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March/April Issue of Vein Specialist

Physicians-In-Training to Experts

Misaki Kiguchi, MD

Member, AVF Board of Directors

At VENOUS2023, the Physicians-In-Training sessions brought together trainees and early career physicians interested in learning more about how to diagnose and treat both superficial and deep venous disease. The faculty started from the basics by demonstrating ultrasound techniques, including live patient scanning. Participants were able to gain hands on experience with the newest endovenous ablation models and hear from the experts about which technique each prefers and why. The IVUS cases elicited varied opinions on sizing and brands of venous stents and how to avoid common pitfalls when using them. Thanks to Dr Lori Pounds and the volunteers, live sclerotherapy treatments provided attendees a close look at its technique, stimulating a lot of “tricks-of-the-trade” discussion among the faculty.

Exemplifying the AVF core values of inclusivity and diversity, trainees and early career physicians from South America, Central America, Canada, and Asia were in attendance, sharing with the group the specific challenges they face in their respective geographies in providing optimal venous care for our patients and starting a venous-focused practice. In keeping with the theme of VENOUS FOR ALL, the Physician-in-Training sessions allowed us to fully learn from each others’ expertise, experiences, and enthusiasm for treating vein disease.

Physician-In-Training Session Faculty

Misaki Kiguchi, MD

Steve Elias, MD

Kathleen Ozsvath, MD

Karem Harth, MD

Avianne Bunnell, MD, RVPI

Pamela Kim, MD

Eric Hager, MD

Thanks to all the AVF faculty, attendees, volunteer patients, and industry sponsors who made this session a success!

American Venous Forum Follows the Great Tradition of the Villavicencio & International Sessions

Ruth Bush, MD

President Elect, American Venous Forum

Tomasz Urbanek, MD

Chair, AVF International Committee

On Friday morning, February 24, 2023, Dr Ruth L. Bush from the USA and Dr Tomasz Urbanek from Poland opened this year’s Villavicencio & International Session during 2023 AVF Annual Meeting. This amazing and robust program is named after Dr Lionel Villavicencio (1926-2019), a Mexican native who advocated for care of patients with diseases of the venous and lymphatic systems in addition to the arterial circulation. 

At the invitation of Dr Norman Rich, he joined the faculty at the Uniformed Services School of Medicine and started the first venous and lymphatic clinic at Walter Reed Army Hospital and the Bethesda Naval Medical Center. Named after this founding member of the American Venous Forum, this year’s program brings together key opinion leaders from around the world celebrating Villavicencio and the international AVF membership.

The session began with stimulating research from the United Kingdom presented by Dr Rachael I. Morris, clinical research fellow in vascular surgery from King's College London and Guy's and St Thomas' NHS Foundation Trust. Dr Morris, a member of Professor Stephen Black's research group, presented a unique study on the impact of venous outflow obstruction on venous return to the heart (preload, cardiac function, and exercise tolerance evaluation before and after endovascular reconstruction in the patients with chronic venous obstruction). Dr Morris’s talk was recognized and awarded as the top oral presentation. Congratulations to Rachel and the entire research team!

Next, Neel V. Gadhoke, a medical student from Rutgers New Jersey Medical School and Center for Vein Restoration, discussed the patterns of reflux in C2 venous disease compared to C5/C6 venous disease. This interesting talk stimulated a robust discussion among the attendees.

From New Jersey, we moved to Austria with Dr Ferdinand Steinbacher presenting a unique experience on the clinical implementation of the high energy low frequency therapeutic ultrasound (HIFU) in the treatment of varicose veins and truncal vein incompetence. This new technology demonstrated promising results and a possible future addition to the treatment armamentarium for chronic venous diseases.

Following the HIFU demonstration, Dr Tomohiro Ogawa, from Fukushima, Japan discussed the clinical significance of mild reflux in the great saphenous vein. His study attempted to answer the question of whether reflux should be treated by endovenous ablation and stimulated an interesting discussion in the session auditorium.

