Glossary

Glossary of Terms

Artery

Vessels carrying oxygen-rich blood FROM the heart. (Veins carry oxygen-depleted blood TO the heart.)

Ascorbic Acid

(Vitamin C) a water soluble crystalline substance, is necessary for the development of collagen. It is also necessary for
the function of many enzymes in the body. Vitamin C is also necessary for the elimination of drug and chemical toxins
from the body. Carnitine, a chemical needed to burn fat, is synthesized by vitamin C. Vitamin C is necessary for the
formulation of neurotransmitters, chemical messengers in the brain and body tissues. Vitamin C is an immunostimulant
aiding the anti-bacterial efforts of white blood cells and stimulating the activity membranes from free radicals by
increasing interferon production. Free radicals are unstable molecules or atoms that hang around in our environment.
They contain unpaired electrons. They will naturally seed out and bond together with other molecules or atoms in
order to form a paired electron, making the new molecule or atom damaged. This damage is the root cause of conditions
like arthritis, heart disease, auto immune disease, cancer, and aging. Inflammatory conditions are caused by this
process. Exposure to UVA, UVB, and UVC rays causes free radical activity and, consequently, inflammation of the skin
(sometimes very deep inflammation.) Even just one exposure to UV radiation will cause a reduction in the levels of
natural anti-oxidants produced by the body. Regular use of topical vitamin C products counteracts the free radical
activity that causes the photodamage associated with aging. It should not be used in place of sunscreen. Aging is the
result of free radical activity and lack of oxygen to the surface of the skin after exposure to UV radiation. An effective
anti-oxidant, vitamin C is also vital to collagen production. When used topically on one side of the face, volunteers
showed a significant reduction in wrinkling and fine lines on that side. Vitamin C is an anti-oxidant which helps fight
free radicals from exposure to UV radiation. It has been found to be necessary to the formation and development of
collagen. Studies have shown that creams containing Ascorbic Acid are effective in reducing the appearance of fine
lines and wrinkles.

Capillary

Extremely small blood vessel.

Catheter

In the context of the Closure procedure, a slender, 60-100 centimeters long device designed to move within the vein
and shut--or close-- it by delivering radiofrequency energy through a group of specially designed electrodes.

Ceramides and Sphingolipids

They are included in barrier lipids which make up about 40% of the skin's outer layer and work to bind the skin
together.. They are the glue that holds the skin together so the environment can't get in and moisture can't get out.
Lipids are lost with aging and the moisture barrier is weakened. At this point, moisture added topically has little effect.
Some research shows that applying ceramides topically has the effect of generating ceramide production in the skin,
thereby increasing the lipid content of the skin. There are two phases in the production of Ceramides. First, the
precursor of the ceramide must be produced. The phytosphingosine building-block must be produced first. Secondly, a
fatty acid is attached to this compound in the second phase which results in the formation of ceramides. The isolated
sphingosine is fermented with a special yeast, under controlled conditions in a medium that is rich in nutrients. When
the yeast cells multiply, they produce the precursor to the ceramide. A plant derived fatty acid, stearic acid is linked to
the phytossphingosine through acetylation process or through the catalytic activity of a natural occurring enzyme to
make a ceramide that is identical to human skin.

Closure

The Closure procedure is an outpatient (day surgery) treatment performed in hospitals, surgical centers, and doctor's
offices. Anesthesia is typically used to numb the treatment area. The Closure catheter is inserted into the vein
through a small opening, often using only a single needle stick. The catheter delivers radiofrequency (RF) energy to
the vein wall, causing it to heat, collapse and seal shut as the doctor pulls the catheter from the vein. Like other
venous procedures, the Closure procedure involves risks and potential complications. Each patient should consult
their doctor to determine whether or not they are a candidate for this procedure, and if their condition presents any
special risks.

Clot

Coagulated blood. (i.e., a thick, viscous lump of blood.)

Collagen

The major protein in connective tissue. It shrinks or thickens when heated.

Color Duplex

Ultrasound system that uses color to indicate the direction of blood flow. This is particularly helpful in visualizing and
evaluating both the deep and superficial venous systems.

Compression therapy

A conservative therapy for venous insufficiency. Typically involves compression stockings with varying degrees of
pressure to improve blood flow and reduce symptoms caused by venous insufficiency. This therapy may temporarily
relieve symptoms, however, does not address the underlying cause of the disease.

Deep veins

Non-surface veins in the leg which enjoy good structural support from the adjacent bones and muscles. They return
blood directly to the heart.

Deep vein thrombosis(DVT)

A formation or presence of a thrombus, or clot, within a deep vein.

Dilation

Enlargement of an opening using surgical tools, chemicals or manual pressure.

Doppler

Ultrasound device that a technician may use to sense the presence or absence of flow in blood vessels.

Edema

Swelling or inflammation caused by fluid buildup. Frequently occurs in the legs and ankles of people with venous
insufficiency.

Efficacy

Effectiveness.

Electrode

In this context, the Closure catheter has multiple electrodes which emit radiofrequency energy to shut--or close--the
vein to be treated.

