The Closure Procedure

by Jonathan Calure, M.D.

The Closure procedure is performed on an outpatient basis using local anesthesia, which numbs the leg before treatment. It is performed in our state of the art surgicenter devoted exclusively to vein care. The Closure procedure consists of four principal steps.

Map the Saphenous Vein. A typical Closure procedure begins with noninvasive ultrasound imaging of the varicose vein to trace its location. This allows us to determine the site where the Closure catheter will be inserted and to mark the desired position of the catheter tip to begin treatment.

Insert the Closure Catheter. After Dr. Calure accesses the saphenous vein, the Closure catheter is inserted into the vein and advanced to the uppermost segment of the vein. We then typically inject a volume of dilute anesthetic fluid into the area surrounding the vein. This numbs the leg, helps squeeze blood out of the vein and provides a fluid layer outside the vein to protect surrounding tissue from heat once the catheter starts delivering RF energy. Saline is then slowly infused into the vein from the tip of the catheter to further create a near-bloodless field inside the vein, allowing the catheter to preferentially heat the vein wall, rather than the blood.

Deliver RF Energy and Withdraw Catheter. Noninvasive ultrasound is used to confirm the Closure catheter tip position and Dr. Calure then activates the RF generator, causing the electrodes at the tip of the catheter to heat the vein wall to a target temperature of typically 85 degrees Centigrade or 185 degrees Fahrenheit. As the vein wall is heated, the vein shrinks and the catheter is gradually withdrawn. During catheter pullback, which typically occurs in 2 minutes, the RF generator regularly adjusts the power level to maintain target temperature to effectively shrink collagen in the vein wall and close the vein over an extended length.

Confirm Closing of Vein. After treatment, ultrasound imaging is used to confirm closing of the vein. If a portion of the vein is not closed, the catheter can be reinserted and energy reapplied. After the procedure, the narrowed vein gradually becomes fibrous, sealing the interior of the vein walls and naturally redirecting blood flow to healthy veins. The Closure procedure is performed in about 2 minutes.

98% of patients who have undergone the Closure procedure are willing to recommend the varicose vein treatment to a friend or family member.

We generally instruct our patients to walk regularly for several days after the Closure procedure and return within 72 hours for an ultrasound examination. Compression stockings are to be worn for 14 days after the procedure. Compression stockings are prescribed as a routine item for varicose vein procedures with the goal of enhancing patient comfort in the initial days after treatment.