Page 5 - Valley Life & Health

THE MORNING CALL SATURDAY, JUNE 29, 2019 5

Dr. Laureti has a simple explanation for his the treatment of venous disease is almost
patients – and one that any Lehigh Valley resident palliative. You’re helping symptoms as they occur,
will be able to relate to: but you’re not curing the whole process. This
“When people leave my office, I want them continues to occur over time.”
to understand. So, I thought of a way to explain While doctors can also offer sclerotherapy –
it that they can relate to,” Dr. Laureti explains. a procedure in which a medicine is injected into
“I look at our two main highways in the Lehigh the vein to make it shrink – to treat spider veins
Valley – Routes 22 and 78 – and both can have for cosmetic reasons, the first concern should
their inherent problems. Rt. 78 is the better be whether these veins are causing any medical
highway because it’s got three lanes in some symptoms that would ultimately be a more
parts, and moves a lot better. So, let’s label 78 as immediate concern.
the ‘deep system.’ Now, on the way back to the
heart, 85 to 90 percent of the blood flow goes KNOW YOUR DOCTOR
back via the deep system. Let’s call Rt. 22 the One thing that Dr. Laureti cautions
‘superficial system.’ About 10 to 15 percent of prospective patients about is doing their
blood flow goes back via the superficial system. homework and looking at the credentials of any
So, we’re trying to reroute from Rt. 22 to Rt. physician that treats venous diseases.
78. Then, you have the roads that connect these “The diagnostic portion of it – being able to
highways – for example, let’s say Cedar Crest read an ultrasound – is very important,” says
Boulevard. They’re called ‘perforators.’ The Laureti, who is a Registered Physician Vascular
perforator veins connect the superficial veins Photo courtesy of Easton Hospital Interpreter (RPVI), a Registered Phlebology
with the deep veins. Now, when the superficial Sonographer (RPhS) and a diplomat of the
system develops insufficiency when the valve Joseph M. Laureti, DO, FACC, board-certified American Board of Venous and Lymphatic
becomes dysfunctional, it can cause problems.” cardiologist at Easton Hospital Medicine (ABVLM). “A lot of people may have
the treatment of venous insufficiency, or the
SIGNS AND SYMPTOMS or eventual worsening that could lead to skin treatment of varicose veins or spider veins on
Because they are so visible on our bodies, discoloration or the formation of ulcers. Many their website, and they’re looking at it more from
varicose veins are a well-known issue. However, people need a simple ultrasound to document a cosmetic angle. Our goal is not cosmetic. Our
the enlargement of veins is only one sign of the presence of venous insufficiency, and due goal is treating your symptoms and your skin
venous insufficiency. Some people – particularly to advanced technology, treatment options are color changes, and that’s a medical goal.”
those who spend the day on their feet – develop minimally invasive.
tired legs, fatigue, swelling, heavy legs or Dr. Laureti prefers to treat patients in what
cramping. If they elevate their legs or lay down he calls a “stepwise fashion,” with the first option
for the evening, their symptoms tend to improve. being a thermal ablation. This is done if doctors
However, the same symptoms happen all over identify venous insufficiency in the greater
again the next day – which is all due to venous saphenous vein, which is the longest vein in the CONSERVATIVE
congestion, when the veins become dilated and body, starting on the inside of the ankle but
stretched. running above the muscle and under the skin WAYS TO
If doctors are able to reroute the blood, the along the length of the leg.
symptoms go away. If symptoms go untreated, “With thermal ablation, you’re basically TREAT VENOUS
this is when skin changes begin taking place and heating the vein and you’re injuring the innermost INSUFFICIENCY
patients experience discoloration in their legs. layer, called the endothelium. You’re basically
While there is a clinical classification system closing it down. The two modalities that I have to Like any disease, venous insufficiency is
in place that doctors adhere to, it’s important close that down via thermal ablation are either most treatable in its earliest stages. Vascular
to know that skin discoloration and edema with radiofrequency or with laser,” Dr. Laureti specialists typically recommend some basic
(swelling) happens in patients with advanced explains. “There is another modality that is fairly treatment strategies that patients can do to
venous disease. Treatment can prevent venous new, called VenaSeal, and it’s a glue that closes help themselves, which include:
insufficiency from becoming advanced. down the vein.” ■ Compression stockings
“The reasons we go after venous disease are, Another procedure that can be done is ■ Frequent elevation of the legs
number one, the symptoms, and number two, called a phlebectomy, which involves several ■ Regular exercise
when we see these advanced skin color changes,” tiny cuts or incisions made in the skin. The skin
says Dr. Laureti. “The cost of treating a venous is anesthetized and the doctor uses vein hooks ■ Dorsiflexion exercises, which is the
ulcer is astronomical, and just relieving this could to pull the vein up and out. Regardless of which action of raising the foot upward
make these changes go away and heal an ulcer, procedure the patient is going through (thermal toward the shin or moving your toes
if not prevent it from happening. And basically ablation, VenaSeal or phlebectomy), they can toward your head
what we’re doing is, we’re closing the superficial expect that these treatments are outpatient ■ Avoiding wearing high heels
vein that has insufficiency. We reroute the blood procedures that take between 40 minutes to frequently (high heels impair
to the deep system.” an hour. It is important to note, however, that
a phlebectomy would never be considered as a venous drainage)
TREATMENT OPTIONS first option for treatment. ■ Avoiding long periods of standing
While venous insufficiency is unlikely to “You never do that first because these veins or sitting (if you stand for long
present morbidity risk, there is still often reason are usually coming off of the other veins. If you periods of time, take frequent breaks
to pursue treatment options. In the more don’t take care of the first problem, the second to sit down or elevate your feet)
severe aspects of venous disease, there could be problem will continue to occur,” cautions Dr. ■ Practicing good skin hygiene
time missed from work due to leg discomfort, Laureti. “The problem is you have to remember,