Endovenous

Inside a vein.

Hematoma

A localized mass of clotted blood confined within an organ, tissue or space.

Incompetent Valves

see Valves.

Incompetent Vessel

Blood vessel that doesn't function properly. In most cases, the valves do not close completely, causing reverse blood
flow which contributes to edema and leg pain.

Ligation

Surgical closure of a vessel with sutures or staples.

Lumen

Interior of a blood vessel.

Minimally invasive

Insuring that a treatment involves as little damage to human skin and organs as possible.

Microphlebectomy

See Phlebectomy.

Occlusion

The closing of a vessel.

Paresthesia

Numbness or tingling often associated with damage to sensory nerves.

Perforator veins

Veins which serve as connections between the superficial veins and deep veins.

Phlebectomy

Developed in the 1950s, a phlebectomy involves removing diseased veins through a series of very small punctures or
incisions with a variety of specialized hooks. It is typically used on varicose veins which are at, or near, the skin's
surface, and is a complimentary treatment to the Closure procedure.

Phlebologist

Physician who specializes in treatment of vein disorders.

Prolapse

Condition in which vein valves are unable to close properly, allowing blood to flow in the wrong direction.

Radiofrequency energy

Energy that generates heat by stimulating naturally-occurring molecules in and around tissues. So-called RF energy
can be used to shrink, cut and/or cauterize tissue, depending on the temperature setting and frequency.

RF energy

Abbreviation for radiofrequency energy.

Reflux

Backward flow. Reflux contributes to the development of varicose veins when incompetent leg vein valves let blood
flow towards the feet instead of the heart.

Retinol

It is vitamin A, which is basic to healthy skin, keeping it soft and plump. Vitamin A may increase collagen, DNA, skin
thickness and skin elasticity. It normalizes the skin and improves the skin water barrier properties. It is useful to treat
environmental dryness, heat, or pollution.

Sapheno-femoral

Junction Intersection near the groin where the saphenous vein and femoral vein join.

Saphenous vein

Long saphenous vein is a large vein running from the ankle to the groin and the short saphenous vein runs behind the
leg from ankle to behind the knee. Problems with valves in these veins often contribute to the development of varicose
veins.

Sclerotherapy

Often used for treatment of small diameter (1-2 mm) surface veins, such as spider veins. The physician injects a liquid,
such as highly concentrated saline solution, that destroys the vein lining so it collapses.

Spider veins

Small blood vessels near the skin's surface which appear as tiny, twisted, purple lines.

Stripping

Surgical removal of an incompetent vessel, historically considered the standard of care for removing incompetent
saphenous veins. Stripping of a saphenous vein typically involves making an incision in the groin region and
surgically tying off the top of the vein. An instrument resembling a thin rod with a bulbous end is then inserted into
the saphenous vein and passed through to the knee. Another incision is made at the upper calf. The stripping device
is then tied to the vein and pulled out through the second incision.

Superficial veins

Veins which are just beneath the skin. Because they enjoy less support from adjacent muscles and bones, they can
develop areas of weakness in their walls and are more likely to become varicose than deep veins.

Thermocouple

A temperature measurement component on the Closure catheter that lets the physician know the precise temperature of
tissue being heated.

Thrombosis

Formation or presence of a thrombus, or clot, within a blood vessel.

Thrombus

Blood clot that may block a blood vessel or be attached to the vessel without obstructing the lumen (i.e., interior of the
blood vessel.)

Ulceration

Formation of an ulcer on the skin.

Ulcer (venous)

Lesion on skin caused by tissue deterioration, usually with inflammation and necrosis (dead tissue).

Valves

Flaps of tissue in the leg veins which open and close to prevent blood from flowing backwards.

Valvuloplasty

Surgical placement of a series of sutures along the base of the valve. This can tighten valve components called
"leaflets", reduce the vein diameter and prevent prolapse. General anesthesia is required, plus 3-6 days post-operative
hospitalization and long-term therapy with anticoagulant drugs. Risks include deep vein thrombosis infection and
bruising. Success rates of 63%-80% have been reported for patients suffering from primary, deep venous
insufficiency3.

Varicose veins

Veins with incompetent valves which are elongated, dilated, tortuous, pouched and thickened. An estimated 10%-20%
of the general population has varicose veins. It is more frequent among women as well as adults after age 504.

Vein

See venous vessels.

Venous blood

Blood which is returning to the heart to pick up oxygen.

Venous insufficiency

Poor or impaired flow of venous blood from the legs and feet to the heart, often characterized by symptoms such as
varicose veins, swelling, aching, skin changes and/or venous ulcers. Caused by over-dilation of venous vessels or
damaged valves resulting in pooling of blood. Deep vein thrombosis can also create this condition. Over time, venous
insufficiency can damage other valves in the veins and speeds progression of venous reflux.

Venous reflux

See Reflux.

Venous vessels

Veins that carry oxygen-depleted blood TO the heart. (Arterial vessels carry oxygen-rich blood FROM the heart.)