Vein Specialist

AVF Newsletter

July/August 2022

Table of Contents

Message from the Editor
Steve Elias, MD

Message from the President
William Marston, MD

Membership

Reflection on AVF Membership
Pavel Kabrik, MD

Fellows Course Highlights
Misaki Kiguchi, MD

Did You Miss This Event?
Daniel Monahan, MD

Knowledge Diffusion through Social Media: Crossroads for Venous Pathology Learning
Antonio Solano, MD and AVF Digital Media Committee

A New Book for a New Year: The Healthy Veins Book
John Blebea, MD and Beverly Chan, MD

Welcome New AVF Members
September/October

International

On February 24th
Phlebologist from Ukraine

Invitation to EVF in Berlin 2023
Erika Mendoza, MD

Getting to Know Latin America
Alvaro Orrego, MD

Venous Leg Ulcers: An Overview
Rashad Bishara,MS, RPVI, FRCS

Copyright © 2022 by The American Venous Forum. All rights reserved.

EDITOR-IN-CHIEF
Steve Elias, MD 

EXECUTIVE EDITOR
John Forbes, MBA 

MANAGING EDITOR
Allie Woodward 

PUBLICATION DESIGNER
Christine Rataj 

Message from the Editor

Steve Elias, MD
Editor-in-Chief, AVF Newsletter
Communications Councilor, AVF Board of Directors
 

Time Is a Jet Plane

Is the term “jet plane” an oxymoron or just not right? When we travel in 2022 most of us get on a jet. But we probably text our loved ones, “getting on the plane now.” Why the improper use of the word “plane”? I don’t know. When we see someone with a DVT most of us ask, “Have you taken a long plane ride recently?” This is relatively unlikely. Not too many commercial plane flights around. How awkward would the words, “Have you taken a long jet ride recently?” sound. Unless your patient is Chuck Yeager. He flew a lot of jets, but Chuck is dead so don’t worry; you won’t be seeing him.

It is the 16th century and the French word jeter emerged. It is derived from the Late Latin word lectare meaning to throw, to toss, impel. By the way, the first jet was the German Messerschmidt ME 62. Those Germans. Along with the jet came “jet lag,” the greatly feared ailment of many travelers. But let’s get back to what started these thoughts, Bob Dylan’s words in the song You’re A Big Girl Now: “time is a jet plane, it moves too fast,” Time is not a jet plane and it doesn’t move too fast. What was the man thinking? Well, to be fair, many times no one quite knows what the man was thinking. All I know is that most upscale magazines, websites, and the New York Times seem to be obsessed with time and watches.

If you want to know the exact time, just look at your phone. If you want to enjoy the visual, emotive sensation of time, look at your watch. Not your everyday, plebeian, plain watch, but your overpriced, unnecessary watch: Rolex, Vacheron Constantine, Panerai, Hublot, IWC, etc. Unnecessary, but coveted by some. Peruse any of the upscale magazines, websites or the New York Times and see a multitude of advertisements for these unnecessary but apparently needed watches to tell you the same time that your cell phone does. Maybe time is not the only point.

This issue of Vein Specialist doesn’t have you wonder, “What is the point?” We tell you: membership. This issue is member centric. Bill Marston’s letter basically tells us what AVF members have been doing for the AVF. A lot has been accomplished this year, but nothing could have been accomplished without member involvement, time, effort. A very personal letter by Pavel Kabrik succinctly tells us what new members experience when they join. Don’t underestimate your impact on new members. In life, sooner or later, it is all personal. Fellows and Early Career members or potential members are where the majority of our growth will come from. Misaki Kiguchi lets us know how successful the most recent Seattle Fellows/Early Career course was. And it was fun. It could not have happened without industry support. Antonio Solano writes about what our members of the Social Media Committee have been doing. They have been doing a lot. Our social media presence is key to involving our members in 2023 and beyond. The old days are just about over. The Healthy Veins Book is finished. John Blebea interviewed by Beverly Chan tells us how it was conceived and how it was completed. Again, a work by many members giving their time. Finally, we hear from our international members – Latin America, Egypt/Africa, Europe, and Ukraine. AVF has a lot of OUS members contributing a lot to AVF. It is time all members understand that even though our name includes the word “American,” about 25% of our members are OUS.

