By contrast, "venous problems are chronic and develop over a long period of time." The most common symptom of what Dietzek calls chronic venous insufficiency (CVI) is varicose veins. Not only are these bulging, ropy-looking veins unsightly but they can also cause discomfort, such as itching, burning, and swelling of the legs and ankles. They can make your legs feel heavy and tired and susceptible to restless-leg syndrome.
As CVI progresses, it can cause skin discoloration, eczema, scarring, and even ulceration. Blood tends to pool and stagnate in varicose veins, which can lead to superficial vein thrombosis or blood clots. With deep-vein thrombosis, the clot may travel to the lungs. Result: a pulmonary embolism and possibly death.
So varicose veins are more than cosmetic. Some 30 million Americans have varicose veins, two-thirds of them women.
Some people have a genetic predisposition, but varicose veins are caused also by hormonal changes (during the menstrual cycle and pregnancy) as well as by standing and sitting for long periods, and the stress of high-impact exercise, such as running.
The main reason for varicose veins is weak and leaky valves. Since there's no pump in the feet to propel venous blood back up the legs to the heart, veins are equipped with a series of valves. Unlike arterial blood, which flows in one direction, venous blood can flow in two directions if the valves are faulty.
Blood is propelled from the lower extremities by the squeezing or contraction of the calf muscle. When the ascending blood reaches a valve, it closes and keeps the blood from flowing back down. In a properly functioning vein, the blood moves up the ladder to the next valve until it returns to the heart.
"It's like the locks of the Panama Canal," Dietzek said.
When the valves malfunction, either because they are lax or leaky, the blood is stranded and flows down the venous channels into various branches. Over time, these branches engorge, enlarge and pop out of the skin as varicose veins.
Since it's not possible to fix the faulty valves, the most common "cure" for varicose veins is to eliminate them. In years past, a common resort was vein stripping. This involved making an incision the entire length of the problematic vein and removing it. It was painful, necessitated surgery in a hospital, with stitches and staples, and left an ugly scar.
What Dietzek calls the "premier" treatment for treating CVI is Venefit, a trademarked term for endovenous radiofrequency ablation. For the past 14 years, Dietzek has been using this method, which was approved by the FDA in 2000. Dietzek says he has performed more than 5,000 procedures.
In Venefit, a catheter is threaded into the underlying cause of the varicose vein, namely the vein or venous channel where the valves are faulty. The idea is to close that vein and thereby decrease blood flow to the surface varicose veins. The catheter heats up to 250 degrees Fahrenheit, remains in the vein for only a few minutes, and is then removed. During that brief period, it cauterizes the lining of the venous channel, causing it to shrink and possibly disappear. In about 30 to 40 percent of cases, the varicose or secondary vein will also reduce in size and potentially vanish.
If that fails to happen, Dietzek turns to microphlebectomy, an alternative to vein stripping. Instead of making a long incision, he uses a needle to puncture the skin in several places to gain access to the varicose vein. Then using micro-instruments, he grabs the vein through one of the access points and removes it, "like a piece of thin spaghetti." No skin stitches are involved. Both Venefit and microphlebectomy can be done in a medical office, have few complications, and are typically covered by insurance.
For the relief of varicose vein symptoms, Dietzek recommends such initial conservative measures as compression stockings and exercise. He favors walking, which contracts the calf muscles (the impact of running can be counterproductive), and certain yoga poses that involve positioning the body so the legs are higher than the heart.
"Is yoga going to correct the faulty valves? No." Dietzek stressed. "But the exercise itself is good for you, and it is going to reduce the pressure and swelling of your veins and help promote proper blood flow."
"Well Being" appears every other week, alternating with Sandy Bauers' "GreenSpace" column. Contact Art Carey at firstname.lastname@example.org. Read his recent columns at www.philly.com/wellbeing.