By BILL BUELL
The Daily Gazette

Sunday, March 21, 2010

Minimally invasive: The words kind of roll off the tongue of Dr. Frank G. Fort. For his patients, it's music to their ears.

For 10 years now, first at the Bellevue Woman's Hospital and for the past five years at his office at 1537 Union St. in Schenectady, Fort has been using a procedure called closure, or the VNUS Closure Procedure, to treat his patients with varicose veins.

The process, which uses radio waves and can be done in a two-hour office visit, replaces the more common process called vein stripping, where the damaged vein is surgically removed. Stripping typically required a hospital stay, anesthesia and surgery, followed by pressure bandages and compression socks, and sometimes results in complications. With closure, patients walk in and walk out, often feeling much better than when they went in.

"I went home and moved furniture the night after my first procedure," said Sharlee Keyworth of Corinth, who took care of her right leg a couple of months ago and then recently returned to have Fort perform the procedure on her left leg. "My legs used to ache, but the left one feels great -- even right after the procedure. The heaviness was gone."

'Like hitting a home run'

Fort was the first physician in the state to begin using the procedure. He started the Capital Region Vein and Laser Centre in 1995 soon after finishing his residency at the Rutgers Medical School and spending some time on a fellowship at the prestigious University of Pittsburgh Health Sciences Center. He is a board-certified surgeon who specializes in phlebology (dealing with diseases of the veins), and was extremely familiar with the old surgical option of stripping.

"No one really knows why we develop varicose veins, but the old way of fixing them required multiple incisions and a lot of pain," said Fort. "There was also always a good chance of reoccurrence. This way is minimally invasive. My patients come in and leave and almost immediately feel better. To me it's like hitting a home run. It's a great procedure."

In Keyworth's case, Dr. Fort went to work on what he called a source vein.

"The scenario I use is the hole in the roof thing," said Fort, who was assisted by Lisa O'Brien, a closure coordinator and vascular ultrasound technician. "If the saphenous vein, or source vein, is not working, I can't treat what the patients see on their legs. I have to fix the top. I can't worry about the second or third floor if there's still a hole in the roof.

"So, we identify that vein with the ultrasound and mark it so we have a landmark on the skin. Then, when we actually do the procedure, Lisa identifies the area again and I place a needle into the vein, like I was starting an IV. Through that needle I place a tiny guide wire and over that guide wire I place a larger IV, which basically secures the place in the vein for me. Through that introducer or large IV, I place a catheter all the way to the top of the leg where the problem is."

The catheter, which is connected to a generator, then delivers radio frequency energy that heats up the vein wall, closing it and shrinking it shut.

"We'll turn on the machine and transfer energy for about 20 seconds onto that segment of the vein, about 2 1/2 or 3 inches, fry it like we're cooking bacon, and then treat the next segment down," said Fort. "In Sharlee's case, we only did three segments, pulled out the catheter and the entire length of the vein is completely sealed off."

Once the diseased vein is closed, blood is re-routed to other healthy veins. The diseased vein is eventually reabsorbed by the body.

Insurance Coverage

Varicose veins were often something people lived with until they heard about closure.

"Varicose veins are like dealing with your teeth or a headache," said Fort. "Can you live with it? Yes, you can, and only a small percentage of cases actually develop into some medical problem more serious. But this procedure is so minimally invasive, people have it and once the skin heals people will never know that you had any kind of procedure on your leg. Surgery isn't required and there's no scarring."

The VNUS Closure Procedure is covered by most health care companies.

"It is the procedure that replaced stripping, so most companies cover it," said Fort. "If you had asked me four or five years ago, it might have been a different story. But Medicare covers it, and, once the government starts, usually the other companies follow. So, the short answer is 'yes.' It is covered."

While Fort's was the first local physician's office to offer closure, it is no longer the only place to get one.

There are also vein centers in Albany, Latham and Saratoga Springs.

"When we started back in 2000 we were one of just 20 centers in the country doing it," said Fort. "But the procedure is so minimally invasive that the demand for it increased considerably, and now it's the standard care. It became sort of a specialty du jour and every Tom, Dick and Harry started up centers all over the place, and some were started by people who don't know much about vein disease. It's important to see your doctor. Closure is just a part of the treatment for a person with vein disease."

Closure was first tested in 1998 with clinical trials in Europe before the U.S. Food and Drug Administration approved the procedure in 1999. The person most responsible for its appearance on the medical scene is Dr. Lowell Kabnick, director of the New York University Vein Center.

Kabnick became known in medical circles around the world by advancing the technique and technology that improved most of today's advanced noninvasive procedures for vein disease. He is an international authority on the diagnosis and treatment of vein disease, and was the first vascular surgeon in the U.S. to perform the VNUS Closure Procedure, as well as another option, VenaCure, which uses laser technology instead of radio waves.

"I went down to New Jersey and learned from the best," said Fort, who was trained by Kabnick. "The procedure is now being used in Europe and America, but in many Third World countries they still do the vein stripping, and there are people in this country who are just living with the disease because they don't know about closure. They think it still involves stripping. They don't know how easy this is."