by Kirti Kamdar, SVP of R&D, VNUS Medical Technologies, Inc.

There’s no way to know just how far back in history man was afflicted with varicose veins – perhaps the cavemen had them under all that hair – but the subject appears in Egyptian writings dating back 3,500 years. Hippocrates himself wrote about varicose veins in 460 BC, describing the first primitive surgical procedures for the condition. Those procedures evolved over the next 25 centuries, but even well after the technology revolution had dramatically changed many other areas of medical practice, physicians were treating venous reflux disease by cutting, slicing, stripping and ligating varicose veins.

VNUS® Medical Technologies was founded over a decade ago with a mission of rendering vein stripping, with its accompanying pain and bruising, obsolete. With an eye towards improved long-term efficacy and enhanced patient safety and comfort, VNUS pioneered endovenous thermal ablation as a minimally invasive technique for treating venous reflux in the greater saphenous vein, the underlying source of varicose vein disease. And while high technology may have come late to the table in this area, VNUS has pushed it far in a very short time.

Eight years ago, VNUS began offering the ClosurePLUS™ catheter, the first catheter for sealing diseased veins from the inside. The device delivered radiofrequency (RF) energy from a generator to the vein walls through an electrode while the device was slowly and continuously pulled back. The heat caused the collagen in the vein walls to contract, and the vessel sealed itself shut. Sealing a typical 45-centimeter vein segment took about 20 minutes, and the whole procedure required about an hour. This proved not only clinically effective but far more comfortable for the patient than any previous surgical technique

VNUS chose to innovate with RF because it is a controllable heat source – the temperature can be directly measured and moderated using computerized adjustments of generator output. Succeeding entrants into the field went in another direction by modifying existing laser devices for varicose vein treatment purposes. Laser energy generates temperatures of over 500 degrees centigrade and cannot be precisely moderated, so while laser devices proved much faster, due to a faster pullback speed, than the original RF device, they have also proven to be more painful for the patient and frequently produce bruising that requires a couple of weeks to heal.

VNUS focused on working closely with physicians to improve the RF technology, finding out what worked (and what didn’t) to improve the efficiency for physicians and the efficacy – as well as the cosmetic results – for patients. A year ago this month, all that collaboration paid off with the release of the ClosureFAST™ catheter, a new RF ablation device that has left previous technologies far behind. The ClosureFAST catheter provided a much faster procedure without compromising on the favorable patient experience for which the ClosurePLUS catheter was known.

The most obvious improvement in the Closure® procedure is a long heating element that replaces the old electrode heat source of the ClosurePLUS catheter and utilizes Segmental Ablation Technology to seal the diseased vessel seven centimeters at a time. The doctor positions the catheter, the RF generator delivers 20 seconds of modulated energy to seal the vein segment, the doctor then withdraws the catheter in a segmental fashion and the process is repeated. It’s dramatically easier and more efficient for physicians, many of whom say they can treat an entire saphenous vein in two minutes – as little as one-tenth of the previous RF treatment time – and thus can treat more patients.. And the patients are dazzled by the speed and comfort of the procedure and the minimal postoperative bruising. Many return to normal activity the next day.

With clinical studies showing the ClosureFAST catheter to be 96.2% effective at the one-year mark, the new catheter is rapidly becoming a best practice for physicians and an emerging gold standard for patients seeking relief from a long-term medical problem. Some practitioners are now seeing an influx of active seniors in their 60’s and 70’s who have suffered from varicose veins for decades but were scared off by stripping or lasers. Now they’re seeing the results of ClosureFAST procedures in their middle-aged children and requesting the same treatment for themselves.

VNUS continues to innovate new solutions to the ancient problem of varicose veins – one example being the ClosureRFS™ Stylet, the only endovenous device cleared by the FDA for treating refluxing perforator veins, which are like ladder rungs between the superficial and deep veins.

With the advent of new technology and ongoing biomedical research, the future holds great promise for patients seeking new options for treating their varicose veins.

We like to think Hippocrates would approve.