The American Venous Forum (AVF) is pleased to announce the establishment of a new leadership position—Chief Scientific Advisor—to guide the organization’s expanding research and scientific priorities. AVF Past President Brajesh K. Lal, MD, a distinguished vascular surgeon and long-time AVF leader, has accepted the appointment.

Dr. Lal has been a driving force behind the AVF’s growth as the scientific leader in venous and lymphatic disease. His commitment and expertise are exemplary. Through his extensive collaboration with the University of Maryland and industry partners, he has helped build a strong, credible infrastructure positioning the AVF at the forefront of clinical research, education, and innovation in the field. His leadership has been instrumental in advancing numerous AVF-supported research initiatives, including the Boston Scientific JURY-2 clinical trial and Translational Research Grant, the Jobst Clinical Grant, the AVF Basic Science Grant, and the Inari DEFIANCE trial.

As Chief Scientific Advisor, Dr. Lal will provide strategic oversight for AVF’s scientific agenda and research operations, working closely with the AVF Research Committee and Executive Leadership to:

• Guide AVF’s research strategy and priorities
• Oversee management of ongoing and future AVF research projects
• Develop new protocols and collaborative opportunities with industry and academic partners
• Support fundraising and grant development efforts to sustain and expand AVF’s research mission
• Promote collaborative use of venous registries
• Provide guidance in developing future evidence based guidelines

This unique appointment reinforces AVF’s commitment to advancing evidence-based venous and lymphatic care and distinguishes the organization as a leader among medical societies. By investing in dedicated scientific leadership, AVF aims to strengthen its competitive advantage, enhance credibility with partners, and ensure continued progress in research and clinical innovation.

Dr. Lal serves as Professor of Vascular Surgery at the University of Maryland School of Medicine, where he leads groundbreaking work in vascular diagnostics, clinical trials, and translational research. He has authored numerous  peer-reviewed publications and has been a steadfast advocate for scientific rigor and collaboration within the venous and lymphatic community.

Learn more about Dr. Lal’s work →

The AVF congratulates Dr. Lal on his new role as Chief Scientific Advisor and looks forward to his continued leadership in shaping the American Venous Forum’s scientific future.

The Annual Venous Early Career Course was held in Chicago September 26-27, 2025. A multi-disciplinary faculty of 7 experts hosted 45 early career clinicians who were flown in from as far afield as Japan. Nearly all attendee travel and lodging were funded by the generous donation of our industry partners . Over the 2 days of interactive, case-based discussion, the attendees were introduced to the entire spectrum of venous and lymphatic medicine. This year, the talks also included open venous procedures and high-risk venous thromboembolism therapy. Two faculty members presented their “worst nightmare” cases. Several industry hands-on sessions allowed participants to evaluate novel technology including interventional devices, adjustable compression wear, and lymphedema pumps. One of the highlights was the live patient demonstration and  vascular ultrasound.

The attendees, as in previous years, raved about the course and rated it as a wonderful experience. Reflecting on the time I’ve spent with the AVF Early Career committee, I believe its success is due to many factors including the caliber of the faculty, who are a multi-disciplinary group with immense and broad experience including participants in device development and trials, guideline and textbook authors. But even more important, has been the emphasis on judgment. Early career venous specialists learn about a range of devices, techniques, and interventions. However, the better clinician must learn to select the right patient for the right procedure, and know when not to intervene.

As in previous years, an early career session will also be held at AVF 2026 in Denver February 28-March 4.

From July 1 to July 18, 2025, I attended virtual lectures at the University of Texas Medical Branch’s  Department of Space Medicine, thanks to an introduction from Ruth Bush, MD, JD, MPH. I am deeply grateful to Dr Bush for her tremendous support in making this significant opportunity possible. I also appreciate Dr Rashad Bishara’s support.

My first space-related experience dates back to my high school days. My parents, concerned about my poor academic performance, hired a medical student tutor for me. That tutor was Satoshi Furukawa, who would later become an astronaut. One day he took me out for a drive. Sitting in the passenger seat of his 1980 Toyota Supra sports car, speeding down Honmoku Street in Yokohama 40 years ago with a future astronaut at the wheel was an unforgettable moment. Ever since my hero became an astronaut, space has always been in my thoughts.

Later, while examining venous disorders and lymphedema in daily clinical practice, I began pondering: “How would the condition change if we removed gravity from the veins and lymphatic system?” I started researching whether I could study this more systematically.

Studying space medicine in Japan is not easy. The Japan Aerospace Exploration Agency (JAXA) offers an excellent environment, but access is difficult. Only 5 universities’ medical schools offer space medicine courses. There is only one academic society: the Japanese Society for Space Environmental Medicine. It is extremely difficult for clinicians to find an entry point.

Further, as I continued studying space medicine, I realized that few things are understood about the venous lymphatic system. At the session on space medicine during the 2023 joint AVLS and UIP conference in Miami, it was explicitly stated that almost nothing is known regarding the venous system change during spaceflight. It was truly shocking.

Against this backdrop, thanks to the tremendous support of Dr Bush, I passed the document screening for the Principles of Aviation and Space Medicine course.

