Endovascular Obliteration of the Greater Saphenous Vein: The Closure Procedure

The Closure procedure is an endovascular method to obliterate the greater saphenous vein as an alternative to surgical ligation and stripping. It is based upon the effect that controlled heat exerts upon the collagen in the vein wall, resulting in shrinkage of the wall and its lumen. The development of the technique and its early applications are reviewed. Technical details of the procedure are described as they have evolved in the Straub Clinic experience. Key points in technique relate to use of positioning of the table to facilitate different stages in the procedure, the use of tumescent infiltration in the subcutaneous tissue to provide a ‘dry’ vein, careful monitoring with the duplex scan during the procedure, and utilization of guidewires to assist in catheter placement are discussed.