150,000 times each year in the USA. There's some risk of injuring small blood vessels, arteries and lymphatics with this operation. There's significant bruising and post-operative pain, and it's very easy to miss tributary varicose veins that become evident later. Recurrent varicose veins occur in up to 65% of patients at 25 years. VNUS closure procedure consists in threading a 2mm catheter under ultrasound guidance from the knee, below the knee or ankle depending on the extent of the venous reflux. Then, local anesthesia is infused along the catheterized vein through 6-10 needle punctures along the course of the vein. This is done with a very small needle. The catheter has a thermocouple which gets heated. This is turned on but pressing a button at the control, and the catheter delivers 20 seconds of heat per cycle; the catheter is pulled back for 7 cms (this is the length of the thermocouple) and the next 7 cms segment is treated and so on until the full length of the abnormal vein is closed. The heat contracts the connective tissue in the vein wall, and the blood and serum is congealed similar to boiling an egg. Within a week, the vein is checked by ultrasound to confirm it's closed and to make sure no thrombus is spread into the deep system. The leg is checked 6-12 months later, and the vein has disappeared completely. There's minimal complications, no pain, and no down time. Both procedures are done in an Operating Room environment using sterile drapes, gowns and gloves.

Vein stripping is the actual removal of the vein, usually the great saphenous. The VNUS CLOSURE or VENEFIT procedure is done using a radio frequency catheter placed within the vein. The catheter heats to 120 degrees centigrade. The heat destroys the vein. The vein scars down and blood flow within the vein stops. The same end effect is achieved, which is the stopping of the venous reflux.

"Stripping" in the classic sense is a 2000 year old operation that now has a poor acceptance due to pain and nerve injury. VNUS/RFA or ablation is vastly different, closing off the vein painlessly with microwave injury with no post op pain and a very very low complication rate.

Standard vein stripping is not an acceptable practice in 2013 in the United States. There is a special type of vein stripping called "Perforate-Invaginate Stripping" (PIN stripping) which is useful for removing a long, straight veins just under the surface of the skin. Endovenous thermal ablation or sclerotherapy techniques are prone to leave a discolored cord for many months under the skin when the treatment is just under the surface of the skin. PIN stripping gives a cosmetically better result much faster than the other techniques for this specific type of vein. However, endovenous thermal ablation either with the VNUS ClosureFast (Venefit) catheter or LASER has become the standard method for treating most incompetent saphenous veins since the treatment is very effective and causes minimal pain or disability compared to vein stripping. The cost of endovenous thermal ablation is minimal compared to the usual cost of vein stripping with hospital or surgery center charges and anesthesia charges.

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