Vein Therapy News

ACP grows, strengthens positions on vein, lymphatic advocacy

By Vanessa Salvia From Christopher Pittman MD’s perch as chair of the American College of Phlebology’s Healthcare Advocacy Committee, he sees an organization poised to do great work on vein and lymphatic advocacy. The vision is there, changes to

the organization’s infrastructure have been made and the way forward has been sketched out.

“Soon the ACP will be the foremost venous and lymphatic medicine organization in the country working on advocacy,” said Dr. Pittman, a vascular and interventional radiologist who leads the team at Vein911 in Tampa, Fla.

As the ACP’s delegate to the American Medical Association (AMA) and with 30 years of medical political leadership including numerous board and chair positions and committee ADVOCACY

continued on page 14

INSIDE 10.8M women have P.A.D.;40M, CVD A wound-care powerhouse Atrius Health trying Empathy forum Team finds VTE biomarker for cancer Study links varicose veins and DVT

AUGUST/SEPTEMBER 2018 Vol. 11, No. 4 VEINTHERAPYNEWS.COM

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An ACP recognized resource for news and information for and about the phlebology community

ELVA, radial tip on 1470 a ‘game-changer’

By Robert Jennejahn and Larry Storer Because physicians have had Current Procedural Terminology (CPT) Category 1 codes to make it easier to bill for foam sclerosant procedures for eight months now, much has been written about success stories using Varithena and VenaSeal.

But endovenous laser ablation (EVLA) or radiofrequency ablation (RFA) procedures have experienced a high rate of success and a low rate of complication for treating varicose veins for years before Polidocanol injectable foam was around.

Patients make a choice of treatment on advice from their doctors, and most patients want to know how much the procedure will cost, how painful is it going to be, and how long is the recovery period going to last.

Doctors make their recommendation by considering the growing number of tools they have at their disposal. There was a time when that recommendation was generally made between EVLA and RFA. For many doctors, that is still the decision that guides their recommendation to their patient.

EVLA delivers minimally invasive thermal energy targeting the wall of the vein. This energy produces occlusion, fibrosis and the vein will shrink and collapse. Blood flow will then be directed to other healthier veins. Diode lasers can be used at the desired wave lengths of 1470nm, 1320nm, 980nm, 940nm and 810nm.

RADIAL TIP

continued on page 12

Polidocanol injected foam...

Product solves issue when veins don’t take a straight path

By Ajit Naidu, MD An estimated one-third of the population in Western countries has untreated venous disease.1 Some of these individuals have lived with debilitating symptoms of venous

insufficiency for a decade or more because their primary care physicians or OB/GYNs have told them that the only treatment is compression stockings or diuretics.

Others with problematic venous anatomy – tortuous veins, calcifications or thrombus in vein segments, refluxing veins below mid-calf – may have been dissuaded from treatment by vein specialists who prefer catheter-based thermal ablation. And then there are patients who’ve had previous thermal ablation or phlebectomy for varicose veins and vow never to repeat uncomfortable procedures

involving multiple needle sticks, numerous incisions, bruising, and significant recovery time.

Polidocanol injectable foam (Varithena from BTG International) solves many clinical problems in treating varicose veins and refluxing truncal veins. Polidocanol microfoam is indicated for treatment of incompetent great saphenous veins (GSV), accessory saphenous veins, and visible varicosities of the GSV system above and below the knee. Microfoam sclerosant therapy poses no risk of saphenous nerve paresthesia, a known complication of laser and radiofrequency ablation, and it effectively treats tortuous varicose branches not amenable to catheter-based ablation technologies. Polidocanol microfoam flows into tributaries and varicosities, shutting them down in addition to the veins being treated.

POLIDOCANOL

continued on page 22

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Volume 11, Number 4

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NEWS 1 ACP strengthens advocacy position

Christopher Pittman, MD and chair of ACP’s Healthcare Advocacy Committee, says the organization’s work on vein and lymphatic advocacy is ready to take off. Dr. Pittman says the vision is there, changes to the organization’s infrastructure have been made and the way forward has been sketched out. In addition, ACP has hired advocacy veteran Robert White to serve as director of Healthcare Policy and Advocacy.

THE PRACTICE 16 Don’t be VEIN

Inbound phone calls have never been more valuable to your practice and this article explains how having a VEIN phone number can prevent you from getting them. A recent Harvard study indicated that phone calls convert to new business 10 to 15 times more than web leads, which only convert 1 to 2 percent of the time.

SECOND LOOK 1 Radial tip an ELVA ‘game changer’

An atraumatic rounded tip design proprietary to Total Vein Systems has become what one physician described as a “game changer” between ELVA and RFA performance. In addition to several physician’s evaluations, a 2017 leg-to-leg study, “Comparison of Endovenous Laser and Radiofrequency Ablation in Treating Varices in the Same Patient,” concluded that “in terms of patient satisfaction, EVLA at a wavelength of 1470nm and using radial fiber is superior to RFA.”

1 Foam helpful after several lasers

Ajit Naidu, MD, explains how Polidocanol microfoam was the only option to treat his 77-year-old patient’s venous insufficiency. Despite more than a dozen laser ablation treatments and multiple plebectomies, the man continued to have significant reflux from partially thrombosed veins. Additional laser ablation treatments were not possible because the veins were partially occluded and tortuous.

18 Varicose veins, DVT link studied

A recent study published in the Journal of the American Medical Association has found a significant association between varicose veins and deep vein thrombosis, and less clear potential associations with pulmonary embolism and peripheral artery disease.

PRODUCT NEWS 25 Book details facial vein treatment

“A Guide to Treating Facial Veins,” a new book illustrating the safe treatment for all facial veins using anatomical principles, has been published by Ronald Bush, MD, FACS, and Peggy Bush, APRN. The book made its debut at the CVC Arterial & Venous Endovascular Conference in July. Online sites will be announced soon.

