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Phlebologie 2010; 39(02): 61-68
DOI: 10.1055/s-0037-1622298
Original article
Schattauer GmbH

VNUS Closure radiofrequency ablation of varicose veins

From Closure PLUS to Closure FASTEntwicklung der VNUS-Radiofrequenzkatheter-Therapie in der Behandlung der Varikose
J. Alm
1   Gefäßabteilung am Dermatologikum Hamburg
,
J. Böhme
1   Gefäßabteilung am Dermatologikum Hamburg
,
M. Kensy
1   Gefäßabteilung am Dermatologikum Hamburg
› Author Affiliations
Further Information

Publication History

Received: 22 February 2010

accepted: 22 February 2010

Publication Date:
04 January 2018 (online)

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Summary

Endovenous procedures are increasingly being used to eliminate epifascial variose veins. The radiofrequency therapies VNUS Closure and VNUS Closure FAST Catheter have established themselves and boast very good results compared to other endovenous procedures with regard to closure rates and postoperative quality of life. Equipment and method: Between February 2005 and December 2009, a total of 2413 patients comprising 3366 great and small saphenous veins were operated upon at the Vascular and Venous Diseases Department of DERMATOLOGIKUM HAMBURG. 2241 great and small saphenous veins were treated with the VNUS Closure FAST catheter, 1125 great and small saphenous veins were treated with the Closure PLUS catheter system. Additionally, 264 recurrent varicose veins were treated with the Closure FAST system. Ultrasound examinations were conducted 7 days after the treatment, again 6 weeks after the treatment, and at the follow-up examination one year after treatment. Any recanalisations were treated immediately. Between January 2007 and January 2009, 57 patients were also treated for perforant veins between stages C-4 and C-6. Gender and age distributions, as well as CEAP classifications corresponded to standard distributions. Compression stockings were only administered in the case of advanced chronic venous insufficiency (C-4 to C-6). The patients were anticoagulated before treatment by means of a low molecular weight heparin as a single shot prophylactic. Anticoagulation through thrombocyte aggregation inhibitors or dicumarin was continued. Results: 1089 great and small saphenous veins were examined after removal with Closure PLUS radiofrequency therapy. The primary closure rate after 6 weeks was 98.9%; after one year, 91.2%; after two years 99.0%; after three years, 98.2%; and after four years, 100%. 2241 great and small saphenous veins were treated with the VNUS Closure FAST Radiofrequency System. 2096 great and small saphenous veins were examined after treatment. The primary closure rate after 7 days was 99.7%; after 6 weeks, 99.6%; after one year, 98.8%; and after two years, 100%. The rate of minor complications after Closure FAST Radiofrequency catheter treatment of the great saphenous vein was 5.3%; after treatment of the small saphenous vein, 5.9% in total. No major complications – such as deep vein thromboses or pulmonary embolisms – were caused, and neither was burning of the skin. The closure rate one week after RFS treatment was 84.6%; after 6 weeks, 86.2%; and after one year, 78.3%. In all of the recurring varicose veins, the recirculation was successfully eliminated. Conclusion: The VNUS Closure FAST Radiofrequency catheter represents a standardised, established procedure for treating epifascial varicose veins to ensure the certain elimination of recirculation. The development of Closure PLUS 6-French and 8-French catheter into Closure FAST Radiofrequency catheter has led not only to a reduced operation duration but also a safe and high closure rate after follow-up. With the new concept of segmental ablation the Closure FAST system eliminates the catheter pullback variability and standardises and simplifies the procedure. The success of the treatment is shown by the complete decomposition of the vein underneath the inflow of the superficial epigastric vein or the inflow of the gastrocnemic veins. However, the long term results for the Closure FAST system are awaited eagerly. The current high closure rates and high patient satisfaction rates give us cause to look ahead with hope.

