Amani D. Politano M.D., M.S.
Dr. Politano’s clinical practice is general vascular surgery for treatment of venous disease and carotid disease. Her research interest is surgical site infections.
Embracing new tech for venous disease
Venous disease affects approximately 30 percent of the population on a spectrum from asymptomatic to advanced disease. The most common issue is venous reflux disease, typically treated with endovenous laser treatment, or EVLT. This month, OHSU will begin offering a new method to improve patient comfort with, and outcomes from EVLT.
New tool for sealing veins
Traditionally, EVLT requires an injection of a tumescent anesthesia of saline and lidocaine. This protects the structures surrounding the damaged veins from the heat of the laser. Injecting the solution is the longest part of the procedure and can require several needle sticks. Now, we have a new tool, VenaSeal™ by Medtronic, that uses a medical adhesive to seal the veins. The Food and Drug Administration approved this closure system in 2015. Utilizing this new system will offer potentially shorter procedure times and greater patient comfort, but it may also improve outcomes. One advantage of this method is that it also protects the nerves. These are often closely paired with veins and insufficiently buffered by the solution method. This allows surgeons to treat the distal vein as well the proximal, which may aid in healing.
Conservative therapy versus surgical intervention
For patients who are asymptomatic or whose primary concern is cosmetic, they will initially benefit from compression therapy, exercise and other risk factor modifications such as weight loss. However, patients with more advanced disease (skin changes, venous stasis dermatitis, ulcerations or symptoms that aren’t helped by conservative measures) are excellent candidates for intervention.
In making a diagnosis, primary care providers may want to schedule an ultrasound to rule out a deep vein clot for sudden swelling. However, if the referral is for advanced or recurrent disease, there are specific imaging studies and documentation required by most insurance providers that our vascular lab has expertise in preparing. When to refer or consult: Unprovoked/uncertain cause of a deep vein thrombosis. Severe or recurrent deep venous thrombosis.
VenaSeal™ Closure System FAQ
When will symptoms improve?
Symptoms are caused by the diseased superficial vein. Thus, symptoms may improve as soon as the diseased vein is closed. When can patients expect to return to normal activity? The VenaSeal™ closure system is designed to reduce recovery time. Many patients return to normal activity immediately after the procedure.
Is the VenaSeal™ Closure System painful?
Most patients feel little, if any, pain during the outpatient procedure.
Is there bruising after the VenaSeal™ Closure System procedure?
Most patients report little-to-no bruising after the VenaSeal™ closure system procedure.
What happens to the VenaSeal™ Closure System adhesive?
Only a very small amount of VenaSeal™ adhesive is used to close the vein. The body naturally absorbs the adhesive over time.
How does the VenaSeal™ Closure System differ from thermal energy procedures?
The VenaSeal™ closure system uses a proprietary medical adhesive to close the superficial vein. Thermal energy procedures use heat to close the vein. The intense heat requires a large volume of numbing medicine, which is injected through many needle sticks. The injections may cause pain and bruising after the procedure.
We strive to be a comprehensive care center for patients with venous disorders. OHSU offers traditional and emerging treatment options, evaluations for central venous destructive causes that could provoke deep venous thrombosis and therapy for post-thrombotic syndrome. We are available to answer questions about venous disease. Please call the OHSU Physician Advice and Referral Service at 503‑494‑4567. To refer a patient, please fax to 503‑346‑6854.Back to articles