Another Tool to Treat Venous Insufficiency

Rachel Norton has been teaching first grade since 1994. In her free time, she likes to go to the beach with her husband and daughters. Rachel, who also likes to cook and craft, is a Florida native who relocated from one coast to the other.

“I’m from Miami and I moved to Lehigh Acres in 1991,” she notes, “so I’ve been on the west coast for twenty-five years.”

As a teacher, Rachel stands most of her day at school. Being on her feet so much has naturally had an impact on her legs. The first indication was the appearance of several unattractive spider veins, which she decided to have treated. She wanted to find a doctor she could trust.

Rachel found Joseph G. Magnant, MD, a board-certified vascular surgeon who specializes in treating veins. Dr. Magnant’s practice, Vein Specialists, which has offices in Fort Myers and Bonita Springs, is dedicated to the modern evaluation and minimally invasive treatment of leg vein disorders.

“I learned he specializes in veins, and that’s all he does all day long,” says Rachel. “I had to trust the doctor I chose, and it was comforting to me to know that was Dr. Magnant’s forte.”

Rachel liked Dr. Magnant immediately and felt she could trust him because of his expertise. Dr. Magnant successfully treated her spider veins, so when she developed more symptoms years later, she didn’t hesitate to return to him.

“My right leg became very achy, and I thought something was wrong,” she remembers. “I wondered why I was experiencing the pain. My leg wasn’t swollen or discolored. I didn’t have bulging veins or anything I could see, but I could feel it.”

Dr. Magnant performed an ultrasound examination and told her she had the early stages of venous insufficiency, which is when blood flows down the legs but can’t flow back up toward the heart. Rachel chose to postpone treatment at that time.
As the months went on, however, Rachel’s symptoms got worse. The pain in her right leg spread into her right foot as well.

“My foot started burning,” she describes. “I couldn’t sleep through the night because it felt like my foot was on fire. There was a throbbing pain that was almost constant, but at times the pain was worse. My foot was burning to the point where I was limited to wearing certain shoes.”

When these symptoms began affecting her daily routine, Rachel returned to Dr. Magnant.
“When I started experiencing the burning in my foot, I went back to him,” she states. “I tried to wait until this summer, but I ended up going back in March.
“Dr. Magnant did another ultrasound. The ultrasound showed that the venous insufficiency had progressed. He said we needed to treat it now. We had a conversation regarding a new procedure called VenaSeal™.”

VenaSeal is a vein closure technique that permanently seals leaky veins using a medical adhesive instead of heat. It produces the same end result as the ablation techniques using radiofrequency waves or a LASER, which Dr. Magnant frequently uses in his vein practice.
“Dr. Magnant said the VenaSeal technique accomplishes the same end result as heat ablation except it uses glue,” comments Rachel. “I would be his first patient to have the treatment. I trusted his expertise. Besides, VenaSeal requires only one insertion of the catheter versus the heat [based] procedures, where they enter the leg multiple times, and I don’t like needles.”

“Rachel has had problems with her right leg for a number of years,” describes Dr. Magnant. “I presented her with the different options for treating her two leaking veins. One was the traditional method with endothermal ablation using either radiofrequency or LASER-based techniques, and the other option was the new technology that’s been available less than a year that uses a medical adhesive, VenaSeal.

“Rachel was willing to take a chance on the new technology. She was my first patient to undergo it. She was a trailblazer, and she has done very well postoperatively.”

Veins are the blood vessels that return deoxygenated blood to the heart and lungs. Inside the veins are one-way valves that assist blood flow against gravity. When these valves become stressed and begin to leak, it causes blood to pool in the ankles or lower legs. The condition is venous insufficiency. It is more common than most physicians and patients realize.

“Forty million adults are affected by venous insufficiency, including one out ofthree people over the age of fifty,” alerts Dr. Magnant. “It is a medical condition, just like hypertension, diabetes and high cholesterol are medical conditions. We need to proactively manage it rather than reactively managing it.”

Dr. Magnant points out that venous insufficiency has many signs and symptoms. Signs are physical findings that can be seen with the eyes. Symptoms are the effects that patients feel. Physicians should check for both.

“There are not just the obvious signs, such as bulging varicose veins,” he explains. “True, varicose veins are part of it and are the easiest signs to diagnose. However, in the absence of varicose veins and in the presence of other symptoms such as heaviness, achiness, nighttime leg cramps and nighttime urination, the physician should consider the possibility of underlying venous insufficiency.

“The investigation of venous insufficiency with ultrasound is so straightforward, so accurate and so noninvasive that it makes perfect sense to be more proactive rather than waiting for the disease to progress or for the complications of the disease, such as skin ulcers, to develop.”

VenaSeal is like the ablation techniques for most of the procedure. Dr. Magnant uses ultrasound to guide a needle into the leaking vein. He then inserts a catheter into the vein and advances it to the top of the leg near the groin to treat the great saphenous vein, the vein running down the length of the leg, or behind the knee to treat the small saphenous vein. Here is where the VenaSeal differs. Instead of heat, it uses a safe, sterile medical adhesive to seal the vein.

“VenaSeal is another tool in our toolbox of options for treating venous disease,” points out Dr. Magnant. “It provides the same level of effectiveness as the endothermal ablation techniques, but it also offers certain benefits for some patients.”
In some cases, the patient’s entire great saphenous vein needs to be treated. Using the endothermal ablation techniques, Dr. Magnant can only treat the vein to the mid calf due to its proximity to a nerve.

“I never treat that vein below the mid calf because beyond that point, the great saphenous vein and the nerve are spiraling around one another,” informs Dr. Magnant. “With VenaSeal, I can treat that vein all the way down to the ankle without significant risk of injury to the nerve.”

Another advantage, and one that was especially attractive for Rachel, is avoidance of multiple needle sticks. VenaSeal requires only one to insert the catheter.

“Some people are very needle-phobic,” notes Dr. Magnant. “For those who feel they’ll pass out at the mention of the word needle, this is a good option for them.”

A third benefit is a decreased risk of any burning sensation or heat injury, although these risks are already very low with the ablation techniques.