Zusammenfassung

Für die Ausschaltung der epifaszialen Varikose werden zunehmend endovenöse Verfahren eingesetzt. Besonders die Radiofrequenztherapie VNUS Closure und der VNUS-Closure-FAST-Katheter haben sich in der Behandlung etabliert und weisen im Vergleich zu anderen endovenösen Verfahren sehr gute Ergebnisse hinsichtlich Verschlussrate und postoperativer Lebensqualität auf. Material und Methode: In unserer Gefäßabteilung wurden von Februar 2005 bis Dezember 2009 insgesamt 2413 Patienten an 3366 Stammvenen operiert. 2241 Stammvenen wurden mit dem VNUS-Closure-FAST-Katheter behandelt, 1125 Stammvenen mit dem Closure-PLUS-Kathetersystem. Zusätzlich erfolgte die Behandlung von 264 Rezidivvarikosen mit dem Closure-FAST-System. Ultraschalluntersuchungen erfolgten nach sieben Tagen, sechs Wochen und im Jahres-Follow-up. Rekanalisierungen wurden umgehend nachbehandelt. Von Januar 2007 bis Januar 2009 wurden 57 Patienten zusätzlich an 78 Perforansvenen (Stadium C-4 bis C-6) behandelt. Die Geschlechts- und Altersverteilung sowie die CEAP-Einteilung entsprachen den Standardverteilungen. Kompressionsstrümpfe wurden nur bei weit fortgeschrittener chronisch-venöser Insuffizienz (C-4 bis C-6) verordnet. Antikoaguliert wurden die Patienten präoperativ mit niedermolekularem Heparin (Single-shot-Prophylaxe). Eine Antikoagulation unter Thrombozytenaggregationshemmern oder Dicumarin wurde beibehalten. Ergebnisse: 1089 Stammvenen konnten nach Closure-PLUS-Radiofrequenzablation nachuntersucht werden. Die primäre Verschlussrate betrug nach sechs Wochen 98,9%, nach einem Jahr 91,2%, nach zwei Jahren 99,0%, nach drei Jahren 98,2% und nach vier Jahren 100%. Mit dem VNUS-Closure-FAST-Radiofrequenzkathetersystem wurden 2241 Stammvenen behandelt. 2096 Stammvenen konnten nachuntersucht werden. Die primäre Verschluss rate lag nach sieben Tagen bei 99,7%, nach sechs Wochen bei 99,6%, nach einem Jahr bei 98,8%, nach zwei Jahren bei 100%. Die Minor- Komplikationsrate nach Closure-FAST-Radiofrequenzkatheter-Behandlung der Vena saphena magna lag bei 5,3%, nach Venasaphena-parva-Behandlung bei insgesamt 5,9%. Mayor-Komplikationen wie tiefe Venenthrombosen oder Lungenembolien wurden nicht induziert, auch keine Hautverbrennungen. Die Verschlussrate nach RFS-Behandlung betrug nach einer Woche 84,6%, nach sechs Wochen 86,2%, nach einem Jahr 78,3%. Bei allen behandelten Rezidivvarikosen konnte der Rezirkulationskreislauf erfolgreich ausgeschaltet werden. Schlussfolgerung: Mit dem VNUS-Closure-FAST-Radio frequenzkatheter besteht ein standardisiertes, etabliertes Verfahren zur Behandlung der epifaszialen Varikose zur sicheren Ausschaltung des Rezirkulationskreislaufes. Die Weiterentwicklung vom Closure-PLUS-6- und -8-French-Katheter zum Closure-FAST-Radiofrequenzkatheter hat neben der deutlich verkürzten Operationszeit zu sicheren und hohen Verschlussraten im Follow-up geführt. Der Behandlungserfolg wird durch den kompletten Abbau der Stammvene unterhalb des Zustromes der Vena epigastrica superficialis bzw. des Einstroms der gastroknemischen Venen dokumentiert.

Keywords

Radiofrequency segmental thermal ablation - varicose veins - endovenous procedure - VNUS Closure FAST

Schlüsselwörter

Endovenöse Radiofrequenztherapie - VNUS Closure FAST - epifasziale Varikose
 

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