MCMC: Vein stripping procedure


Two days after getting a relatively new treatment for varicose veins, Jill Durow of The Dalles was back walking the golf course. A week later, she was swinging the clubs. Two months out, she was actively hiking the red rock country around Sedona, Ariz.

Durow, 51, owed her quick recovery to a vein closure technique called radiofrequency ablation, the latest treatment advance away from invasive incisions and stripping of problem veins.

“That was an absolutely brutal procedure, for patient and doctor alike,” says Dr. Jeff Mathison, Durow’s physician and one of four at Mid-Columbia Surgical Specialists.

“It was painful. It sometimes took a month to six weeks to get 75 percent recovery. It was more risky – you could get infections, deep blood clots. And it wasn’t foolproof. People still developed varicose veins later on.”

Vein swelling (varicose veins), bleeding beneath the skin, pain and even open ulcers can result from failure of valves in veins, the vessels that return blood to the heart. When the valves don’t do their job, some of the blood can flow backward, what’s known as “venus reflux.” As pressure builds, veins bulge and sometimes break.

Treatments have varied over the years, depending on the severity of the problem. For seriously varicose veins, surgeons would cut into the leg, hook the vein and pull it out. Not fun. Plus which, it was complicated – and costly. It required general anesthesia, use of an operating room, more time, more labor.

For the past year, however, Mid-Columbia Surgical Specialists has been getting much more positive results from radiofrequency ablation. It involves insertion of a catheter into the troubled vein, and use of high-frequency signals to heat vein walls until they collapse.

Some surgeons also close veins by using catheters equipped with lasers. Mathison says Mid-Columbia Surgical Specialists opted for radiofrequency ablation because it’s more comfortable for the patient.

“If you compare this procedure with vein stripping, this minimizes wound infection, damage to arteries and nerves, and post-operative pain,” Mathison says. “And you’re less likely to have a recurrence of varicose veins.”

It’s also less costly, and thus, more acceptable to medical insurers. Radiofrequency ablation costs 60 to 70 percent less than vein stripping, Mathison says, down from as much as $15,000 to as little as $2,500. It requires only a local anesthetic, and takes an office visit of less than an hour.

“Now, even Medicare is paying for this,” he says. “Before, the patient needed medical complications (from venus reflux) to get insurance coverage. And even then, we’d have to take pictures and send them to the insurance companies.”

Durow, 51, learned about the procedure during a presentation by one of Mathison’s partners, Dr. Bill Hamilton.

“The closure procedure sounded better to me,” she says. “The vein stripping, it sounds pretty gruesome.”

She said a leaky valve had caused a bruised look in her legs. “They just zipped the vein closed, and now it’s gone away,” she says.

Mathison says Mid-Columbia Surgical Specialists has done about 80 vein closures since November of 2005. That may be in part because it’s the only clinic providing radiofrequency ablation between Portland and the Idaho border, Mathison says.

“Some people are still doing conventional vein stripping, but you’ll see less and less of that in the next few years,” he says. “This will be the standard of care.”

As far as Jill Durow is concerned, it already is.

“I’ve recommended it to my friends,” Durow says of radiofrequency vein closure. “If I needed to do it again, I would.”