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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,
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