What is Ultrasound Guided Radiofrequency?
Ultrasound Guided Radiofrequency is where thermal energy generated by a Radiofrequency machine is used to treat Varicose Veins below the surface of the skin. To treat Varicose Veins under the skin requires an Ultrasound to visualise the Varicose Veins so the treating doctor is able to accurately place the catheter needed to deliver the Radiofrequency energy.
What is the VENEFIT procedure?
The term VENEFIT procedure is the name commonly given to the Ultrasound Guided treatment of Varicose Veins by Radiofrequency. VENEFIT is the tradename of the Radiofrequency machine used for the treatment of Varicose Veins. The procedure is sometimes still referred to as the VNUS treatment as this was the name first used by COVIDIEN which is the company that manufactures the Radiofrequency machine.
What is CLOSURE FAST?
The name CLOSURE FAST refers to the special catheter that is used in the VENEFIT procedure and is really just a marketing term used to promote the speed and ease of the Ultrasound Guided Radiofrequency procedure.
How established is the VENEFIT procedure?
Since 1998 over 500 000 VENEFIT procedures have been performed worldwide.
In the UK it is an approved procedure with the National Institute for Health and Clinical Excellence (NICE). In the USA Radiofrequency Closure treatment is one of the most popular nonsurgical techniques for the treatment of Varicose Veins.
When is VENEFIT used to treat Leg Veins?
The VENEFIT is used to treat deeper and larger Varicose Veins that years ago would have been treated by surgical stripping. The VENEFIT is used to target the main drainage veins from either the groin or from the back of the knee. The VENEFIT is not usually used to treat Varicose Veins that have recurred after past Varicose Vein surgery and these Varicose Veins are usually best treated by Ultrasound Guided Sclerotherapy. The VENEFIT is not used to treat superficial and Spider Veins and these Leg Veins are usually treated best by Surface Sclerotherapy.
How is VENEFIT different from Vein Surgery?
During surgical vein stripping, incisions are made in the groin and calf, and a stripper tool is threaded through the vein, to pull the vein out of the leg. With the VENEFIT procedure, only one tiny incision is made at the insertion site and the Varicose Vein is then closed and left in place. This minimally invasive approach eliminates the pain and bruising associated with vein stripping surgery. Surgical Stripping requires admission to hospital, General Anaesthesia and a prolonged recovery period of several weeks until return to full activities. VENEFIT can be performed in a Leg Vein Clinic with only local anaesthetic and immediate return to activity.
How does VENEFIT work?
The VENEFIT machine produces heat through Radiofrequency (RF) energy from a very high frequency alternating current, in the million of cycles per second called Mega Hertz. The Radiofrequency heat is delivered through a fine probe that heats the inside of a Varicose Vein wall. If sufficient heat is applied to the inside of a Varicose Vein the collagen in the Vein wall contracts and the Varicose Vein collapses. By progressively applying radiofrequency heat along the length of a Varicose Vein the entire Varicose Vein can be closed off. The Varicose Vein that has been closed off becomes fibrous and is eventually absorbed into the surrounding tissue and completely disappears.
What are the advantages of VENEFIT?
Compared to Surgery Stripping the VENEFIT procedure has the advantages of the convenience of being performed in a Leg Vein Clinic rather than requiring hospital admission, no general anaesthesia, rapid return to normal activity, including walking, driving and work, and fewer complications such as scarring, wound infections and Deep Vein Thrombosis. Importantly studies demonstrate very good long term results when compared with Surgical Stripping.
Compared to Ultrasound Guided Sclerotherapy the VENEFIT procedure has the advantage of being more effective on more severe Varicose Veins. Ultrasound Guided Sclerotherapy is often used in combination with VENEFIT as a follow up procedure for any residual branch Varicose Veins.
Compared to Ultrasound Guided Laser treatment the choice of VENEFIT often comes down to the preference and experience of the doctor performing the procedure. Both treatments target the more severe Varicose Veins and have similar costs and out of pocket expenses with the same Medicare rebate. The VENEFIT does seem to have some advantages in the first 2 weeks after treatment with less pain and bruising and less risk of nerve damage but the long term recurrence rates for both procedures are very similar.
How quickly can normal activity be resumed?
Patients are walking immediately following the VENEFIT procedure, and typically resume normal activities and work within one day.
Where is the treatment done?
The VENEFIT procedure does not require admission to hospital and can be performed on a walk in walk out basis in our Leg Vein clinic rooms. VENEFIT has become increasingly popular as an alternative to Surgical Stripping operations because of no need for hospitalisation, no need for general anaesthesia, and immediate return to normal activity.
How is the VENEFIT procedure done?
A small local anaesthetic injection is made at the knee or ankle, depending on which Varicose Vein is being treated. A small puncture wound (~4mm) is made and then a tiny catheter, which carries the ClosureFast Radiofrequency fibre, is passed through the skin into the Varicose Vein. Using a special Duplex Ultrasound Scanner for guidance the tip of the Radiofrequency fibre is precisely positioned in the Varicose Vein. Heat is delivered from the Radiofrequency machine through the fibre to heat up and collapse the Varicose Vein. By slowly withdrawing the catheter the full length of the Varicose Vein can be destroyed segment by segment.
