Anastasia Medical Group

Center for Advanced Vein Care - North Florida


Good Morning America - Diane Sawyer interview with Dr. Mark Adelman and his Closure® patient

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The treatment of venous insufficiency requires the detection and eradication of superficial veins that are the location of venous reflux. Venous reflux is present in varicose veins, and may be observed in the great saphenous vein or the short saphenous vein.

Perforator veins pass through the deep fascia to connect the superficial venous system to the deep system. Healthy perforator veins allow the superficial veins to drain into the deep veins; the valves in the perforator veins prevent blood from flowing backward out of the deep veins into the superficial veins.

When perforator veins become incompetent, the valves fail to function properly, allowing a back flow of blood from the higher-pressure deep vein into the superficial veins. This may cause a blow out in the superficial system and lead to the development of varicose veins, skin changes around the ankle or leg ulcers.

P's in the figure below are the potential sites of some but not all perforators in the lower extremity.

Prior to treatment with the ClosureRFS device, the patient’s leg is scanned to verify the location, size and shape of the perforator to be treated.


The design of the ClosureRFS device allows for treatment of incompetent perforators under ultrasound guidance. Treatment of incompetent perforators can be either the primary procedure or an adjunctive procedure to treatment of superficial venous reflux with the VNUS ClosureFAST or ClosurePLUS catheter.

The VNUS Closure procedure has become a useful alternative method for the treatment of varicose veins. Vein Closure can usually be used to treat those patients who would have previously been treated by vein stripping. Closure of the greater saphenous vein is the minimally invasive alternative to vein stripping. Instead of stripping the vein, the Closure device seals the vein shut.

Vein Closure is not a procedure for every varicose vein or every patient with varicose veins. Phlebologists use the Closure procedure most often to close suitable great saphenous veins. The use of the Closure process has now been extended to treat several other veins such as anatomically suitable short (lesser) saphenous veins, anterior accessory saphenous veins, and some perforator veins. Usually the GSV cannot be seen with the naked eye by simply looking at the leg of a patient with varicose veins. Often it is the source of many of the varicosities in the affected leg. Its location and the role it plays in varicose vein formation can be shown with ultrasound examinations. The greater saphenous vein is located on the inside of the thigh. The vein starts at the groin and goes down the inside of the thigh and leg to the ankle.

The following illustration shows how the VNUS Closure procedure using the ClosureFAST™ Catheter closes the greater saphenous vein (GSV). The GSV runs from the groin to the ankle. Electrical energy is applied to the catheter electrode in order to heat the vein wall and shrink the vein closed. The VNUS catheter is placed inside of the greater saphenous vein usually below the knee. Since the vein cannot be seen by the naked eye, it is entered under ultrasound guidance or with a small incision.

The following drawings depict the manner in which the new and improved ClosureFAST™ Catheter is used.

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