Treatments for Veins and Varicose Veins - VNUS Closure® and Closure® FAST™ ablation
VNUS Closure® was the first of these new "keyhole surgery" techniques for varicose veins that came into the UK.
The first case performed as a "keyhole surgery" technique in the UK was by Mr Mark Whiteley and Judy Holdstock of The Whiteley Clinic, on the 12th of March 1999.
There had been other attempts at using heat to close veins ever since about the 1930s. However, it was the VNUS Closure® technique and the modern ultrasound machines that allowed us to position the VNUS Closure® catheter precisely, that made this technique successful and open the door to other keyhole surgical techniques.
The VNUS Closure® technique used radio frequency current which it passed through electrodes into the vein wall causing it to heat up to 85°C. The first cases in the UK were all performed under general anaesthetic and the procedure was very slow. Mr Mark Whiteley perfected the technique making sure that every vein he treated closed, giving his patients the best treatments he was able to do.
Other doctors in the United States and other countries using VNUS Closure® at the same time started using local anaesthetic, but had a failure rate of 5% to 40% at one year. Mr Mark Whiteley and Judy Holdstock used to run teaching courses to try and encourage surgeons to use their technique and replicate the excellent results they produced.
In addition, Mr Mark Whiteley and Judy Holdstock invented the TRLOP technique to close perforators using VNUS Closure®in 2000. Please see the page on SEPS/TRLOP for more information.
Although VNUS Closure® appeared before EVLA (laser treatment) many surgeons turned to EVLA as it was quicker and easier to use under a local anaesthetic.
Therefore the American VNUS company produced a new catheter called the Closure® FAST™ to speed up the treatment and to be used specifically under local anaesthetic (tumescence).
The first Closure® FAST™procedure in the UK was performed by Mr Mark Whiteley and Judy Holdstock on the 5th of March 2005.
The Closure® FAST™ has a 7 cm long end, which heats up to 120°C. This temperature permanently destroys the vein, as did the previous VNUS Closure® procedure, but much quicker.
At The Whiteley Clinic, we do use the Closure® FAST™ on appropriate patients. However, although this technique has been seen on the BBC News and several other television shows, as with most marketing they concentrated on the benefits and not the drawbacks.
For those patients with straight veins that are reasonably large and with regular walls, the Closure® FAST™ is excellent, with almost no postoperative pain in our experience.
Unfortunately, the catheter itself is not particularly flexible and so it is not suitable for very small side branches which we at The Whiteley Clinic have shown that you have to treat if they are present. The catheter is also more expensive than the EVLA equivalent at the current time and also cannot be used in small segments of vein under 7 cm long which we commonly find in people with recurrent varicose veins.
We also do not like to use it in the small saphenous vein as this vein has some large nerves very close to it, and heating 7 cm at once stops us from identifying exactly where a nerve might be being heated. Finally, veins with clot or scars do not allow smooth passage of heat and therefore the excess energy of the EVLA is more appropriate for these veins.
As such, the Closure® FAST™ is an excellent procedure but only in selected patients. At The Whiteley Clinic we have developed protocols to identify exactly who will benefit most from which treatment.