In the next presentation, Dr Matthew Vuoncino, from the University of California, Davis focused on the identification of risk factors for recanalization of truncal veins following endoluminal ablation. Following him , Dr. Øystein H. Rognerud, Oslo University Hospital, Norway, presented a proposal for a novel hybrid procedure to improve the patency of iliofemoral stenting in patients with compromised infrainguinal inflow vessels in postthrombotic chronic venous obstruction. The session finished with a very thought-provoking talk on hypersensitivity reactions after cyanoacrylate closure for the treatment of incompetent superficial veins presented by Dr Kazuyo Sujino from Yokohama, Japan.

Undoubtedly, this year’s great Villavicencio & International Session confirmed the role and importance of international collaboration and knowledge exchange, a characteristic and benefit of the AVF. The session moderators and AVF thank all speakers for the interesting presentations, fascinating and robust research, and thought-provoking discussions. We invite all session participants to the next Villavicencio & International session to be held at VENOUS2024 in Tampa, Florida, USA.

Allied Health / Aesthetics Program
Energizes VENOUS2023

Lorraine Loretz, DPM, MSN, NP

Member, AVF Membership Committee

When the AVF Program Committee began planning for the historically popular Aesthetic Vein Session at VENOUS2023, they looked for a way to engage allied health member interest. Many, if not most, venous practices employ advanced practice providers (APPs, which include nurse practitioners and physician associates) and registered nurses. It is no secret that the majority of cosmetic vein services are delivered by APPs and RNs. There also has been unprecedented growth in delivery of cosmetic vein services within the medical aesthetic community. As AVF is a leader of venous education and research, the Program Committee decided to open the popular Aesthetic Program for virtual streaming to all physicians and allied health professionals free of charge.

While our focus was to create a robust variety of topics on sclerotherapy, there was growing interest for other venous education directed to our Allied Health membership. Without formal vascular training or residency for APPs, continuing education becomes the primary source of information for career development. Physicians also benefit from structured programs for their provider staff, clarifying roles in delivery of patient care.

The combined Allied Health/Aesthetic Program opened with a talk on the role of APPs in a vein center including an outline for orientation required for an APP in venous practice. Such orientation provides didactic information coupled with physician shadowing and progressive clinical management leading to independence in patient care responsibilities. Supplemental roles include vein center accreditation management, development of the venous cosmetic program, and community outreach. Post-session survey responses revealed near unanimous desire for more APP venous practice education to generate consistency in venous training of non-physician providers.

Subsequent presentations focused on cosmetic vein care, beginning with sclerotherapy science and histology-based recommendations. Sclerotherapy tips and tricks were greatly appreciated as was the presentation on complication management. A superb presentation on mechanical compression covered specifics of this modality, which is so important in care of the venous patient. Alternative cosmetic vein treatment with laser modalities and specialized treatment of hand, feet, and facial veins rounded out the topics. The session ended with a lively debate on sclerotherapy as provided by a vein center versus a medspa, followed by a live sclerotherapy demo. Consensus was reached that no matter where the service is offered, care must be evidence-based; providers must be trained to deliver procedures using standard of care techniques and protocols; vascular back-up should be available; and a future eye should be cast toward the exploration of competency credentialing.

With a robust attendance at the live session and double that number registered for virtual streaming, this year’s session was overwhelmingly successful. Post-session survey responses clarified a need for more frequent hands-on sclerotherapy training. As AVF strengthens its strategic plan for Allied Health professionals this year, educational offerings with a structured pathway to venous practice and further sclerotherapy instruction will be the focus of development for VENOUS2024. See you there!

Allied Health and Aesthetic Session Co-Moderators

Lorraine Loretz, DPM, MSN, NP

Private Practice, Shrewsbury, MA

Julianne Stoughton, MD, FACS

Division of Vascular and Endovascular Surgery
Massachusetts General Hospital
Harvard Medical School, Boston, MA

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