Varicose veins are caused by venous reflux affecting over 25 million Americans. Minimally invasive treatments like radiofrequency ablation using the VNUS Closure system are effective alternatives to traditional surgery for varicose veins and venous reflux. The VNUS Closure procedure uses a catheter to deliver radiofrequency energy to shrink and close diseased veins, providing improved treatment outcomes over surgery with faster recovery times.

1. Varicose VeinsJohn F Eidt MDVascular Surgery

2. Varicose VeinsVenous anatomyVenous physiologyVaricose veinsSymptomsTreatment

3. AnatomySuperficial veinsDeep veinsPerforating veinsCommunicating veins

4. 25 Million people suffer from venous reflux disease, the underlying cause for most varicose veinsVNUS Closure is the minimally invasive treatment for the medically indicated treatment of varicose veinsImages courtesy of Paul McNeill, MD and Rajabrata Sarkar, MD

5. Annual U.S. IncidenceU.S. PrevalencePrevalence and Etiology of Venous InsufficiencyVenous reflux disease is 2x more prevalent than coronary heart disease (CHD) and 5x more prevalent than peripheral arterial disease (PAD)1Millions

6. Prevalence and Etiology of Venous InsufficiencyOf the estimated 25 million people with symptomatic superficial venous reflux1 :Only 1.7 million seek treatment annually2

7. Over 23 million go untreatedPrevalence by Age and Gender3,4

8. Superficial VeinsGreat saphenousSmall saphenousVein of Giacomini

9. Venous SystemDeep femoral v.Perforating v.Femoral v.Popliteal v.Small saphenous v.Great saphenous v.Perforating v.Venous blood flows from the capillaries to the heartFlow occurs against gravityMuscular compression of the veins Negative intrathoracic pressureCalf muscle pumpLow flow, low pressure systemImage source: Fundamentals of Phlebology: Venous Disease for Clinicians. Illustration by Linda S. Nye. American College of Phlebology 2004.

16. Pathophysiology of Venous Insufficiency

17. Risk Factors and Symptoms of Venous Insufficiency

18. Manifestations of Venous InsufficiencySuperficial venous reflux is progressive and if left untreated, may worsen over time. Below are manifestations of the disease.5Skin UlcersSwollen LegsSkin Changes Varicose Veins 20+ million 2 to 6 million500,000 Photos courtesy of Rajabrata Sarkar, MD, PhD.

19. CEAP ClassificationsClinical Classifications of Venous Insufficiency (CEAP)Class 0 - No visible or palpable signs of venous diseaseClass 1 - Telangiectasias or reticular veinsClass 2 - Varicose veinsClass 3 - EdemaClass 4 - Skin changes(4a) Skin changes including pigmentation or venous eczema (4b) Skin changes with lipodermatosclerosis Class 5 - Healed venous ulcerationClass 6 - Active venous ulceration

20. Types of VaricositiesVaricose veinsSaphenousNon-saphenousReticular veinsVenulectasiaTelangiestasia

27. Lateral Reticular Complex

31. TreatmentCompressionSurgeryStrippingAmbulatory phlebectomyRadiofrequency ablationSclerotherapyInjectionLaser

59. SclerotherapyHypertonic salineEthoxyscerol – polidocanolSodium tetradecyl sulfate

67. The VNUS Closure® SystemThe VNUS Closure System is a minimally invasive treatment alternative for patients with symptomatic superficial venous reflux and varicose veinsUsing a catheter-based approach, the VNUS ClosureFAST™ catheter delivers radiofrequency (RF) energy to the vein wallRF energy creates conductive heatingthat contracts the vein wall collagen, thereby occluding the vein

68. VNUS Closure® Procedure using the ClosureFAST™ Catheter

69. Radiofrequency AblationProcedure Video

70. Efficacy of the ClosureFAST™ CatheterThe ClosureFAST™ catheter ablates the vein in 7cm segments with 20-second treatment cycles, resulting in vein shrinkage and occlusion. Interim data from a multicenter prospective study have shown 97.4% vein occlusion 1 year post-treatment.6

71. Post-Procedure InstructionsAmbulate frequently, a minimum of 30 minutes daily

72. Avoid heavy/strenuous exercise for a few days

73. Avoid prolonged sitting or standing

74. Wear compression stockings for up to 2 weeks

75. Patient should return for duplex scan within 72 hoursVNUS Closure® Visual ResultsOne week post-treatment*Pre-treatment*Individual results may vary