Sat08302014

Your Health

Varicose veins: Closure procedure removes enlarged vessels in minutes

Photo Photo By Eren Gknar/Special To The Town Crier Image Courtesy Of Vnus Dr. Hardeep Ahluwalia, above, performs the Closure procedure, inset, on a patient's varicose veins.

You don’t have to be vain to want varicose veins removed.

While they may look ugly, the twisted and bulging veins cause more than just cosmetic problems. These enlarged or swollen blood vessels occur mostly in the legs, causing heaviness, burning and pressure, not unlike the sensation of having a blood-pressure cuff on one’s arm.

For that reason, Medicare, TriCare and Veterans Administration military health plans all cover a minimally invasive treatment that heats, shrinks and seals the vein in minutes. A boon for older patients who won’t have to undergo general anesthesia, the Closure procedure targets venous reflux disease, which causes varicose veins.

It’s a painful condition that produces swelling, pain and disfigurement in 25 million Americans, predominantly women and seniors. According to the Mayo Clinic, potential complications of venous reflux disease include ulcers caused by blood building up over a long period of time and thrombophlebitis, blood clots deep within the veins.

“In the summer, my veins burned like a fire,” said 82-year-old Ruth Barnes, a Los Altos resident who sought treatment from El Camino Hospital’s Dr. Hardeep Ahluwalia, medical director of vascular and endovascular surgery.

This was the second time Ahluwalia used the procedure on Barnes’ legs.

“There were large, big ropey veins and ... fluid overload,” said Ahluwalia of Barnes’ condition.

While vacationing with her husband in Lake Tahoe in August, Barnes experienced typical symptoms like pressure, heaviness and fiery discomfort in her legs. She made an appointment to have her veins treated.

“My feet were so swollen,” she said.

Barnes was talkative and cheerful before undergoing the procedure – called “The Lunch Break Surgery” because it’s so speedy. Her only sedation was a 5 mg Valium, and she said she experienced little discomfort – except for slight pressure – during the 15-minute outpatient operation.

Years ago, Barnes underwent an old-fashioned and gruesome procedure at Stanford Hospital: vein stripping. With the patient under general anesthesia, using a stripping tool, the doctor makes cuts in the groin and calf, then pulls the vein out of the leg, often causing scarring and bruising.

According to Ahluwalia, physicians not directly involved in vascular specialties may not be aware that vein stripping is now obsolete. He said he’s also concerned about “fly-by-night operations that can’t use the technology appropriately and fall back instead on vein stripping using general anesthesia.” Older patients can be knocked out of commission for days.

 

Relief in just minutes

Ahluwalia is in the vanguard of doctors offering the Closure procedure, which allows patients to return to normal within minutes and resume their routines with no downtime.

“Everyone will tolerate this procedure better than classic open operations that require big incisions,” said Ahluwalia, who has removed varicose veins via the technique for six years.

A graduate of New York University, he earned his medical degree from Ross University School of Medicine in the West Indies and finished his postgraduate work at UCLA. He then did a fellowship at Duke University in vascular surgery, working with prominent phlebotomists.

Ahluwalia said he performs more than 20 such procedures a month at his El Camino offices in Los Gatos and Mountain View, with so much demand that there’s a long waiting list. Most insurance plans pay for the operation, which costs approximately $2,000.

During Barnes’ procedure, Ahluwalia first made a barely noticeable incision in her leg, which had been numbed by lidocaine, a local anesthetic. Barnes remained awake the entire time, saying she felt giddy.

The technique uses ultrasound to help the physician find the troublesome vein. Then, the doctor inserts a tiny catheter, trademarked by San Jose’s VNUS Medical Technologies, into the diseased vein.

In Barnes’ case, Ahluwalia found the enlarged vein, a small saphenous vein, located close to the surface of the skin. Other veins, like the femoral, run deeper in the leg. Ahluwalia heated the vein using radio-frequency energy, causing the vein’s wall to shrink and collapse. He then removed the catheter, closing the vein.

 

What causes varicose veins?

Healthy veins have valves that open and shut to help the blood flow to the heart. Venous reflux disease – varicose veins – occurs when the valves that keep the blood flowing become damaged. When the valves don’t close as they should, symptoms like pain, swollen legs, heaviness and fatigue occur. The disease can cause skin ulcers and worsens if left untreated.

Factors contributing to varicose veins include obesity, multiple pregnancies, age, gender and family history. Those who stand for long periods on the job also put too much pressure on their legs, causing veins to swell.

Among the contributors for Barnes: she used to be diabetic and was much heavier, she gave birth to three daughters and her mother suffered from varicose veins.

Post-surgery, Barnes sat straight up on the table.

“I feel fine, like I’m happy,” she said. “I would recommend this operation, and (Ahluwalia) is a fabulous doctor.”

Instructed not to drive herself home, Barnes headed for the hospital cafeteria for lunch before getting picked up. Ahluwalia noted that patients are welcome to stay for a bite to eat.

“They’re not restricted in their activities,” he said, and can even shower normally.

For more information, call (650) 962-4690.
 

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