A decade ago, getting rid of varicose veins meant general anesthesia and surgery, typically followed by pain, bruising, and a weeks-long recovery. The latest technology, cleared near the end of 2006 by the Food and Drug Administration, uses heat to deflate the problematic veins in less than five minutes.
"So far, [my] success rate has been 100 percent," says Phillip Levin, a vascular surgeon at Cedars-Sinai Medical Center who has treated approximately 50 people with the new device. "It's pretty much a cure," agrees Jennifer Heller, a vascular surgeon at the Johns Hopkins Vein Center. (Neither doctor has financial ties to the manufacturer.) Varicose veins form when valves in major leg vessels, which normally flush blood upward toward the heart, malfunction and allow blood to spill backward and pool in branches below. The dysfunction can lead to throbbing and chronic pain.
"I lost a quarter inch off my calf," says Levin's patient Deborah Heine, 36, of Santa Monica, Calif., who opted for the new method after putting off treatment for years, fearful of surgery. Doctors thread a tiny catheter into the vein with ultrasound guidance, then zap the walls with radio-frequency heat so the vein is "cooked from the inside out," as Levin puts it. Like a deflating balloon, the walls collapse and seal shut, and blood is rerouted to healthy veins. The patient is awake throughout, and discomfort is minimized by local anesthesia. Radio-frequency treatment itself isn't brand new, but an earlier device was slower and didn't get as hot. A similar technology, FDA approved since 2002, uses laser energy rather than radio-frequency heat to effectively shrink the veins.
Though experts debate which of the nonsurgical techniques is best, one study has found that patients treated with laser were 33 percent more likely to have pain—and 50 percent more likely to require drugs to manage post-procedural pain—than people treated with these radio-frequency catheters. "We're seeing less pain and less bruising with radio frequency than with laser," says vascular surgeon Jose Almeida of the Miami Vein Center, who headed the trial. He uses both technologies in his practice. Still, some specialists are swayed by their satisfaction with laser: "We have a six-year track record showing a 97 percent success rate," says Neil Khilnani of Weill Cornell Vascular, "and a very low rate of side effects." Any pain is treated with over-the-counter medications.
As with any vein treatment, complications can arise. Doctors worry most about blood clots, a "realistic risk," Levin says. A clot can be treated with blood thinners, but if unrecognized, it can migrate to the heart or lungs and cause death. In August, VNUS Medical Technologies, the manufacturer of the radio-frequency device, sent a letter to all users revising its instructions in response to a low but noticeable trend in blood clots. Burning and tingling can also occur, but Levin says these effects are rare.
Once the leaking vein has been sealed off, protruding veins fed by the leak do tend to shrink but won't always disappear. Some specialists, including Levin, usually remove the bulging veins after nuking the main vein, by inserting hooked tools through tiny needle holes in the skin.
Sometimes, a heat-sealed vein reopens to fail yet again. But preliminary data from a 13-center international study suggest that such failures with these second-wave radio-frequency catheters are rare and that veins are still shut a year later in about 96 percent of the cases. And anecdotally, both doctors and patients are pleased. Says Heine: "I tell anyone who has these not to put off treatment. Literally, the next day, it was like a miracle."