What are all the options for closing a saphenous vein?

By Dr. Cohen

The saphenous veins in the legs are the most common sources of varicose veins. While physicians once removed them through painful “stripping”, we now do it by simply closing them off. This process is called “ablation” and there’s more than one way to ablate a vein.

All the ablation procedures are very safe, quick, and effective. And they can be performed in the office with only local anesthesia and essentially no down time. They all involve insertion of the treatment tube (catheter) into the saphenous vein. But the differences may make one a better choice for you.

The two procedures that have been around the longest use heat energy to seal the veins shut. They are Radiofrequency Ablation (or RF, closure, closure-fast) and Endovenous Laser Ablation (or EVLT, EVLA). These are similar in that they both require some local anesthesia. We call this “tumescent anesthesia” and it involves a series of mild needle sticks along the path of the vein. The anesthesia not only numbs the area, it also protects surrounding tissues from heat injury. Both RF and Laser are equally safe and effective and recovery is quick.

The difference is that Radiofrequency Ablation heats the vein using radio waves and Endovenous Laser Ablation uses light energy from a laser. (Lasers come in different wavelengths and the longer wavelengths (like 1470 nm) cause less pain and bruising than the shorter ones).

There are now newer methods of ablation that don’t require uncomfortable anesthetic injections or heat, so these procedures are quicker, less painful, and avoid any risks of thermal injury. And the recovery is generally easier. They are Mechano-Chemical, Varithena Microfoam and VenaSeal.

The first, Mechano-Chemical Ablation (or MOCA, Clarivein) is a process that uses a combination of mechanical and chemical treatment. The mechanical part involves of a painless soft spinning wire on the tip of the catheter. The chemical is the sclerosant medication injected through the catheter. The MOCA or Clarevein procedure is painless except for a small injection of anesthetic where the catheter is first inserted

Another new technique is Varithena Microfoam Ablation. Varithena uses a mixture of a sclerosant medication called Polidocanol and a gas mixture of carbon dioxide and oxygen. These are combined to create a foam which painlessly ablates the saphenous vein shut. An advantage to this technology is that varicose veins on the skin surface can often be treated at the same time as the saphenous vein.

The latest is called VenaSeal, which injects Cyanoacrylate Glue inside the vein to essentially “glue” the vein shut. Research has shown this to be a safe and effective treatment, and VenaSeal is currently FDA-approved, but not yet available in the United States.

Because these newer methods avoid the possibility of thermal injury to skin nerves and the skin itself, they can be safer when treating saphenous veins close to the ankle or very close to the skin surface.

Insurance coverage for EVLT and RF is pretty standard now. However most insurance companies do not yet include Clarivein, Varithena, or VenaSeal treatments in their coverage policies. Insurance coverage for these non-thermal treatments can often be obtained but is not always assured.

Ask your vein doctor about these options, if they’re available and which one is best for you.

If you are experiencing bulging veins and are not sure what to do, you can arrange for a quick and easy consultation right now by calling 201-265-5300.

About us: There are 20 million Americans with vein problems that can seriously affect the quality of their lives. And as we age, they just get worse. As one of the few New Jersey medical practices committed exclusively to vein care, Advanced Vascular Vein Care is uniquely capable of alleviating those problems, whether they are medical or cosmetic. All treatments are non-surgical, usually covered by insurance, and delivered in an office setting. And we do it as it should be done – with compassion, excellence, affordability, convenience, and the personal touch. Call 201-265-5300 or visit AdvancedVascular.com for a quick and easy consultation.

Share This