Thermocoagulation, VeinGogh™, EVRF ™ and Ohmic Theramolysis
These modalities use high frequency electrical currents to create resistance (ohms) and generate heat energy. The technology was originally introduced many years ago and marketed by the Ellman International Company (Surgitron). The technique involves introducing fine insulated needles through the skin into the vein. They produce localized heat energy to breakdown the vessel wall causing the treated part of the spider vein to immediately shrink and “disappear”. Applications are typically limited to vessels less than 0.3 mm in diameter and larger veins would generally require combined therapy such as sclerotherapy or Microphlebectomy. This technique has been extended by Veinwave EVRF ™ in Europe to treat vessels as large as 4 mm in diameter by using a specially designed thermocoagulation catheter which is introduced through the skin; however it is not yet available in the United States and would require local anesthesia to tolerate the heat generated by this method.
The VeinGogh ™ is listed as a needle type epilator in the FDA’s registration Dn listing database under 21 CFR 878.5350. This product was originally marketed as a spider vein device that could be used by non credentialed medical personnel but subsequent investigation by the FDA reclassified this as an epilator (hair removal electrolysis system) which cast a cloud over the integrity of the representation of this device.
In general these devices cause small controlled burns which cause instant shrinkage and subsequent degeneration of the vessel wall. This can be uncomfortable when used at higher power settings and may leave “kitten claw marks” which go on to heal in about 2 – 3 weeks. Generally the device requires 100 or more applications to cover a playing card area and the devices marketed in the United States do not address the reflux in the larger reticular (feeding veins) which can lead to recurrences if not also combined with sclerotherapy or Microphlebectomy. Alternatively the use of Microphlebectomy and topical laser therapy can address both the spider vein and reticular vein issues without requiring sclerotherapy for those patients with hypersensitivity to sclerotherapy.