Considerations and background about the treatment of big varicose stem veins with the high frequency catheter (radio waves catheter- VNUS)

Please note: If a conventional surgery of varicose veins is not possible for there is also no basis for a procedure with the high frequency catheter (HF-catheter). There will not be more surgeries just because there is a generator with an HF-catheter available.

The principle of the procedure with the high frequency catheter is the treatment of the sickened vein from the inside with heat energy that generated by a high frequency generator and is exposed as microwaves at the tip of a catheter between thin electrodes that heats up the membrane of the sickened vein and shrinks/fuses it by that. This minimal invasive treatment can be performed with general anaesthesia or with a modern version of local anaesthesia the so called tumescence anaesthesia.

In detail the sickened vein will be found over a micro access (1,5 mm) usually between the knee joint and the inner ankle and then a sterile catheter is placed wit the control of an ultrasound.

A generator connected to the catheter produces predefined energy (at the vein membrane) and temperature to heat up the protein molecules at the vein membrane so that they shrink but not burn. By pulling back the catheter slowly a thermally damaged vein is left behind that scars over gradually and can remain in the body.

 The advantage of this procedure is that it involves only minutely invasive surgery but provides superior cosmetic results. Due to the fact that the regular inguinal cut did not take place and the vein stays in its normal position, our patients are normally able to return to work after 4-5 days after the surgery when the compression bandage is removed. But the exception proves the rule as always.

Adverse reaction:

Generally the laser or the catheter do not cause many haematomas or Wundschmerz.   At most you will feel a traction along the shrunken vein like an inflammation of the vein, what by American physicians is considered to be a sign for the correct reaction of the vessel.

Accompanying varicose veins:

It makes sense that a conditioned flexible catheter can not pass badly arched knot. But to get the best cosmetical result possible anyway the knots are removed at the same time micro surgical, also without any cuts. This works with small circular accesses of the sizes of about 1,5 mm diameter that heal normally without any scars.

Ironically the most troubles occur because of this more conventional part of the procedure, e.g. bruises or passagere nerve irritation.

Principally there are statistical risks about the surgery with the high frequency catheter (just like in every other surgery) that can not be avoided totally even with the most possible carefulness of the surgery team:

·        Burning of the surface of the skin that can come up when the shrinking vein lies very close to the surface of the skin what makes the heat of the vein membrane reach the skin

This is prevented by injecting a liquid into the interval of vein and skin with the control of an ultrasound as an isolating layer.

·        Please consider that the heat of the high frequency catheter causes an artificial inflammation of the vein. This means that also the symptoms of an inflammation can occur, it depends on the used amount of energy.

In some cases especially very slim patients had in spite of many precautionary measures strong pain and concretion along the affected vein for days after the surgery.

·        In very rare cases the fiber glass optics or the catheter can get stuck

In this case the first thing we try is to push it forward over a second injection site. If that does not work we might have to switch over to the conventional method of surgery. This procedure we will debate with you explicitly in the preliminary talk.

·        Development of a vein thrombosis. This risk always exists when there is a manipulation of  a vein.

For the endoluminal procedure you will be heparinized before the surgery begins (Heparin injection) to prevent the development of a thrombus.

·        The catheter could injure the vein membrane what then could cause local bleeding

To prevent this from happening we control throughout the entire procedure the catheter with an ultrasound.

·        Damage of the feeling nerve: like the conventional stripping method the minimal invasive surgeries also always have a risk for that especially at the lower leg.

Because of this the varicose vein is only shrunken to a certain spot beneath the knee joint. Branches further below are removed mechanically with micro pliers. As long as a nerve did not get completely cut through accidentally possible dysfunctions of the feeling go down within a couple weeks (up to 12 months).

·        Infections: Since the procedure is performed over minimal accesses/ tap spots the risk for an infection is very little. But as for any other surgery there is always a statistically risk for an infection.

On the sum effect we have only observed a noteworthy low percentage of patients with vein inflammatory pain and irritation of the nerves.

You should also know about this:

If you tend to only accept concepts that results have been pursued over decades you are not the right patient for this procedure.

The therapy is 5-6 years old and therefore relatively new. This is why we can not present ten-year-results al well as information about the reappearance of varicose veins compared to the method of stripping after ten years.

But the long-term information about the conventional removal of varicose veins is not as good as it has always been claimed: Fischer (one of the most prestigious European varicose vein surgeons) has published his numbers in 2000 in the German specialist magazine Phlebologie (29, 17-22) after which a total of 47% of the patients had  relapse varicosis after the stripping, mild versions in 37% of the cases and severe versions in 10% of the cases. Also on the occasion of an international opinion-forming-conference in 1998 in Paris (REVAS: recurrent varicosis after surgery) it was established that after the conventional stripping after 5-20 years between 20% and 70% of new varices reappear on the operated leg.

Our own findings are with about more than 1300 endoluminal patients are compared to that more encouraging. All previous patients were content with the minimal invasive procedure. Only for 7%-8% of the patients the welded vein for unexplained reasons opened again.