What is the Closure procedure?
   A minimally-invasive surgical procedure that uses radiofrequency energy to occlude, or close, the saphenous vein. The Closure system received marketing clearance in the U.S. in March 1999. As of March 2003, more than 20,000 Closure procedures have been performed worldwide.

Does it work?
   Yes. In extensive clinical tests involving more than 300 patients conducted in Europe and the United States, VNUS Medical Technologies has demonstrated that the Closure system is effective at occluding veins and significantly reducing patient symptoms. Also, recent published studies have found that at 12 and 24 months following the Closure procedure, 90% of treated veins remained reflux free and a significant reduction of limb pain, fatigue and edema (swelling) was observed.

How does it work?
   The Closure catheter delivers bipolar radiofrequency energy directly into the vein wall. The passage of heat through the vein wall as the catheter is withdrawn causes resistive heating which shrinks the vessel. The Closure catheter's flexible electrodes cause the vessel to collapse around the catheter thereby closing the vein and eliminating "valve leakage", or reflux.

What are the patient benefits?
   Unlike vein stripping, the Closure procedure is minimally invasive, requiring no general anesthesia and lets most patients walk out of the medical facility within hours. Conversely, stripping is often performed under general anesthesia which necessitates a longer time within the medical facility. Convalescence following stripping can take weeks and involve significant pain.

Are patients satisfied?
   98% of patients surveyed at 6 months post-Closure would be willing to recommend Closure to a friend with similar leg vein problems.

After the saphenous vein is occluded, or closed, can it grow back?
   In theory, blood flow can resume. However, the probability of the saphenous vein reopening appears to be no more than 10% out to 2 years. One published report found that at 2 years 90% of Closure treated veins were invisible to ultrasound, suggesting permanent obliteration.

How was Closure developed?
   The Closure technology and procedure were developed over a four year period by a team of medical engineers, in association with a Silicon Valley physician inventor with more than 125 patents. Is it available in the United States? The Closure system received marketing clearance in the US in March 1999.

Does Closure require an operating room?
   No. Many physicians performing Closure procedures use ambulatory centers, surgi-centers and/or medical offices.

Does it require general anesthesia?
   No. Most physicians numb the leg and vein with a local anesthetic solution.

How long does the procedure take?
   Approximately 45 minutes, though patients normally spend 2-3 hours at the medical facility due to normal pre and post-treatment procedures.

Can Closure and other procedures, such as phlebectomy, be done in the same session?
   Many physicians who have been doing Closure procedures remove varicose veins via phlebectomy in the same leg during a single operation, if needed.

Does it hurt?
   Although some people are more sensitive than others, few patients complain of any pain. Some have said they can feel a little heat when the catheter is energized.

Is it necessary to be on an anticoagulant (blood thinner) after surgery to prevent clotting?
   Ambulation walking for instance is the recommended method to prevent clotting after most venous procedures, including Closure. The final judgment is made by the physician. However, we believe that anticoagulant therapy is not generally necessary when only the Closure procedure is performed.

Can the same Closure catheter be used on both legs?
   Yes, if the same patient is treated in one session.

Can a Closure catheter be recycled?
   No. Closure catheters are designed to be used once and discarded.

What potential risks and complications are associated with Closure?
   Like other venous procedures, Closure involves risks and potential complications. To determine if you are a candidate and if your condition presents any special risks, you should consult your doctor. Potential complications include, but are not limited to the following: vessel perforation, thrombosis, pulmonary embolism, phlebitis, hematoma, infection, skin burns and paresthesia.
A caution is advised if you have a pacemaker, internal defibrillator or other active implanted device; aneurismal section in the vein to be treated, or if you have documented peripheral arterial disease. Consult your physician for more information.

How long is the recovery period?
   Most patients are home within hours of the procedure. The normal post operative regimen is to wear compression hose on the treated area for a few days.

How long after Closure should a patient have a follow-up visit?
Within 2-3 days.

Do insurers regard Closure as a cosmetic procedure?
   It depends on the physician's diagnosis. Patients with venous disease in their saphenous veins often present with symptoms such as leg pain, leg fatigue, or swelling. There is a medical necessity to provide a therapeutic procedure for these patients and this is regularly recognized by most insurers. Treatment of leg veins in patients exhibiting only visible varicose veins with no other symptoms, and no saphenous vein incompetence is generally not reimbursed by insurance companies.

If both legs undergo Closure procedures and a vein is later needed for a heart bypass, would the surgeon be able to harvest another vein in lieu of the saphenous vein?
   Yes. Most cardiac surgeons prefer to use an internal mammary artery (IMA) for heart bypasses. Also, the saphenous vein below the knee may serve as an appropriate bypass conduit.