Leg pain caused by varicose veins was making it hard for Clifford Buster to remain on his feet during night shifts as a CVS drugstore clerk.
"When it first started, I wondered whether I could make it through the night," said Buster, 70, of Grandview. He frequently had to sit down at work to ease the pain.
Varicose veins can be ugly, but they cause life-altering symptoms for an estimated 25 million Americans. Buster's problem, which persisted for a year, has improved since he underwent an outpatient procedure called radiofrequency ablation.
Dr. Raghu Kolluri of Prairie Cardiovascular used a catheter inserted at various points in Buster's legs to cauterize and close off an unhealthy vein that was allowing blood to leak into surrounding tissue.
"I feel 80 to 90 percent better," Buster said.
Kolluri, a vascular medicine specialist based at Prairie Diagnostic Center, 401 E. Carpenter St., has performed radiofrequency ablation since his arrival in Springfield 5½ years ago and is the only doctor in the area offering it.
The procedure is a more attractive option for treating severe varicose veins than vein stripping, the surgical removal of veins that has been performed for decades. Covered in most cases by Medicare and private insurance, radiofrequency ablation has been approved by the Food and Drug Administration since 1999.
Little or no pain
Kolluri does three or four ablations a week at the diagnostic center. But he said many patients who could benefit from the treatment don't get it because their primary-care doctors don't know about the procedure. They only know about stripping, a surgical procedure that is done in the hospital and can result in a painful recovery.
As a result, Kolluri said, the patients don't get referred to a specialist. Many patients are given drugs called diuretics for months or years to relieve symptoms that can include pain, swelling and discoloration of skin.
Ablation can be more effective for many of these patients, Kolluri said. There is little or no pain afterward, and many patients can return to work or normal activities the next day, compared with a week or more of painful recovery at home for patients after vein stripping.
Infection danger
The exact cause of varicose veins is unknown, but the result is that the walls of veins lose their elasticity. Because veins return blood to the heart and lungs with the help of valves to prevent backward flow, unhealthy veins that have become longer and wider allow blood to flow in the wrong direction and pool in tissues.
This pooling can cause discoloration, pain and other problems. Sometimes the skin can be weakened, leading to open sores that grow and won't heal, Kolluri said.
Some of these patients develop overwhelming infections and die, he said.
Buster was referred to Kolluri by his cardiologist and was treated at Memorial Medical Center's Wound Healing Center for a sore on his right ankle that wouldn't heal before he underwent ablation procedures six months ago.
When the half-hour ablation procedure shuts down an unhealthy vein, circulation to surrounding tissues improves because other, healthier veins take over, Kolluri said.
For people whose primary concern is the appearance of their legs, there are cash-only medical spas in St. Louis, Chicago and other cities that offer ablation procedures to eliminate varicose veins causing few or minor symptoms, Kolluri said.
Medicare and other insurance plans don't pay for those procedures, he said.
National authority
Kolluri, 37, is considered a national authority on the technique. He has lectured about it at meetings of doctors around the country. But he said he has no financial interest in and hasn't been paid by VNUS Medical Technologies, the California-based company that makes the catheter used in the procedure.
Kolluri said he performs the procedure only on patients with significant symptoms, and only after other non-invasive therapies such as leg elevation and compression therapy have been unsuccessful.
Medicare pays about $1,100 for radiofrequency ablation, and private insurance can pay several thousand dollars for it. Kolluri says about 20 percent of the money goes to pay the doctor. The rest offsets the cost of the catheter, conscious sedation for patients, nursing staff and other institutional expenses, he said.
Medical studies indicate that the technique is at least as effective as vein stripping, with a quicker recovery and less post-operative pain, though ablation can cost more than stripping because of the newer medical equipment involved.
Potential complications from ablation, which can include infection, bruising, a 1 percent risk of a deep-vein thrombosis and a 0.5 percent risk of pulmonary embolism, are comparable with vein stripping.
Kolluri said the procedure brings him much satisfaction.
"Patients love it because then their leg ulcers ... magically start healing," he said.
Ablation preferred
An ablation that Kolluri performed on Mike Welter of Cantrall has accelerated the healing of a painful wound on Welter's left calf.
The wound first emerged 14 months ago and made it hard for the 66-year-old Illinois State Police retiree to sleep, travel or pursue an antique-selling business with his wife, Carol.
Skin grafts and other treatments at Memorial's wound center helped to shrink the wound. Since the ablation procedure Oct. 18, it has continued to shrink.
"Now it's almost healed," Welter said, adding that he feels better knowing improved circulation in his leg will help him avoid another such open sore.
It's been two years since Kolluri performed ablations in both of Sally Mansfield's legs, providing relief to a pharmacist from White Hall who works 10-hour days.
"I never sit down," she said.
Mansfield, 53, said the procedures eliminated the burning sensation she felt in her legs for six years or more and relieved some of her worry about developing leg ulcers in the future.
Because her health insurance has a high deductible, she had to pay several thousand dollars out of pocket for the first ablation procedure. But she said she preferred ablation to stripping, which she underwent 16 years ago.
She still remembers the pain after the stripping procedure and recovering in bed for two weeks at home.
Dorothy Trutter, an administrative assistant at Illinois College who lives in Alexander, had four ablations from Kolluri to eliminate varicose veins that were punishing her after exercising or doing chores.
"My calves would be achy and tired. I would have swelling," she said. "It was like my legs were going to fall off."
She had the first ablations in 2009, then in September, and the last one was performed Oct. 25.
"I went back to work the next day," said Trutter, who is in her 60s. "There was no down time at all. My legs feel so much better."
Dean Olsen can be reached at 788-1543.
Photo: Ted Schurter/The State Journal-Register -- Mike Welter of Cantrall, walking his dogs with his wife Carol, has regained a higher level of mobility after undergoing a new, minimally invasive procedure to fix a varicose vein.
Second photo: Dr. Raghu Kolluri
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