Dr. George Fall uses a catheter that emits radio frequencies to block a varicose vein. (Clint Austin / caustin@duluthnews.com)
Faster, cheaper alternative gains foothold in fight against varicose veins
Now the first option for many surgeons treating varicose veins, radio frequency can get blood flowing again in as little as an hour.
By: John Lundy, Duluth News Tribune, Published on Nov. 5, 2011
Dr. George Fall speaks in almost evangelical terms when it comes to using radio frequency on varicose veins.
“There’s less convalescence, there’s less pain, and the economic benefits are just unbelievable,” the Ashland-based vascular surgeon said Friday, comparing it to the traditional surgical method known as vein-stripping. “We need to get the word out.”
Fall, 52, has been in surgical practice for 18 years and estimates he has performed about 500 of the radiofrequency procedures. They’ve almost entirely replaced vein-stripping in his practice. That surgery was almost worse than the problem it treated, he said.
Varicose veins affect half of people older than 50, according to the U.S. National Library of Medicine’s MedlinePlus, and occur more often in women than in men. Commonly found in the backs of the calves or on the inside of the leg, they develop when valves in the veins that allow the blood to flow toward the heart stop working properly. The blood pools in the offending veins, causing them to grow larger.
The veins can be painful and unsightly, and in severe cases they produce skin ulcers.
The technique Fall uses is called a VNUS Closure procedure. The doctor closes diseased veins by inserting a catheter into a vein and heating the vein wall with radiofrequency. That causes the offending veins to close, and blood is naturally rerouted to healthy veins.
Vein-stripping can cost between $20,000 and $30,000, Fall said. A radiofrequency procedure costs about $8,000. Insurance companies typically cover it, but they require a three- to six-month wait to see if the condition can be treated adequately by the patient wearing specially designed compression stockings, Fall said.
The procedure is 87 percent effective through five years, Fall said.
The radiofrequency procedure is touted as “lunch break” surgery, because the patient can come to a doctor’s office during lunch, have the procedure done and return to work. But that’s only in ideal circumstances, Fall said on Friday. Complicating factors can push the time out to perhaps two hours.
That was the case for Stacy Colich of Cloquet, who underwent the procedure on Friday afternoon at the Lakewalk Surgery Center on London Road. Colich was fully awake, only her right leg and her head exposed, throughout the procedure. Soft music (including the theme from “Grey’s Anatomy”) played in the background. Colich, who is a diabetes educator at St. Luke’s hospital, was engaged from beginning to end, chatting with Fall and commenting on the sensations she observed (“pinpricks” “pressure” “vibration”).
Colich, 49, said she underwent varicose vein-stripping 17 years ago. Her varicose veins were induced by pregnancy. Fall said that’s fairly common, because of the amount of the blood that comes through the veins during pregnancy.
For Colich, the varicose veins made themselves felt with heaviness, fatigue and pain all at once, she said. The vein-stripping, a procedure that requires full anesthesia, reduced the symptoms by about 80 percent she said. The symptoms again started getting worse after eight or 10 years. But she put up with it until she happened to see a TV commercial for Lakewalk Surgical Center about the radiofrequency process.
An initial consultation, a follow-up visit and an ultrasound of Colich’s leg preceded Friday’s procedure. “Every patient has a different map, if you will, based on that dynamic ultrasound that they go through,” Fall said.
When Fall actually applied the radiofrequency to Colich’s diseased vein, it took only about 40 seconds. The vein was being heated to 120C. “They don’t like me to use the word ‘burn,’ but that’s what we’re doing,” Fall said.
When it was finished after about two hours, Fall covered the wound with tape, a bit of glue and a piece of gauze.
Afterwards, Colich had a positive assessment.
“It was actually quite easy, really minimal pain,” she said.
After her vein-stripping 17 years ago, Colich had to stay off her feet for several days, she said. After that, it was at least four weeks before she could resume normal activities.
This time around, she’ll have to spend the weekend off her feet with her feet higher than her head. On Monday, she’ll be back on the job.