Registered nurse Karen Pierce, emergency department director at Saint John's Health Center in Santa Monica, used to nurse patients recovering from painful varicose vein operations. Though her own left leg had unsightly varicose veins that would swell and ache when she had to stand for long periods, it didn't bother her enough to undergo the standard ligation and stripping procedure that often required a two-week hospitalization and days of missed work.

Pierce, 54, had developed the varicose veins over the course of her 27 years as a Saint John's emergency room nurse. Following the birth of her second child, the bluish-purple varicose veins got bigger.

"People would ask, 'What's wrong with your leg?'" recounted Pierce. She took the comments in stride, but was concerned knowing that varicose veins can predispose people to blood clots and thrombophlebitis.

Her interest was piqued when she saw an article in the Saint John's Health Center newsletter about a new, minimally invasive varicose vein procedure. Available in the U.S. for the last four years, the VNUS Closure procedure using special catheters that deliver radiofrequency energy to seal the source of varicose veins has been successfully used to treat 50,000 patients worldwide.

Pierce contacted vascular surgeon, Dr. Phillip Levin, to see if she was a candidate for VNUS Closure. He sent her for a simple noninvasive ultrasound study of her leg. The study confirmed that she was a good candidate, and she underwent the 1 1/2-hour procedure on May 11.

Procedure of choice

Dr. Levin, one of five board-certified surgeons in the Vascular Surgery Associates Medical Group, almost exclusively uses the VNUS procedure now for his varicose vein patients. Over the past two-and-a-half years, Dr. Levin and his partners have performed 180 VNUS outpatient procedures at both Saint John's and Cedars-Sinai Health Centers. They consider VNUS vastly improved over the traditional procedure where varicose veins are pulled out over a stripper device.

"The old ligation and stripping method left a lot of torn vein branches which led to more bruising," said Dr. Levin.

The VNUS Closure procedure uses ultrasound guidance to maneuver a catheter that has been inserted via a needle puncture at or below the knee. A dilute novocaine-like solution is injected around the catheter to minimize tissue trauma.

As the catheter is pulled back at approximately two centimeters per minute, the electrodes emit radiofrequency waves that create heat measuring 85 degrees centigrade (double normal body temperature) causing the vein which is responsible for the varicosities to contract and seal. Once the source of the varicose veins has been eliminated by the Closure method, the remaining varicose veins are removed with a crochet-like "venous hook" inserted into tiny, 2 millimeter incision sites on the leg.

"I like the VNUS procedure because I know exactly what the temperature and catheter resistance is at all times," said Dr. Levin. He prefers the significantly lower temperature of the VNUS radiofrequency method over the much higher temperatures used with laser procedures which can produce higher rates of bruising. According to Dr. Levin, VNUS patients have minimal bruising and are usually back at work within two or three days.

Short recovery

Within hours of her VNUS procedure at Saint John's Health Center, Pierce was home and walking with a compression bandage. She experienced only slight bruising and minimal discomfort as she walked to build up her collateral circulation. She was able to return to work two days later. Her medical insurance covered all but $2,400 of the bill.

"Before, varicose vein procedures were considered major surgery, and patients had (bandage) dressings from hip to toes. Now, it's a simple outpatient procedure," said Pierce. A fitness enthusiast who enjoys bicycling and an active lifestyle, Pierce smiled as she noted one other post-op benefit: "I look better in shorts."

For more information on the VNUS procedure, contact Vascular Surgery Associates at (310) 652-8132 or (310) 315-5765. On the Internet, log on to www.vnus.com or www.vascularsurg.com.