The course included 40 young space medicine specialists attending from around the world. The content of the lectures ranged beyond medicine, covering topics from physics—such as what G-force is—to concepts for next-generation space stations, new spacecraft, and design of lunar stations. Presentations were given not only by NASA, but also by private space companies. Beyond space-related topics, lectures covered aviation, diving, barotrauma, and health management in extreme environments.

Many conditions beyond venous lymphatic issues were emphasized, including ophthalmology’s Spaceflight-Associated Neuro-Ocular Syndrome (SANS), otolaryngology’s motion sickness, orthopedics and rehabilitation’s osteoporosis and muscle atrophy, psychiatry’s mental health, surgical procedures includong remote operation in space, and urology’s urinary tract stones–all receiving significant explanation time.

Overall, the emphasis was strongly on preventive medicine and public health approaches rather than drug-based treatments. This is because astronauts’ health is a fundamental prerequisite to date, and due to restrictions on bringing flammable materials into the ISS or spacecraft.

Throughout all lectures, only 2 hours touched on the circulatory system and venous lymphatics. This is not because they are unimportant, but rather because much remains unexplored and unknown. However, in 2019, a blood clot was discovered in the left internal jugular vein of a healthy astronaut, suddenly making it a hot topic. Causes were examined from various angles, but the situation remains unclear with no definitive answers. Additionally, circulating blood volume decreases by 70%, and body fluids shift toward the head increasing arrhythmias. Step-by-step, the left heart system becomes atrophied.

Not only microgravity, but radiation stress is also significant. Cosmic radiation is ionizing radiation present in the space environment, consisting of electromagnetic waves like X-rays and gamma rays, as well as particle radiation such as protons, neutrons, electrons, alpha particles, and heavy particles. Earth is protected from cosmic rays by its strong magnetic field and atmosphere. The moon has no atmosphere or magnetic field and gravity is 0.3G. Mars has gravity of 0.6G, an atmosphere with the atmospheric pressure 0.01 atm, and no magnetic field. Beyond the space station, shielding is also a major challenge for lunar habitation and Mars exploration.

While applying for joint research with NASA, ESA, or JAXA is an option, scientific research related to space seems to have quite high barriers. Parabolic flights, often used for microgravity experiments, are also costly, making research methods quite challenging. Finding low-cost research methods—such as focusing on head-down bed rest, mice tail-up models, in vitro studies, and radiation—might be crucial for practical reasons.

The space-related industries, including IT, aviation, and legal frameworks, continue to grow at an annual rate of 9%. The momentum of commercial spaceflight is also accelerating, and even those people with history of several diseases will increasingly venture into space. Long-term stays on space stations, short-term stays in commercial spaceflight, bodily changes under artificial gravity, the moon’s environment, and Mars’ environment all present questions: What happens to our bodies? How risky is it? A vast, unexplored frontier lies particularly within the lymphatic and venous systems, suggesting much work remains to be done. It would be great if more vein specialists tackled this.

Figure Caption:
(A)Mr Satoshi Furukawa, Astronaut (Photo. from JAL Foundation)
(B)Honmoku Street, Yokohama (Photo. by hamarepo.com)
(C)(D)TOYOTA 1980’s Supra (Photo. by HIROKI_KOZUKA)

There are significant gaps across physician specialties and institutions regarding the treatment of venous thromboembolism (VTE), such as with pulmonary embolism (PE), where there are often delays in care and misdiagnosis. Given the prevalence of VTE, American Venous Forum and other leaders in blood clot care created Get Out the Clot to address discrepancies in treating VTE. The campaign aims to work toward standardizing care for blood clot conditions, including expanding access to the latest innovations to improve patient outcomes.

The Get Out the Clot initiative has released the results of a survey to assess the state of VTE care in the U.S. This multidisciplinary survey of 269 healthcare professionals involved in the treatment of VTE, including interventionists and non-interventionists, reveals inconsistencies in how PE and deep vein thrombosis (DVT) are treated, highlighting the need for more standardized care protocols.

The findings reveal:

Divergent Treatment Patterns

• Only 56% of interventionalists surveyed believe their protocols provide clear direction based on PE risk beyond medical management and treatment approaches vary, even for patients with the same risk profile.
• More than 50% of physicians surveyed do not have a formal response team at their institution, such as a pulmonary embolism response team (PERT) or venous thromboembolism response team.
• Just 35% of survey participants perceive the ultimate treatment decision to be made by consensus among specialties.

Advanced Therapies Are Steadily Gaining Adoption

• Interventionalists believe the benefits of newer advanced treatment options such as mechanical thrombectomy and CAVT can improve patient outcomes, including:
• minimizing ICU stays (57%) and
• rapidly improving hemodynamics (55%).

Similar Trends in DVT Care

• Only 39% of interventionalists surveyed believe that their protocols provide clear direction for DVT treatment beyond medical management, and approaches vary across patient types.
• While nearly half of DVT patients are currently treated with anticoagulation alone, 71% of interventionalists surveyed say that they would like to see their hospital expand use of thrombectomy for DVT.
• 70% of interventionalists believe the most recent innovations in DVT treatment with thrombectomy improve patient outcomes.

