Tired, achy legs: Surgeon uses radiofrequency to treat painful vein condition

On airplanes, Karlynne Arbuckle's legs felt so thick and sore she could hardly stand it. She'd put them in her husband's lap to get comfortable, and she prowled the plane cabin as much as she could. She'd lie awake at night because her legs were throbbing, driving sleep away. At the end of almost any day, they were painfully enlarged.

She was suffering from superficial venous reflux disease. Three weeks ago, Utah surgeon Dr. Peter Jensen used radiofrequency — one of several treatment options — to quell it in an hourlong outpatient procedure.

Veins have a tough job. They're supposed to get oxygen-depleted blood uphill against gravity without a pump to where it can be oxygenated and start its journey again — a process helped immeasurably by valves that keep the blood from flowing backward. The shallow vein system isn't designed to handle the load. Unlike the deep-vein system, it doesn't have the support of muscles and other tissue. It also has fewer valves. And when the valves don't work well, backflow can occur, the results ranging from unsightly varicose veins to severely painful legs and even ulcerations.

Some patients seek treatment for varicose veins. But many patients don't have prominent varices. Instead, they have achiness, heaviness, fatigue, swelling. Their shoes may fit differently because of sporadic swelling. That's what drove Shannon Trujillo, 37, to seek care. She had varicose veins, but said she'd have lived with that. It was the achy, tired legs that drove her.

When venous reflux is suspected, a "careful" ultrasound scan is needed to see what's going on, Jensen said. Ultrasound reveals the vein function, patency and anatomy.

Treatment options for venous reflux cover a range, starting with comfort measures like compression hose and elevating your feet. For a surgical fix, the mainstay has long been vein stripping, where a knot is tied in one end of the greater saphenous vein, then the whole vein is withdrawn through a hole near the ankle and removed. A few years ago, catheter-based therapies including laser and radio frequency were introduced. Jensen of Utah Vein Specialists offers radiofrequency to collapse the offending vein without removing it. He uses laser, as well sometimes, but likes radio-frequency as gentler, using less heat.

Jensen, by training a cardiothoracic and vascular surgeon, calls the greater saphenous vein the "mighty Mississippi of shallow blood return." But not all of Arbuckle's blood was making the trip, so he treated her with a procedure called VNUS Closure, doing each leg a week apart.

He threaded a catheter through the vein under local anesthetic and placed it where the deep and superficial veins meet, watching it all under ultrasound. Once he was in the right place, he used the catheter to deliver radiofrequency to heat and collapse the great saphenous vein. As the catheter's withdrawn, it shrinks the collagen, which contracts the vessel, and destroys the lining so that it seals and scars shut. It then remains behind where it becomes, over time, undetectable from other tissue.

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