Speaking of time, is it time to understand which US cities have a rat problem? You know those rats. Scary creatures with a bad rap. Chicago, NYC, and Los Angeles lead the list of those with a rat problem. Not surprising, a lot of people want to live in these cities; I guess the rats do as well. I’ve never seen a rat. Nasty, scary, aggressive creatures. Really? Maybe not. They are relatively smart as far as nasty, scary, aggressive creatures can be. They have been trained to successfully search for earthquake and landmine victims. I just don’t want to think about what the rats do once they find the victims. And so we have come full circle, the oxymoron: jet plane, nice rats. Contradictory terms that may mean something in the right context. We hope this issue has reinforced the AVF concept of unity and focus of purpose: our members and the pursuit of science. No one is an oxymoron. The image of time as a jet plane moving too fast with Dylan wearing a Panerai watch being tracked down by predatory rats in NYC may seem incomprehensible. This issue of Vein Specialist is not. It keeps you grounded, focused, and safe from the ravages of time and rats. Take a breath. Relax. You’ve got time and there are no rats. See you at the annual meeting with our fellow members.  

Message from the President

William Marston, MD
President, American Venous Forum

Serving as president of the entire membership of the American Venous Forum is a tremendous honor.  I have always considered the AVF to be the pinnacle of venous research and science. Since my early days in the society, I have learned so much from members and leaders of the AVF who were excellent mentors to me. I am very excited about the current status of the Forum and the potential we have in the coming years to grow the capabilities, influence, and impact of our society.

In the past year, under the leadership of President Tony Gasparis and Executive Director John Forbes, the AVF has made great strides in expanding its educational offerings, establishing a strong operational base, and diversifying income sources to be less dependent on industry. As a result of the energetic leadership of your Board of Directors, our committees, and our outstanding staff, a number of impactful programs were developed and brought to fruition. Among them are:

• The AVF-BSCI Translational Research Grant.

A new grant for translational venous disease was initiated with the support of Boston Scientific, providing $85,000 for an original, translational research project in venous disease.

• The AVF developed the capability to produce, market, and manage numerous educational webinars, many supported by industry.
• Partnership with Intervein China, a venous society in China, on a series of international webcasts to discuss and exchange ideas on the management of venous/lymphatic disease. Six webcasts were completed in 2021 with 9 planned for 2022.
• The launch of the Venous Policy Navigator, a subscription-based tool containing up-to-date requirements from more than 330 payers to assist with billing and reimbursement of venous procedures.
• The introduction of Venous Classification Workbooks for the new CEAP and pelvic venous disease systems. Each offers CME credits.
• Infrastructure to design and manage multicenter prospective clinical trials in collaboration with the University of Maryland.

The JURY trial, the initial study, is nearing completion of patient enrollment at this time.

• The successful merger of the AVF with the American Venous Forum Foundation, which has already enabled the AVF to operate with greater efficiency while streamlining our mission-centered activities.

These efforts have charted a direction for the AVF where we are increasing our administrative capabilities to support the ideas produced by our committees. AVF members are clearly the thought leaders in the venous space. Continuing this trajectory in the current and coming years is critical to the health of our society as well as the health of our patients.

In 2022, we have already achieved several new accomplishments including:

• A very successful Annual Meeting, VENOUS2022, which attracted nearly 600 attendees from all over the world.
• The AVF basic science grant, specifically to support basic science in the venous and lymphatic areas. This grant will initially be supported by a $15,000 annual stipend with efforts being taken in the coming year for growth.
• Establishment of a new Documents Review Committee to assist in final preparation of AVF-developed documents for publication as well as documents submitted from outside entities for AVF review and support.
• Significant new guidelines:
  • AVF/SVS/AVLS varicose veins guidelines
  • Part 1 of the new VV guidelines has been completed and submitted for publication
  • AVF/SVS guidelines on the management of upper extremity DVT
  • Significant progress with final guidelines expected within the next 6 months
• Completion of The Healthy Veins Bookslated for publication in January 2023.

As we continue to work on these and other important projects, as well as prepare for VENOUS2023, I would like to highlight a major emphasis for the current year. As you are aware, patients with venous disease are diverse in many ways and clinicians interested in the treatment of venous/lymphatic disease are becoming increasingly diverse. AVF leadership believes that it is critically important for the Forum to support diversity, equity, and inclusion in its fundamental core values. A new ad hoc DEI committee was established earlier this year, co-chaired by Drs Ruth Bush and Kathleen Ozsvath. The committee is examining all aspects of AVF operations, programs, and initiatives to identify areas for support and improvement of our DEI goals. VENOUS2023 will have a significant focus on DEI with specific sessions throughout the meeting including research and discussions related to the management of venous disease in diverse populations. Diversity among those presenting information to the Forum will also be a significant focus in planning.

