David Greuner, M.D, a cardiovascular surgeon at NYC Surgical Associates, talks about a new cutting-edge way to get rid of varicose veins that doesn’t involve going under a knife.
Interview conducted by Ivanhoe Broadcast News in November 2016.
This no knife procedure you created this right?
Dr. Greuner: Correct.
Why the need for this no knife procedure compared with the conventional way of removing various veins? Is it mainly the difference in scarring?
Dr. Greuner: Yes, normally the conventional way of removing varicose veins doesn’t really leave a lot of scarring. It usually happens on people that have an olive complexion or darker which we have a lot of in the New York area. A lot of blacks, a lot of Mediterranean’s, a lot of middle eastern and what happens is they tend to form keloids or hypertrophic scarring which means scars that are a little bit more exaggerated than what would happen in a fair skinned person. When these people have a lot of venous disease and require a lot of little incisions, to address each vein, it can cause quite a disfiguring result on somebody that wants their legs treated for a cosmetic reason as well.
It was mainly then because of the scarring that you came up with this alternative way. Explain to me the way you go in a conventional procedure.
Dr. Greuner: The conventional approach with which varicose veins are addressed today is using what is called a sheath. A sheath is a little sleeve that’s plastic and it goes in and it houses a catheter that goes in through the sheath. That usually leaves a scar of about five to ten millimeters and usually patients have four or five veins that are on a more severe side on each leg. The average patient requires four or five cannulations for four or five different veins and if these cannulations don’t heal perfectly it can be quite disfiguring.
And with the new procedure?
Dr. Greuner: With my procedure the catheter was thinned down so it fits through a needle. Its actually a very simple concept the catheter just had to be thinned down to where it goes through a needle which is just the same size as one used to draw blood, and by going through a needle it doesn’t require any incision at all. Needle puncture sites heal up very well without any scar even in the most scar-prone skin.
With your procedure it’s not just the needle there’s actually a thin catheter inside the needle.
Dr. Greuner: Yes, basically in the conventional procedure you use the needle as well. You just use a needle to get into the vein then through the needle you put a wire and then over the wire you house a sheath, which is that plastic envelope for the catheter. My device basically eliminates two of those steps. Basically the needle acts as the sheath so you don’t need to put a sheath in. the needle serves a double purpose. It is used to get into the vein, acting as the sheath as well as the initial puncture tool and it seals up without you having to even make an incision on the patient.
Is there an advantage besides the limited scarring or the no scarring, with your way is there another advantage to only having basically one instrument going in?
Dr. Greuner: Yes it does a lot. Without having to use a sheath your access is a little bit more maneuverable. Meaning you can treat different veins in different angles, it can be extremely precise with which way you cannulate things and you can treat a lot of other veins that you wouldn’t normally be able to fit a sheath into. It technically makes things a little bit more versatile as well.
Talk to me about the difference in scarring between the two procedures.
Dr. Greuner: The difference in scarring in a person that’s fair skinned and not prone to scarring is not going to be that significant, but somebody like myself of African American or mediterranean descent, or somebody with this sort of skin texture or color is going to result typically in either a dark scar or a raised scar or even a keloid. Given the fact that many people address this for medical as well as for cosmetic concerns, any scarring can be a significant impediment to their happiness.
With your way what do we see afterwards?
Dr. Greuner: With my way there’s zero scar on any of these people. No matter what your skin color, no matter how severe your vein disease is, we can address it without any single scar whatsoever.
You’ve been doing this new procedure for about how long?
Dr. Greuner: I started about three years ago and we have thousands of patients treated since then. Initially we did have a couple of little device problems with maneuverability etc. but it’s all pretty much been resolved.
How does it make you feel to come up with something that’s so impactful?
Dr. Greuner: Believe it or not, when I developed this technique, I didn’t consider it to be groundbreaking. It was just common sense for me to address a problem I saw frequently. However, it seems to have garnered a lot of attention from a variety of outsiders. My patients seem to appreciate it very much. It was just a simple concept and a very simple solution to a problem that was rather irksome. When you do a huge volume of any given procedure, even the smallest inefficiencies or imperfections seem to be glaring problems, and I wanted this made as perfect as possible.
Difference in cost between the old way and the new one?
Dr. Greuner: Zero difference in cost. In fact it’s a little bit cheaper because you don’t have to buy a sheath.
Covered by insurance?
Dr. Greuner: It is covered by insurance and it’s actually a little bit cheaper because you don’t have to pay for the sheath which is pretty much rendered defunct in this procedure.
I see you’re pretty humble about having discovered this. What’s been the impact on the industry though?
Dr. Greuner: Some of our device reps don’t love it because we render them a little bit unnecessary for some of the devices, but our patients opinions, which is what counts, are extremely positive.
In terms of recovery any difference there?
Dr. Greuner: Zero difference in recovery. In fact it’s a little bit better again because there is no incision. Typically with the sheath incision which is you know small to be honest but it’s usually in lower parts of the legs and people tend to have a little bit of swelling after the procedure and a lot of drainage that comes out of this little sheath incision. With our procedure they don’t even have any drainage at all.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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