What is VNUS?
VNUS is the name for a new technique to remove varicose veins.
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.
How is VNUS 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. VNUS avoids the need for a cut in the groin and there is minimal bruising. This means people who have VNUS can usually return to normal activity sooner than those who have standard treatment.
Is VNUS better than standard surgery?
It is now thought that VNUS is superior to traditional surgery for 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 VNUS 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 VNUS is much less than traditional surgery. In addition, people who haveVNUS 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. 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 VNUS are. Only time will tell.
Is everyone with varicose veins able to have VNUS?
No. Some people have large, winding veins that are not suitable. Mr Braithwaite will be happy to discuss whether your veins are suitable for VNUS. Mr Braithwaite's research suggests that about 70% of people with varicose veins can be treated with VNUS.
Is VNUS all I need for my veins?
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 VNUS will result in very little scarring of the leg.
What are the advantages of 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?
VNUS uses special catheters that cost about £700 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 VNUS as an extra.
Will my insurance company pay for VNUS?
VNUS has been approved by the Government agency NICE. Most Insurance companies will now pay for VNUS but a supplementary fee may apply.
The Nottingham vascular surgeons were the first surgeons in the United Kingdom approved by BUPA to perform VNUS. Mr Braithwaite also has approval from PPP and other insurers to perform VNUS.
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 (Queen's Medical Centre). 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.
If you would like to see Mr Braithwaite as a Private Patient, please contact him at either the
Park Hospital or
Nottingham Nuffield .
Can I find out more about VNUS?
Yes. Visit the VNUS website:
www.VNUS.com
Are there any alternatives to VNUS?
Varicofoam, foam injection of varicose veins is another new technique used by Mr Braithwaite.
Venocuff valve repair is a technique that Mr Braithwaite plans to introduce.
A technique using a laser to heat the blood in the long saphenous vein is available. The procedure, known as
EVLT , 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.
EVLT is a new technique that is not available as an NHS patient and long tern results are not known.