Seeking Closure

Painful, debilitating: varicose veins. For better treatment, turn up the heat.



Jeffrey Petersen, MD

Nearly 25 million people in the United States suffer complications of prolonged venous reflux.




“There is little, if any, pain with the closure procedure — most patients don’t require oral sedation for relaxation. They can get up and walk out of the office after the procedure.”



SINCE HER EARLY 20s , Donna Kurowski has battled pain, swelling and pressure in her legs from varicose veins — tortuous, twisted and painful veins with poorly functioning valves.

As a staff nurse at the university’s Pain Management Center, Kurowski actively works with chronic pain patients. She also has a 10-year-old son who keeps her busy. Although prolonged standing would trigger intense pressure and pain, Kurowski never let the condition interfere with life.

“I didn’t let it limit my activities,” she says. “I learned to make adjustments and find ways to elevate or reposition my legs. Or, I’d just deal with the pain.”

Jeffrey Petersen, MD, assistant professor of medicine, wanted to help Kurowski improve her quality of life and suggested that she undergo the VNUS closure procedure to treat her varicose veins.

The innovative procedure is a minimally invasive treatment for a condition called superficial venous reflux, which causes pain, swelling and varicose veins.

Jeffrey Petersen, MD, performs the VNUS closure procedure at Washington University’s Center for Dermatlogic and Cosmetic Surgery.

The condition can be precipitated by genetics, age, pregnancy, traumatic injury and can occur in people with professions — nurses, chefs, waitresses, hair stylists — that require prolonged standing.

The NIH estimates that nearly 25 million people in the United States suffer from complications of prolonged venous reflux. Studies reveal that 41 percent of American women may have varicose vein disease by the time they reach their 40s and 50s.

Symptoms include pain, fullness, heaviness, aching, visibly enlarged veins, swelling, skin discoloration and ulcers around the ankles.

Normally, veins carry blood from the extremities toward the heart. In varicose veins, the blood flows backward, resulting in pooling of impure and acidic blood that contributes to multiple medical pathologies.

“People mistakenly think the procedure is cosmetic, but many patients are very unhappy due to the pain and discomfort,” says Petersen, who now performs about 20 closure procedures monthly. “Patients often don’t realize it’s a medical condition that’s usually covered by insurance.”

The VNUS procedure uses radiofrequency or laser heat placed directly into the wall of the saphenous vein, which runs from the ankle to the groin. Over time, faulty valves in the saphenous vein can result in unattractive, bulging and painful varicose veins. The radiofrequency or heat causes the vein wall to collapse, cutting off the source of blood.

The VNUS procedure became available in the United States in 1999 as an alternative to traditional vein stripping, the surgical removal of veins from the leg. Vein stripping usually requires general anesthesia, an extended hospital stay and a long recovery, and it causes significant swelling, bruising and pain.

Kurowski had vein-stripping surgery in 2001. “Recovery from the procedure was really painful, and I was very bruised,” she says. “By nighttime I was exhausted from the pain and pressure, and I couldn’t go back to work for two weeks.”

Last year, a study in the Journal of Vascular Surgery compared vein stripping and the VNUS closure procedure by evaluating procedure-related complications, overall patient recuperation and quality-of-life issues. In every measurable category, patients who underwent the closure procedure had better outcomes.

A fan-shaped catheter delivers radiofrequency energy to the vein wall durIng the minimally invasive VNUS closure procedure.

“There’s a dramatic difference,” Kurowski says. “A week after the closure procedure most of my bruising was gone, and the pain and pressure in my leg was considerably better.”

Petersen says that European studies have shown that more than 91 percent of legs treated with the VNUS procedure were free of venous reflux, the underlying cause of varicose veins, two years later.

“There is little, if any, pain with the closure procedure — most patients don’t require oral sedation for relaxation,” he says. “They can get up and walk out of the office after the procedure.”

Petersen performs the closure procedure at Washington University’s Center for Dermatologic and Cosmetic Surgery in West County.

During the procedure, a mixture of intravenous saline solution, lidocaine (a local anesthetic) and epinephrine (a drug that contracts blood vessels) helps reduce blood loss and postoperative bruising while providing anesthesia. First, Petersen inserts a thin catheter in the damaged vein through a small incision. Using an ultrasonic guide, the catheter is manipulated up the vein, and radiofrequency energy is delivered to the vein wall, causing it to heat, collapse and seal shut.

Once the diseased vein is closed, healthy veins take over, and normal blood flow returns to the leg, allowing the swelling, pain and discoloration to noticeably improve.

After the procedure, a compression garment is worn for several weeks to aid healing. Patients can resume normal activities in one to two days but must refrain from strenuous activities, prolonged standing and heavy lifting for a few weeks.

Just days after her procedure, Kurowski felt considerably less pressure and pain in her leg. And while she didn’t undergo the closure procedure for cosmetic reasons, she was certainly happy to see bulgy veins and pigment discoloration disappear.

The solution has legs: VNUS procedure works for varicose veins and ulcers

In addition to eliminating unsightly and painful varicose veins, the VNUS procedure provides relief for venous leg ulcers, painful lesions that result from varicose veins and can cause eczema, other inflamed skin conditions and permanent scarring.

Standard treatment for leg ulcers is compression bandaging combined with anti-bacterial dressings over a period of 12 to 24 weeks. However, many patients fail to respond and end up undergoing multiple costly therapies in an attempt to alleviate symptoms.

Petersen is researching the use of the VNUS procedure to treat both ulcers around the ankles and venous changes to the leg. The study aims to stop those changes from occurring and to decrease the frequency of ulceration.

Petersen’s research reveals that patients who receive the closure procedure for ulcers experience an 80 to 90 percent reduction in ulcerations.

Before and during the procedure, ulcer patients wear a device called an Unna boot which presses on the skin and helps keep the wound closed.

“Many of these patients have dealt with chronic leg ulcers for five to 10 years and are very unhappy,” Petersen says. “We can resolve this condition with VNUS closure, and many times patients will not need to see a physician for further treatment, which makes it very rewarding.”