See the State of VTE Care Infographic, for more details and findings.

Get Out the Clot is a collaborative educational initiative uniting American Venous Forum, International Society on Thrombosis and Haemostasis, National Blood Clot Alliance, Penumbra, The PERT Consortium® and Society for Vascular Medicine.

If you’re among those who passed up the chance to take your company’s course on AI-skills building, or decided to play in a softball league instead of attending a nighttime AI-training class, you may be in for some serious regret. No, it’s not about losing your job to AI—it’s about parlaying your expertise in a long-sought increase in pay.

Indeed, there is a new hiring spree in town. While the job market remains frustratingly tight in most cases, some firms are harking back to the days of the Great Resignation by making fantastic-sounding offers to people who have domain and AI skills together. Lawyers with AI skills, for example, now earn more than twice as much as their non-AI-skilled peers, according to  , while elite candidates in the tech field have been the beneficiaries of a headline-grabbing hiring spree. There are even compensation premiums for people who understand AI adoption and automation across less glamorous specialties like logistics and manufacturing. “It’s a new ball game,” says compensation expert Tom McMullen, senior client partner at Korn Ferry. “Companies are really rethinking how they reward people based on these emerging skill sets.”

To be sure, skills-based compensation has been around for decades (remember when fluency with Microsoft Excel was worth listing on a résumé?), and companies have long paid premiums for the skills that are critical to their success—sometimes to their own detriment. “Corporations get very enamored with the newest hot capability,” says Ron Seifert, North America workforce reward and benefits leader at Korn Ferry. But AI expertise is receiving unique compensation attention, largely because Gen AI has emerged and captured virtually every industry in just two and a half years, and firms need people who can lead their corporate AI strategies. “The skills that were important five years ago just aren’t important right now,” says Shanda Mints, vice president for RPO analytics and implementation at Korn Ferry.  “Instead, it’s very niche skills that people have because they didn’t go down the beaten path.”

The question, of course, is how to compensate for these hard-to-find skills. Experts advise that rather than paying for the skills themselves, firms buy the outcomes associated with those skills over time, says Seifert. This requires the legwork of first identifying those outcomes, then thinking through whether they’re faster than or superior to than other options. For delivering an expected outcome within a set period of time, a potential funding structure might be to grant either equity that vests over multiple years (which also encourages retention) or a percentage of base pay at regular intervals. “Twenty to fifty percent of base pay wouldn’t be a crazy figure,” says Seifert.

The risk, of course, is that any compensation rooted in base pay means a permanent expense. To get around that, experts say, some firms dip a toe in by providing small, onetime bonuses for completion of trainings, which incentivizes the rank and file to upskill. “It raises awareness of the opportunity,” says Seifert.

Experts say firms can also look beyond compensation when trying to attract rare skills. “Money isn’t the only thing that makes the world go round,” says McMullen. Sought-after employees are attracted by other incentives too, like career paths that will give them meaningful and interesting ways to apply their expertise. Still, the allure of higher pay sure doesn’t hurt in today’s inflation-plagued economy, with firms quickly realizing that devising a new compensation strategy is mandatory. Companies who play ball, McMullen says, are “definitely going to win over those that give annual 3% compensation increases to everyone.”

This article originally appeared on KornFerry.com. Reprinted with permission.

So, so you think you can tell Heaven from Hell?

Blue skies from pain?

Can you tell a green field from a cold steel rail?

A smile from a veil?

Do you think you can tell?

~Pink Floyd, “Wish You Were Here,” from the album by the same name, Columbia Records, 1975.

Do you think you can tell AI from HI (artificial intelligence from human intelligence)? This issue of Vein Specialist is mostly about AI. This issue of Vein Specialist was written mostly by AI. See if you can decide. We started out with the idea that we’d ask AI some questions about vein disease. Our Newsletter Committee members came up with the questions. AI came up with the answers. It took some work.

Here’s what happened. After we came up with topics, we asked ChatGPT to give us article titles and an abstract as to what the article should include. Then we called Claude. Who the hell is Claude? He describes himself as, “Claude is next generation AI assistant built by Anthropic and trained to be safe, accurate and secure to help you do your best work.” We gave Claude ChatGPT’s recommendations. We unleashed Claude. The articles that you read were created by Claude and not by the ghost Newsletter Committee members whose names are credited. They just reviewed the articles but didn’t change anything. No HI was involved except to point out that many of the references were bogus. Yes, Claude was not “accurate” as billed. But we left everything as is. No revisions.

Pink Floyd released a later album in 1987 entitled A Momentary Lapse of Reason. You may think we had a momentary lapse of reason by releasing this issue of Vein Specialist. Once we went down the AI rabbit hole we couldn’t turn back. Or as the song “Learning to Fly“ on the album says:

Into the distance, a ribbon of black

Stretched to the point of no turning back….

A fatal attraction is holding me fast

How can I escape this irresistible grasp?

We don’t know where AI will ultimately take us but here’s the journey we took. Hope you enjoyed the ride. Glad you are here.