CINDY ELLEN RUSSELL / CRUSSELL@STARBULLETIN.COM
Kathleen Lum had suffered from severe varicose veins on the inside of her calves since she was 13 years old and has since had them removed. CLICK FOR LARGE
Clinic untangles vein disorders
A highly innovative surgeon develops new ways to revive blood circulation
Kathleen Lum took her father to the Kistner Vein Clinic because he was having circulation problems, and two weeks later she was there getting swollen veins removed.
"I've had varicose veins since I was 13 years old," said the 50-year-old Kaneohe woman. "I never thought there was a way to get rid of them."
During consultation with Dr. Robert Kistner for her father, however, she found he could correct her enlarged veins, and she had both legs treated in about 3 1/2 hours in October.
"I was thrilled with the results and the whole procedure itself," she said. An avid tennis player, she waited a week, then was back playing, she said.
She thinks they look pretty good. "I walk an hour a day to keep them toned and fit so I can show them off," she said.
Kistner, renowned for research and development of surgical procedures, came here from the Cleveland Clinic in 1966 and joined Straub Clinic & Hospital where he started the Department of Vascular Surgery.
After 38 years he retired from Straub in December 2004 because of "a passion" to offer developments in diagnosis and treatment of vein disorders outside Straub.
He started his clinic at 858 S. Beretania St. about a year ago and also does vascular work at Queen's Wound Care Center where he said many people wind up with serious vein problems.
"Hawaiian patients have tremendous problems. Massive obesity can produce all the features of bad venous disease in a patient."
Kistner is participating in a National Venous Screening Program developed by the American Venous Forum to make vascular health a national health-care priority.
"The problem with veins is people don't understand them, they don't know about them and they don't pay attention to them," he said.
About 20 percent of the population has chronic venous disease, he said. But 80 percent to 90 percent of vein problems can be treated, which was not true five years ago, he said.
Also a professor of surgery at the University of Hawaii's John A. Burns School of Medicine, Kistner explained that the body's "venous pump" works this way:
Arteries carry blood from the heart to the body, and veins return blood to the heart. One-way valves keep blood from flowing back into the legs. When a valve is not working right, the wall of the vein gets weak and begins to leak, which can cause blood to pool in the leg. This is called "venous insufficiency."
Horrendous problems can occur from chronic venous insufficiency, Kistner said, such as pulmonary embolism or blood clots that travel to the lungs and kill about 200,000 Americans each year.
Blockages also can cause chronic leg swelling, debilitating ulcers and prolonged disability. But early diagnosis and aggressive treatment can prevent complications and death, Kistner emphasized.
Lum said she "had a leakage from my main valve branching off and causing bulging of the veins. It never stopped me from wearing shorts because I had them all my life. I never thought anything of it."
But as she grew older, she said her legs felt heavy, and she had to elevate them after tennis matches. She coached tennis, and after standing for a time, she said, "My legs would get really tired, and if a ball hit my legs, they would bruise easily."
She said her Hawaii Medical Service Association health plan covered the cost.
Kistner and Dr. Fedor Lurie, also a vascular surgeon at the clinic, located the leakage with ultrasound and used a minimally invasive "closure" procedure to destroy the swollen veins.
The procedure involves inserting a thin wire or catheter into the vein and emitting heat from radio waves at the tip to make the vein shrink, Kistner described.
Kistner was a consultant to a company in 1995 trying to develop a simpler way to repair a leaking valve so an operation would not be necessary, he said. They found they could make a damaged valve work again if they left heat in long enough to make the veins shrink, he said.
He was the first to use the closure procedure in Hawaii at Straub, he said.
Development of ultrasound in 1994 also revolutionized the diagnosis of vein problems, he said.
Spider veins, closer to the skin's surface and smaller than varicose veins, are also important to research at his clinic, Kistner said.