Chair of the AVF DEI Committee,
Ruth Bush

Chair of the AVF DEI Committee,
Kathleen Ozsvath

I would like to emphasize one extremely important aspect of membership in the AVF. As all of you are aware, the AVF is a member-driven society. We exist and thrive primarily due to the energy and engagement of our membership. We can do more if we have more members who are interested and able to do the work of the society. The real output of the society comes from the “under the radar” work of each of our committees on a daily basis. Examples of this work include:

1. Guidelines committee members who do literature searches to identify evidence for guidelines.
2. Research committee members who review and score grants.
3. Program committee members who review and score abstracts.
4. Communications committee members who write articles for the newsletter.

These are only a few of many examples, but this is how the AVF creates important output that improves the care of our patients. Without volunteer members willing to do this work we cannot remain relevant.

I realize that it may be difficult to understand how to become involved in the work of the society. The fact is that we need all members who have an interest in assisting the Forum and the time to do so. Annually, near the end of the year, we forward to the complete membership a request for volunteers. Members indicate their committee preferences, and we do our best to match volunteers to committees of their choice. This year more than 90% of members who volunteered were able to be placed on one of their committee choices. We invite all AVF members to let us know how they would like to participate in the work of the Forum.

I am very excited about the preparations underway for VENOUS2023. The program committee led by Chair Mikel Sadek is developing an exciting program and is currently evaluating an excellent pool of abstracts submitted for the meeting. I am confident that the program will support the long-term reputation of the AVF meeting as the source of the most impactful venous research meeting of the year. In addition, the meeting will allow excellent opportunities for networking, peer support, and re-engaging with those that you may have lost touch with during the pandemic. I hope that all of you will make plans to join me in San Antonio February 20-23 at the beautiful La Cantera Resort for VENOUS2023. I look forward to seeing you there.

Sincerely,
Bill William Marston, MD
President, American Venous Forum

Reflection on AVF Membership

Pavel Kabrik, MD
Member, AVF Membership Committee

 

As someone who was recently placed on the AVF’s Membership Committee, I began to look back on how I became a member of the AVF.

As a student, I had the opportunity to begin research in venous disease. At that time, vascular surgery was a relatively new field to me, and I knew even less about the venous disease aspect of the field. The people who first got me interested in vascular surgery and, particularly, in venous disease were Drs Anil Hingorani and Enrico Ascher. They introduced me to the American Venous Forum, which I joined in 2019. At the time, I believed it would help further my interest in the venous field through what I learned by going to meetings and getting more exposure which I could then translate to clinical practice in the future– along with furthering my research interests.

As an AVF member, I have further learned of all the benefits of being a member. The AVF has helped me increase my interest in the venous disease realm of vascular surgery, helped me find mentors such as Dr Windsor Ting, and experience various educational benefits. Being around those who have similar interests in the venous field in terms of research and helping advance the care of patients with venous disease has become the most valuable aspect of being part of the society. A particular area of interest, which I believe anyone interested in vascular surgery should have, is chronic venous insufficiency. Given how prevalent it is in the population and the need for physicians and allied health members, including those outside of vascular surgery, to recognize the disease process makes it a growing priority.

I would like to invite anyone with an interest in treating venous and lymphatic disease, both physicians and allied health members alike along with students who wish to become vascular surgeons, to consider joining the American Venous Forum. By becoming a member of the AVF, you will reap the benefits of being of a member of this society, which can be used for the rest of your career.

Join the AVF by November 30, 2022 to receive the following bonuses*:

• $100 off AVF membership dues for 2023. Includes up to 3 free months of membership. Membership will be valid through December 31, 2023.
  Enter this discount code at application checkout: BAM!2022
• Choice of $125 discount for VENOUS2023 registration OR$100 coupon for ShopAVF.

*New member bonuses are limited to new Physician Members (National & International) and Recent Graduate Members.

Learn more here.

Fellows Course Highlights

Misaki Kiguchi, MD
Chair, AVF Early Career Committee
Member, AVF Digital Media Committee

The AVF Fellows and Early Career Course and the West Coast Vein Forum this year took place at the same time and same venue on September 22-24 at the Edgewater Hotel in Seattle, Washington. The Fellows Course had 56 participants including faculty. As has been tradition, each fellow was able to attend free of cost – thanks to the support of our industry partners and AVF.

The AVF Early Career Committee planned a unique case-based learning environment that allowed constant interaction between faculty and fellows in a unique, intimate, small-group setting. From Dr Steve Elias’s running around the room asking fellows, “What would you do?” to Dr Carson and Dr Kiguchi’s discussing practical solutions to complications of superficial vein treatments in their own practices, the sessions were filled with lively discussion. Drs Attaran, Harth, and Hedayati all provided excellent talks on “tips and tricks” phlebectomy, current VTE guidelines, and how to choose one superficial venous ablation technique over another. Their enthusiasm in teaching these young fellows was palpable. Thanks to all of the speakers who devoted their time in preparation and attending!

