A surgeon at Spokanes Holy Family Hospital has begun offering a minimally invasive treatment alternative to vein stripping for people who suffer from whats called superficial venous reflux, the underlying cause of varicose veins.


The surgeon, Dr. Debra A. Kontny, who specializes in laparoscopic, thoracic, and vascular surgery, says she has performed the treatment alternative, called the VNUS Closure procedure, only about 20 times so far. She adds, though, that she has become a huge advocate of it and believes it eventually will replace vein stripping as the standard treatment method.


I personally would rather have this. I would recommend it to my family, she says. It has renewed my interest in vein surgery.


Vein stripping is a procedure, typically done in an operating room under general anesthesia, in which damaged veins are removed from the legs. Healthy veins then take over.


The VNUS procedure is an outpatient treatment, introduced in the U.S. four years ago, in which a small catheter connected to a radio-frequency generator is used to seal shut malfunctioning veins in patients legs rather than removing them. The procedure uses technology patented and now marketed by VNUS Medical Technologies Inc., of San Jose, Calif.


Kontny claims the procedure virtually eliminates the pain, bruising, swelling, and scarring associated with vein removal. Also, because it is handled on an outpatient basis, involves little trauma to the body, and can be done under a local or regional anesthesia, recovery time is short, and a patient typically can resume normal activities after a couple of days, she says.


All of that potentially could spell sizable growth in demand for the procedure, considering that varicose veins afflict an estimated 10 percent to 20 percent of the adult population. In the U.S., that equates to 20 million to 25 million people, most of whom are women.


To understand how the VNUS procedure works, its helpful to first understand more about superficial venous reflux. It occurs in whats called the saphenous vein, which runs up the leg from ankle to groin. That veins job is to help return oxygen-depleted blood to the heart, and it contains valves that open and close to assist it in that task. The problem occurs whendue to a variety of possible causes, ranging from genetic factors or pregnancy to excess weight and a lack of exercisethose valves become damaged or diseased.


That allows a backward flow of blood into the legs. The pooling of the blood there leads to pain, swelling, and varicose veins, which are veins near the skin surface that have become stretched and distorted from the increased pressure caused by blood flowing in the wrong direction. Varicose veins, the documented occurrence of which dates back to around 1550 B.C., are know for their distinctive blue color and bulging appearance.


Treatment options


In modern times, patients have had several choices for treating varicose veins, depending on severity. One option is lifestyle changes, such as eating less and exercising more, and wearing support hose.


Another option is a procedure called a phlebectomy, developed in the 1950s, in which saphenous branch veins are removed through a series of tiny punctures or incisions with a variety of special hooks. That procedure, though, doesnt address the damaged valves in the saphenous vein that caused the problem, and thus varicose veins can recur.


Some doctors, therefore, advocate removing the saphenous vein. In many cases, that stripping eliminates the pain associated with varicose veins and greatly reduces their potential for recurrence, medical literature indicates.


In a stripping procedure, the surgeon makes an incision in the groin and surgically ties off the top of the saphenous vein. An instrument that looks like a thin rod with a bulbous end then is inserted into the vein at that location and passed through down to the upper calf, where another incision is made. The stripping device then is tied to the vein, and the vein is pulled out through the second incision. The procedure often causes significant bruising, though, and also can cause post-operative pain and some nerve damage.


With the VNUS Closure procedure, the surgeon typically makes a single, small incision near the knee and inserts the catheter into the saphenous vein. The catheter then is positioned near the groin, energized, and slowly withdrawn. The radio-frequency energy transmits to the vein wall, causing it to heat, collapse, and seal shut. Kontny says the procedure takes only about 45 minutes to perform. Ultrasound equipment also is important to the process. Its used for pre- and post-operative assessment, and, Its like my eyes into the vein during the procedure, Kontny says.


After the diseased vein has been closed, or removed in the case of vein stripping, healthy veins take over and empty blood from the legs.


Anybody who would be a candidate for vein stripping would be a candidate for this, Kontny says.


She says a similar procedure involves the use of lasers, but she considers the VNUS procedure a better option because it causes less damage to tissues.


Kontny, who does general vascular surgery and has specialized training in breast and vein surgery, joined the Holy Family medical staff in August 2001 and also is on staff at Sacred Heart and Deaconess medical centers. Her main office is at Holy Family, though, and she says the North Side hospital bought the equipment needed to perform the VNUS procedure, thus becoming the first hospital here to offer it.


She says she first developed an interest in the VNUS procedure about a year ago, then took a course on how to do it in Phoenix, Ariz., and began performing the procedure here in January.


Kontny says, though, that she has no desire to be swamped with vein surgeries because she prefers having a more varied surgical practice. She says she hopes other surgeons here will embrace the VNUS technology and begin using it to meet what she thinks is sure to be a rising demand.


VNUS Medical Technologies says on its Web site that its Closure procedure was first used in Europe in 1998. Since then, it says, more than 10,000 patients have been treated successfully worldwide.