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VNUS Closure Radiofrequency Ablation for Varicose veins (RFA)
If you would like to see Mr Braithwaite as a Private Patient for RFA or other varicose vein treatment, please contact him at either the Park Hospital or Nottingham Nuffield.
What is RFA ? Radiofrequency ablation is the name for a new technique to remove varicose veins. The first system to be used is made by VNUS technologies and it is known as VNUS Closure. There are other manufacturers of Radiofrequency systems. How does it work? A fine tube (catheter) is passed through the skin near the knee and then threaded up the diseased long saphenous vein. The catheter is attached to a power unit that heats up the end of the catheter. The heat seals the walls of the vein so that no blood can flow through it. The operation is normally done under general anaesthetic but can be done using local anaesthesia. How is RFA different to standard surgery? If you have varicose veins then one of the causes is normally an incompetent long saphenous vein (LSV). Research has shown that it is important to remove this vein to treat varicose veins and reduce the chance of them coming back soon. Standard surgery, frequently requires a cut in the groin to disconnect the LSV and then it is removed by a stripping device. This can cause dramatic bruising. RFA avoids the need for a cut in the groin and there is minimal bruising. This means people who have RFA can usually return to normal activity sooner than those who have standard treatment. Is RFA better than standard surgery? It is now thought that RFA is superior than traditional surgery for the treatment of patients with long saphenous varicose veins. Doctors normally want to know the results of scientific studies before they are happy that one treatment is better than another. A randomised trial of RFA and the standard technique has been done in the United States of America. Mr Braithwaite took part in this study when he was a visiting scholar to the Straub Clinic in Honolulu with Dr Robert Kistner and Dr Bo Eklof. The evolves study has shown that the degree of pain after RFA is much less than traditional surgery. In addition, people who have RFA return to normal activity much more quickly. Mr Braithwaite and his colleagues in Nottingham have completed the first stage of a study on recurrent varicose veins treated with VNUS Closure. This has shown that VNUS is better and quicker than traditional recurrent groin surgery. Longer term results are awaited. We do not know what the recurrence rates of varicose veins after RFA VNUS) are. Only time will tell. Studies from around the world show that recurrence rates are no worse than with traditional surgery. How much experience has Mr Braithwaite with RFA (VNUS)? Nottingham is the second busiest unit in the United Kingdom. Up to September 2006, Mr Braithwaite has done several hundred endovenous procedures. Results from studies by Mr Braithwaite on RFA (VNUS), have been presented at National and International meetings in the United Kingdom and United States of America. A randomised trial has been published in the European Journal of Vascular Surgery. Mr Braithwaite runs training courses for other surgeons to learn the technique. Mr Braithwaite has been asked to assess a new device for radiofrequency. For a limited period of time, he plans to offer treatment with the new device to NHS patients in Nottingham. The new system works as well as VNUS but takes a much shorter time to treat the vein. Early results have shown that it takes less than 2 minutes to treat the long saphenous vein. This compares with 15 minutes using the VNUS closure plus™ system. Is everyone with varicose veins able to have RFA? No. Some people have large, winding veins that are not suitable. Mr Braithwaite will be happy to discuss whether your veins are suitable for RFA. Mr Braithwaite's and other surgeons' research suggests that about 70% of people with varicose veins can be treated with RFA. Is RFA all I need for my veins? RFA (VNUS) will remove the major superficial veins, including the LSV and anterior thigh veins. It is, however, usually necessary to have the bulging veins around the calf removed through small cuts called avulsions. Mr Braithwaite uses a technique that along with RFA (VNUS) will result in very little scarring of the leg. What are the advantages of RFA (VNUS)? Apart from the lack of a cut in the groin, there is minimal bruising of the leg and people can return to normal activities more quickly? What is the catch? RFA (VNUS) uses special catheters that cost about £400 each. During the operation, an ultrasound machine has to be used and a technician is required to control it. The operation can take longer than the standard method. All of these things cost more so you may have to spend between £900 and £1200 more if the operation is done privately. It is not clear if NHS patients can opt to pay for RFA (VNUS) as an extra. Will my insurance company pay for RFA (VNUS)? RFA (VNUS) has been approved by the Government agency NICE. Most Insurance companies will now pay for VNUS- the code used is L8540 or L8541. Some insurance companies are not able to pay for the full cost of treatment so a supplementary fee may apply. The Nottingham vascular surgeons were the first surgeons in the United Kingdom approved by BUPA to perform VNUS. . Why do some surgeons not offer VNUS? There may be many reasons. Some surgeons may not have been trained to use VNUS. They may prefer an alternative technique like EVLA, or they may feel the operation takes longer than traditional surgery. If your surgeon does not offer a treatment that you have read about they should be able to give a reasonable explanation. The General Medical Council (GMC) has advised doctors that they should make patients aware of the various treatment options for the condition they have. Can I get VNUS on the NHS? Not yet. It is not clear if NHS patients can opt to pay for VNUS as an extra. The NHS will only pay for proven techniques that can be shown to have major advantages. Mr Braithwaite thinks that it is unlikely that VNUS will be available on the NHS in the near future. Mr Braithwaite is, however hopeful that the results of a study on VNUS in NHS patients who have recurrent varicose veins will show that it should be available to NHS patients. If you would like to have VNUS as an NHS patient then please make an enquiry to Mr Braithwaite at QMC. If there is a demand, it may be possible to arrange the introduction of VNUS to the NHS. Nothing is guaranteed and the only option may be private treatment. Are there likely to be any future problems if I have VNUS? All patients who have varicose vein surgery have a chance of wound infection, nerve injury and recurrence of the veins. The only additional risk that may occur with VNUS is the development of a cord of tissue in the thigh where the LSV has been treated. This has been seen in patients who had endoluminal diathermy, an older and less efficient method than VNUS. If the cord develops, patients feel a tightness in the thigh when they cross their legs. Are there any complications associated with VNUS? All operations carry some risks. The particular risks of VNUS are burns to the skin and possibly a slightly increased risk of Deep vein thombosis (DVT). Both of these can be avoided by the use of techniques at surgery that Mr Braithwaite will be happy to explain. Some patients who have RFA with VNUS experience an odd sensation or sensitivity in the thigh. This tends to start about 3 to 5 days after treatment. The sensation disappears in most people within a few weeks. Very rarely (1 in 200 chance) the discomfort can last longer and be more intense. This can also occur with traditional surgery and laser treatments. Are there any risks to vein surgery? Yes. Please click here to see the risks of vein surgery Can I find out more about VNUS? Yes. Click on the following: Are there any alternatives toVNUS? Varicofoam. Foam injection of varicose veins is another new technique used by Mr Braithwaite. Venocuff valve repair is a technique that Mr Braithwaite has introduced to the United Kingdom as part of a clinical trial.. EVLA. A technique using a laser to heat the blood in the long saphenous vein is available. The procedure, known as EVLA, can be performed entirely under local anaesthetic. The treatment helps with the aching of the legs associated with varicose veins but people still need to have the lumpy veins in the area of the calf removed. This can be by injection or removal under local anaesthesia. For a summary of options to help choose your treatment, click here.
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