The highlight of our program included “live” sessions on real patients. Without the support of Drs Meissner and Gibson who were able to provide appropriate patients from their practices, this opportunity for our fellows to see ultrasound and sclerotherapy live and up-close would not have been possible. The case-based scenarios provided by Philips and their IVUS machine with pre-recorded case scenarios enabled fellows to interpret common deep venous suprainguinal pathologies. The Fellows Course was supported by 9 corporate sponsors and 13 exhibit tables. This immersive industry support allowed each fellow to rotate through a hands-on station to try out devices and products.

Thanks to our integrated program with the West Coast Vein Forum, our fellows were also able to experience the expertise from headliner faculty, including Drs Kathy Gibson, Fedor Lurie, Bill Marston, Steven Abramowitz, and Mark Meissner. Their insight on developing a vein practice, the future of venous training, and reimbursements was invaluable to this early-career crowd.

The AVF Early Career Committee is committed to encouraging the “next wave” of venous leaders to get involved in the AVF and we hope the Fall Fellows Course was a testament to this commitment. Please join us and have your fellows and residents join us at the AVF Annual VENOUS 2023 Meeting in San Antonio, TX on February 22-25 for more hands-on, live trainee and early career orientation programing.

Thank you to our sponsors

DID YOU MISS THIS EVENT?

Daniel Monahan, MD
AVF Education Councilor
Member, AVF Board of Directors

The 5th West Coast Vein Forum (WCVF) was held in Seattle September 22-24 – this time in parallel with the Fall Fellows and Early Career Course in the same venue. The Early Career course was well-attended; the WCVF less so.  But despite smaller numbers, everyone had a great experience. Our headliner faculty at WCVF included Drs Kathy Gibson, Fedor Lurie, Bill Marston, and Mark Meissner. Their spectacular presentations taught me that those involved with research have a special insight into the rest of the scientific literature.  Huge thanks and appreciation to them all.

I want to thank Dr Elna Masuda, who has been a huge supporter of the meeting and added her insights as we planned it and to our committee that created the program with experienced vein practitioners in mind. Many thanks also to our AVF administration who orchestrated the whole meeting, with different meeting rooms and audiences and arranging meals and receptions. The meeting took place in the beautiful Edgewater Hotel with a storied rock-and-roll past, right on the water in Seattle, which provided excellent service and spectacular ambience. Drs Eri Fukaya and Kanhe Nguyen graciously attended and presented their Jobst Winners presentations (for 2021 and 2022) with timely updates. Finally, a ton of appreciation for our industry sponsors without whom the meeting could not happen and for their engagement with all attending.

Topics ranged the gamut of vein treatment issues from spider vein sclerotherapy to complex ilio-caval reconstructions. We also had combined sessions with the Early Career group which enabled interactions of more experienced with newer vein practitioners. Those attending all said it was the best meeting they’ve been to and would definitely come again. The faculty also expressed their pleasure with a smaller group and more intimate interactions and hope there will be future WCVF meetings.

WCVF’s mission from the beginning has been to address challenges and controversies in vein treatment with an initial West Coast-centric attitude. Current practices are generally reviewed, and then engaging situations where the science is indefinite, with best recommendations presented. Our speakers are well-known experts and leaders in the vein field, many of whom hold or have held top leadership positions in our societies. Lively discussion occurred as one or more had stronger feelings about management in various complicated situations. Our committee recognizes that often the best encounters and conversations at scientific meetings are in the hallways. Our goal has been to bring those conversations into the larger group setting. The venues have been selected so attendees don’t have to miss a lot of work, but can also opt to spend a few days in locations like Napa Valley, Monterey, Dana Point, Lake Tahoe and this year, Seattle. If, and when, we meet again, I hope many of you will join us.

Knowledge Diffusion through Social Media: Crossroads for Venous Pathology Learning

Antonio Solano, MD
Member, AVF Digital Media Committee

In past years, social media has allowed people to keep in touch with individuals all around the world. The transmission of information is migrating from newspapers and television to academic and social platforms, supporting globalization of knowledge. Regarding medical practice, trends have shown physicians’ engagement to exchange their own clinical opinion and advise with immediate circulation. In just seconds, Twitter can help you get an answer for your next surgical planning or start debate of current treatment practices between peers. Thus, the technological era poses a wide spectrum of possibilities to enrich venous knowledge.

