Treatment of Varicose Veins with Percutaneous Closure

Minimally Invasive Procedure Offers an Alternative to Vein Stripping

An estimated 20% of adult Americans have painful varicose veins in the leg. Venous reflux — the backflow of blood in a vessel that's often the underlying cause of varicose veins — frequently forces people to dramatically change their lifestyle, especially when they work on their feet and can no longer tolerate being on their feet all day.

Whether the initial cause is genetics, pregnancy, prolonged standing, excess weight, inadequate exercise, or a damaged saphenous vein, the "plumbing" problem in the body's circulatory system that causes varicose veins is nearly always the same.

The valves in the saphenous vein fail to close properly to prevent the blood's backflow, and the veins near the skin surface are stretched and distorted from the increased pressure caused by blood flowing in the wrong direction.

Although the condition is rarely life-threatening, it is often painful and unsightly.

Studies have found that at 12 and 24 months following percutaneous closure, 90% of treated veins remained reflux free and a significant reduction of limb pain, fatigue, and edema was observed. In one study that also assessed patient satisfaction at 6 months, 98% of patients indicated they would recommend this treatment option to a friend with similar leg-vein problems.

Until recently the standard treatment has been an operation called vein stripping that involves removing the saphenous vein from the leg to re-route the blood flow, and that generally requires a long recovery with significant postoperative bruising and pain.

At Stony Brook, we offer an attractive treatment option known as percutaneous closure.

This minimally invasive technique relies on a simple needle stick to gain access to the saphenous vein, thus avoiding incisions in the skin for exposure of the vein. For selected patients, this approach offers considerable benefits.

Before closure (left) and two weeks after closure.
            Highlights of Percutaneous Closure
Treatment of Varicose Veins
  • Relief of symptoms
  • Short recovery
  • Return to normal activities within 1–2 days
  • Same-day procedure
  • Local or regional anesthesia
  • Reduced postoperative pain
  • Minimal temporary bruising
  • Good cosmetic outcome with minimal to no scarring

Percutaneous closure of the saphenous vein has proven itself to be a promising alternative to traditional vein stripping surgery for venous reflux. The procedure has become increasingly popular as physicians become more familiar with this treatment and its associated benefits.

About the Procedure

Percutaneous closure of the saphenous vein is done by placing a catheter (thin tube) into the saphenous vein to deliver radiofrequency energy or laser energy to the vein wall, causing it to collapse and seal shut. The physician typically makes a single, small puncture near the knee and inserts the slender catheter into the saphenous vein.

The catheter is then positioned near the groin, energized, and slowly withdrawn, sealing the vein shut. There are no stitches, and most patients return to normal activity within a day or two.

The procedure is minimally invasive and can be performed under local anesthesia on an outpatient (day surgery) basis. Patients have reported feeling little, if any, pain during the procedure. Some common side effects may include temporary tenderness and numbness.

Most patients report a noticeable improvement in their symptoms in 1–2 weeks following the procedure, and experience good cosmetic outcomes with little to no scarring.

As this newly developed procedure becomes more commonly used, more and more insurance companies are covering the costs, when deemed medically necessary.

At Stony Brook, we perform percutaneous closure on an outpatient basis at our Ambulatory Surgery Center, next to University Hospital.