Vein Specialist

The case competition held during VENOUS2025 was a highly informative event that showcased some of our trainees’ excellent work. The session featured 14 cases covering various topics related to venous disease. Khanh Nguyen, MD, from Oregon Health & Science University (OHSU) organized this new initiative.

The event took place the evening of February 16, 2025. To encourage the spirit of collaboration, competitors joined four break-out groups; each with four presenters and a facilitator. The groups presented their cases and, through critical discussion, selected the best abstract from their group for a podium presentation. Four semi-finalists then presented their cases—with engaging phots and videos– from the podium, Finally, the audience used the audience response system on the conference phone app to vote for the best of the four selections based on the podium presentation. The winner of the best abstract presentation and the group that selected the winning abstract were recognized at the VENOUS2025 awards session on Wednesday, February 19, 2025.

The winner of the inaugural Case Competition was Andrew Huang, MD from the University of Michigan for Recurrent Deep Venous Thrombosis (DVT) Caused by Hip Ganglion Cyst. Eni Nako, MD from OHSU was the second-place winner for her case entitled When All Else Fails, Properly Placed Multilayer Compression Remains Paramount to Healing Recalcitrant Venous Leg Ulcers. The images of presentation were exquisite, the management of the case well explained, and the presentations enlightening.

The audience was very enthusiastic about the various presentations and engaged in lively discussions.  Overall, the case competition session of VENOUS2025 provided attendees with a wealth of knowledge and insights into the breadth of venous disease and gave the trainees an excellent platform to showcase their skills. The diverse range of topics and backgrounds of the speakers highlighted the quality of the science and the commitment to the trainees that the American Venous Forum offers at its annual meeting.

Coincident with annual meeting each year, AVF leadership transitions. We are so grateful for the investment and commitment made by our now Immediate Past President, Ruth L Bush, MD, JD. Into her shoes now steps Joseph Raffetto, MD, a vascular surgeon with a varied and fascinating background. We are thrilled to introduce you to Dr. Raffetto based on his responses to a few questions from AVF staff.

Tell us about your family.

I was born in Italy on a U.S. Army Base Camp Darby in Livorno. My father was a Lieutenant in the U.S. Army Intelligence and was stationed in Italy because he was fluent in Italian. My dad met my mom in Livorno at a ball and they soon married. My identical twin brother and I were born at Camp Darby; we lived in Italy for 10 years allowing us the chance to attend elementary school in Milano and Bologna. After my family moved to San Francisco, we welcomed my other brother, Michael.

My mother was an excellent homemaker, a U.S. citizen and was the driving force for me to be a better person. She had a passion for art and ran our family hotel, Hotel Manzoni in Montecatini Terme, Tuscany for 20 years. My father worked in national and international banking. He was a kind, accomplished, giving person who proudly served in the U.S. Army. Both my parents were instrumental in my achieving my medical goals, I would not have been able to do so otherwise.

What are your hobbies and passions outside of medicine?

My favorite and most relaxing times are being in the ocean. I love to surf and paddle board. I have also dived reaching Rescue Diver certification and working on my Divemaster. My favorite place to be is in Costa Rica. I have been to Costa Rica 28 times and each time there are new moments and experiences. My wife and I love the country so much there that we bought property and are building a home.

I love being outside and have run a fair amount including 24 marathons, 6 Boston Marathons for charity, and 1 ultramarathon with my twin brother in Tuscany which was incredible. I now like a walk-run hybrid approach to aerobic exercise, and do various strength and core exercises during the walk/run. I enjoy reading and, of course, love red wine and really good Italian food.

Tell us about your AVF journey.

In 1999, my two mentors—Dr. Menzoian and Dr. Park—encouraged me to apply for the Beiersdorf-Jobst Research Fellowship. I received the award at the annual meeting and launched my venous career in the basic sciences. At the same meeting, I also received the AVF Venous Research Award.

Since that time, I have become increasingly involved in the organization. I have served as chair of both the Program Committee and the Research Committee, as a councilor at large and on the Board of Directors. I am excited to assume the Presidency of AVF and look forward to leading the organization with purpose and intention.

What is your vision for the AVF in the coming years?

My vision for the AVF has several components, including but not limited to:

1. To encourage physicians in training and early career practitioners to engage in clinical and basic research in the field of venous disease.
2. To promote early career practitioners to engage in committee work that will be instructive and rewarding
3. To continually evaluate our educational needs to meet the demands of clinical practice and optimize patient care and outcomes
4. To prioritize the knowledge gaps that affect the management of patient care and provide avenues toward establishing effective research studies to affect best practices
5. To increase our partnership with industry to answer unanswered questions and address research questions that will improve our measured patient outcomes and relations with health policy
6. To continually self-assess our AVF societies strengths and areas to improve (SWOT analysis) and make meaningful changes that will have positive impacts on education, research, leadership, community service, and patient care
7. To build our relations with our International Community and worldwide venous societies, and provide the support and expertise to promote equitable and rewarding clinical outcomes, collaboration in clinical research and mutual interests, and foster growing relationships to expand the knowledge to be shared throughout the world
8. To expand our membership for all clinicians, advanced clinical practitioners, technologists, scientist, industry, and administrators, providing a diverse society that offers opportunities and a learning environment for each person to build self efficacy, professional development, and the breadth of venous disease fundamentals and governance.

The AVF is excited about Dr. Raffetto’s presidency. We look forward to sharing more about his perspectives and vision over the coming months.

The implementation of the Lymphedema Treatment Act (LTA) on January 1, 2024, marked a milestone for patients who require compression therapy. However, challenges remain in ensuring comprehensive coverage and appropriate reimbursement.

The USMCA has dedicated significant advocacy efforts to expanding the Healthcare Common Procedure Coding System (HCPCS) landscape. More than 25,000 different lymphedema compression garment products are on the market, and the Centers for Medicare and Medicaid Services (CMS) initially published just 78 HCPCS codes. The USMCA submitted numerous HCPCS applications and during the November 2024 public meeting was successful in securing 12 new and revised codes that will be effective April 1, 2025. More codes and fee schedule adjustments are needed in the future to best represent clinical practice and market rates.

What Doctors Need to Know

Physicians play a vital role in ensuring their patients receive the compression therapy they need. For Medicare beneficiaries, in the absence of a medical policy, coverage is still being determined on a case-by-case basis by the Durable Medical Equipment Medicare Administrative Contactors (DME MACs). In their documentation, providers should:

• Diagnose patients with the appropriate ICD-10 code, as lymphedema-specific codes are required for reimbursement (I89.0, Q82.0, I97.2, or I97.89).
• Specify the affected anatomical areas.
• Determine whether the patient requires custom or off-the-shelf products and provide supporting documentation explaining why.
• Consider both daytime and nighttime compression needs.
• Reaffirm compression garments as part of the patient’s ongoing treatment plan during annual check-ups.

The USMCA continues to engage with key stakeholders and will advocate for accessible coverage across national and state payers. Providers, patients, and suppliers are encouraged to share denials and participate in advocacy efforts to ensure lymphedema patients receive the compression therapy they need.

For more details and resources, visit www.usmedicalcompressionalliance.com.