The AVF Digital Committee created #PollOfTheWeek, an initiative aimed to address daily clinical practice topics as well as discussion of venous pathology guidelines. We want to open a new space for knowledge interchange among colleagues, endorsing continuous learning. From trainees to experienced vascular surgeons, anyone can participate in this online round table. Now, the crossroads for venous pathology learning is just a click away.

Be a part of the conversation – Follow @VenousForum for Twitter!

A New Book for A New Year: The Healthy Veins Book

John Blebea, MD
Past President, American Venous Forum

Beverly Chan, MD
Chair, AVF Patient Education Committee

Dr Beverly Chan, Chair of the AVF Patient Education Committee, interviewed Dr John Blebea, past president of the American Venous Forum, treasurer of American Vein and Lymphatic Society, and clinical professor of vascular surgery at Central Michigan University College of Medicine, about the soon-to-be-published patient-focused The Healthy Veins Book: Understanding Varicose Veins and Leg Swelling.  The full-color, lavishly illustrated 40-chapter book represents the work of 53 authors under Dr Blebea’s editorship and will be available in hardcover and digital formats in December.

Dr Chan: Dr Blebea, you have written more than  250 publications, mentored 3 decades of residents and fellows, and have focused on venous disease throughout your career. Tell Vein Specialist readers what was your inspiration for The Healthy Veins Book.

Dr Blebea: Like most things in medicine, this book builds on the efforts of others in the past. The first edition of the Handbook of Venous and Lymphatic Disorders in 1996 provided the template for the definitive textbook on venous and lymphatic diseases for clinicians. (By the way, the 5th edition will be coming out in 2023, under the editorship of Dr Peter Gloviczki.) It was later thought that a companion resource for patients would also be helpful. Therefore, under the leadership of Drs Michael Dalsing and Gary Lemmon, the AVF developed an on-line book, The Layman’s Handbook of Venous Disorders, with 20 chapters from the clinician’s Handbook adapted and re-written for lay people. This resource was available on our website, but I thought that it was time both for an updated and more comprehensive book specifically written for the public.     

Dr Chan:   So how did it come to fruition?

Dr Blebea: We were fortunate to receive a $50,000 educational grant from the Bristol-Meyers Squibb Foundation to get us started. Since that initial grant, we have received continued support and further funding from the AVF Foundation, which represents the contributions of our members and industry supporters. Needless to say, getting this book written and published required the efforts of many people besides myself. The Healthy Veins Book was made possible because of the tremendous contributions of 53 leading experts in venous disease in the United States and Canada representing 42 different institutions. In addition, we had Ms. Deborah McBride to help with editorial development and publishing, along with the administrative leadership of the American Venous Forum, led by its Executive Director John Forbes and Director of Mission Advancement Jeff Mendola. Multiple companies also graciously allowed our use of images of their products, which will be very helpful to readers.

Dr Chan:  What makes this book different from others already published?

Dr Blebea: There is no other comparable book. It is the only book specifically written for patients with venous disease. At 256 pages in a hard cover format, it provides in its 40 chapters a comprehensive yet understandable review of the entire range of venous disease. We include chapters on the anatomy and pathophysiology of varicose veins, deep venous disease, blood clotting disorders, lymphedema, and pelvic venous insufficiency, among other topics. As would be expected, the natural history and treatment options for each of these disorders are also included. More than 150 color illustrations and diagrams clarify the content.

Dr Chan:  What kind of frustrations do you find with your vein patients when they come to see you? How will this book help?

Dr Blebea: When we see new patients in consultation, we try to explain to them as thoroughly as possible their likely diagnosis and recommendations for treatment. For patients with venous disease, they will often be seen a second time before an interventional procedure. However, present-day clinicians have only a limited amount of time to examine a patient, talk to them about their problem, and complete the inevitable paperwork associated with required documentation and procedure scheduling. Most of us attempt to enhance the patient’s understanding by giving them a copy of a detailed informed consent document– such as those developed by the AVF– or a descriptive brochure. This book will provide patients with a much more detailed and comprehensive explanation of their venous disease and potential treatments. The chapters were specifically written so that they can be read and understood independently of each other. Therefore, a patient being prescribed compression stockings need only read the chapter by Dr Joseph Caprini or someone about to undergo cyanoacrylate adhesive closure the chapters by Drs Allesandra Puggioni and Steve Elias. Each chapter has commonly asked questions that most people have about their venous problem which they often forgot to ask during their office visit. The book also has a detailed Index and Glossary w