The VENEFIT procedure can take about 1-2 hours depending on if one or more Varicose Veins are being treated.
Is the VENEFIT procedure painful?
Local anesthesia is used and patients typically report feeling little, if any, pain during and after the procedure.
Are there any requirements before VENEFIT?
All treatments are performed on an outpatient basis in our Leg Vein Clinic and there is no specific preparation required before treatment. We do recommend not shaving or waxing the legs in the 24 hours before any Leg Vein treatment including VENEFIT. We do recommend wearing loose fitting clothing and comfortable footwear as patients need to be able to wear compression stockings after treatment and be ready to walk for at least 30 minutes after treatment. We advise not applying any leg moisturiser on the day of treatment as some small dressings may need to be applied to the skin. Patients can elect to bring shorts to wear during the procedure.
What needs to be done after VENEFIT treatment?
Walking after VENEFIT is very important to stimulate blood flow through the deep veins and reduce any risk of Deep Vein Thrombosis. The usual recommendation is a 30 minute walk immediately after treatment and at least 30minutes daily for two weeks. Usual daytime activities can be resumed immediately after treatment.
It is advised to avoid strenuous physical activity such as running and gym workouts, including both cardio and weights, for one week after treatment. It is also advised to avoid standing still or sitting for long periods. Long hot baths, saunas and spas should be avoided in the first week after VENEFIT but there is no restriction on sun exposure.
It is the general recommendation that any air travel should be avoided for 2 weeks after VENEFIT and long haul flights (over 4 hours) should be avoided for 4 weeks after VENEFIT to reduce any added risk of a Deep Vein Thrombosis. If a plane flight is unavoidable then cover with a blood thinning injection (eg Clexane) may be advised. The precise advice for airplane travel after VENEFIT does vary depending on the severity of the Varicose Veins being treated and if there are any other risk factors for Deep Vein Thrombosis.
Compression stockings are usually advised to be worn after VENEFIT continuously for 7 days and then for a further 7 days during the day only. It is routine to perform a follow up Ultrasound scan after VENEFIT.
What if veins are needed for bypass surgery in the future?
The VENEFIT procedure treats diseased Varicose Veins only. Varicose veins that are treated by VENEFIT are not appropriate for cardiac bypass surgery. Cardiac Surgeons can use other healthy veins and arteries should bypass surgery be necessary in the future.
How soon will Varicose Vein symptoms improve?
Many patients notice an immediate relief of symptoms such as pain, leg heaviness and fatigue. The full benefits of the procedure may take 1-2 weeks.
Is there any scarring, bruising or swelling, after the procedure?
Patients report minimal to no scarring, bruising, or swelling following the VENEFIT procedure.
Is the VENEFIT procedure done during pregnancy?
Elective procedures such as the VENEFIT are avoided during pregnancy and generally not performed until after breast feeding is completed. If Varicose Veins are causing significant symptoms during pregnancy these are best managed by appropriate compression hosiery.
How many VENEFIT treatments are needed?
A single VENEFIT procedure is used to target the main Varicose Veins and in the same treatment session both legs can be treated. Follow up treatments to remove branch Varicose Veins by Ultrasound Guided Injections and Spider veins by Surface Injections is often necessary after VENEFIT.
It is not uncommon for patients to develop further new Varicose Veins and Spider Veins after any Leg Vein treatment including VENEFIT. If there is a genetic tendency to develop Leg Veins in the first instance there will still be a tendency to develop more Leg Veins in the future. Also the tendency to develop Leg Veins increases as patients get older. Fortunately, it is in only a small percentage of patients that a repeat VENEFIT procedure might be necessary, and most new Varicose Veins and Spider Veins that develop after VENEFIT can be managed be either Ultrasound Guided Sclerotherapy or Surface Sclerotherapy.
What are the costs of VENEFIT?
The cost of the Mapping Scan that needs to be performed before the VENEFIT procedure qualifies for a Medicare rebate, with the out of pocket expense to the patient of about $160. The Mapping Scan is performed in our Leg Vein Clinic by the Vascular specialist who performs the VENEFIT procedure and not by a Radiographer at an outside Ultrasound clinic.
The VENEFIT procedure, as is the case with the Ultrasound Guided Laser procedure, is more expensive than injection based Varicose Vein procedures because of the additional time and costs of the single use catheters and equipment that need to be used. Private Health Insurance does not cover out of Hospital procedures such as the VENEFIT. The VENEFIT procedure does qualify for a Medicare rebate and as a medical procedure with a Medicare rebate GST is not applicable. The Medicare Safety Net can apply when out of pocket medical expenses exceed a certain threshold, however Medicare has placed a cap on the out of pocket expenses for Varicose Vein treatments that can contribute to the Medicare Safety Net. In some circumstances an income tax rebate can be claimed for out of pocket health expenses exceeding a certain threshold but this varies with individual circumstances and would need an Accountants advice.
The cost of VENEFIT does vary according to whether one or two legs are being treated but expect the out of pocket expense to be around $2500 for VENEFIT treatment on one leg and $4500 for VENEFIT treatment if both legs are treated.