EDITORIAL 254-399-6484

VEIN THERAPY NEWS < AUGUST/SEPTEMBER 2018

3

THE

VTNREPORT GE TO SPIN OFF GE HEALTHCARE INTO A STANDALONE BUSINESS Industrial conglomerate GE announced June 26 that it will be spinning off its GE Healthcare unit as a separate company as it struggles to deal with a cash crunch.

GE stated that GE Healthcare would become a standalone company as the remainder of GE would focus on its aviation, power and renewable energy businesses. GE is also planning to fully separate its Baker Hughes industrial services business.

AuntMinnie.com noted that the news came as a shock throughout the radiology business, where an adage among purchasing managers once claimed “You’ll never get fired for buying GE” – a testament to the company’s reputation and staying power. While GE had been struggling with a cash crunch since 2017, the company’s CEO John Flannery had said that healthcare would remain a key part of GE’s operations going forward.

In announcing the move, Flannery said that GE Healthcare and Baker Hughes are excellent examples of GE at its best – “anticipating customer needs, breaking barriers through innovation, and delivering life-changing products and services.

“Today’s actions unlock both a pure-play healthcare company and a tier-one oil and gas servicing and equipment player,” he said in a prepared statement. “We are confident that positioning GE Healthcare and [Baker Hughes] outside of GE’s current structure is best not only for GE and its owners, but also for these businesses, which will strengthen their market-leading positions and enhance their ability to invest for the future, while carrying the spirit of GE forward.”

BOSTON SCIENTIFIC ENTERS AGREEMENT TO PURCHASE REST OF CRYTERION MEDICAL Boston Scientific Corp. has entered a definitive agreement to acquire Cryterion Medical Inc., a privately-held company developing a single-shot cryoablation platform for the treatment of atrial fibrillation (AF). The addition of this cryoballoon platform positions Boston Scientific as the first to have both cryothermal and radiofrequency (RF) single-shot, balloon-based ablation therapies in its portfolio. Boston Scientific has been an investor in Cryterion since its inception in 2016 and the transaction price for the approximately 65 percent remaining stake not already owned by Boston Scientific consists of $202 million in up-front cash.

The quickly expanding global electrophysiology (EP) market is estimated to reach $5 billion in 2018. Additionally, single-shot ablation therapies are believed to be the fastest growing subsegment within the EP market, with rates well into in the double digits, and trending toward more than $1 billion during the next few years.

Patients with AF – a common heart rhythm disorder – are often treated with anti-arrhythmic drugs, as well as cardiac ablation. Ablation therapy is the process of delivering RF (heating) or cryothermal (cooling) energy to the areas of the heart muscle responsible for the abnormal heart rhythm. Both types of energy can be used to isolate pulmonary veins, which are often the source of AF. The Cryterion Medical cryoablation platform uses cryothermal energy to interrupt the irregular electrical signals that can cause AF. Developed with a next-generation balloon catheter, advanced mapping catheter, steerable sheath and enhanced console, the system is designed to streamline overall procedural workflow, enhance maneuverability and improve positioning in challenging anatomy.

Boston Scientific expects the transaction to be immaterial on an adjusted earnings per share basis through 2020, and accretive thereafter. On a GAAP basis for 2019 and subsequent years, the transaction is expected to be less accretive, or more dilutive as the case may be, due to amortization expense and acquisition-related net charges. For 2018 on a GAAP basis, the transaction is expected to be accretive due to a one-time gain on prior investment. VT N

BRITISH COLUMBIA RESEARCHERS PRODUCE FIRST ANGIOPLASTY-READY SMART STENT Vascular stents are some of the most commonly implanted medical devices, keeping millions of arteries open to uninterrupted blood flow. Though they tend to work well at first, too many end up being re-stenosed by new deposits of plaque and scar tissue often forms in the vicinity, blocking blood flow through the stent. Typically, renewed patient symptoms are the first indication that restenosis is occurring. Being able to detect the rate of blood flowing through a stent can help identify whether something is amiss.

Researchers at University of British Columbia have developed a vascular stent that has a builtin sensor for measuring blood flow and a radio antenna to transmit the readings to an external device. The technology doesn’t require any changes in implantation procedures and should be

4

applicable to be integrated into existing stents. The researchers describe the device as “the first angioplasty-ready smart stent.

SHEFFIELD UNIVERSITY DEVELOPS PATCH TO IMPROVE TREATMENT OF MOUTH ULCERS Researchers at the University of Sheffield, U.K., and the Danish company Dermtreat have jointly developed an innovative patch, known as the Rivelin, to improve treatment for mouth ulcers.

The patch allows for highly-targeted treatment of ulcers with steroids and other drugs, while providing a protective barrier around the affected area. Current treatments require mouthwashes or ointments that distribute the treatment over the entire mouth and only offer short contact times between the drug and lesion.

The patch is created with a manufacturing technique known as electrospinning, where a scaffold of ultrafine biocompatible fibers is woven with highly controlled structural parameters, such as porosity and surface area. The Rivelin patch is made up of two layers: an outer hydrophobic layer (manufactured from polycaprolactone) and an inner layer of polyvinylpyrrolidone/Eudragit RS100 fibers, with mucoadhesive properties to stick to the inner-mouth, gums, or tongue. This inner layer is also loaded with the drug to treat the ulcer.

“The patch acts like a plaster inside your mouth, which means it is very effective at directly targeting the specific area as well as forming a protective barrier,” said Dr. Craig Murdoch, School of Clinical Dentistry, University of Sheffield. “Patients who have trialled the patch found it to be very comfortable to wear and they were really pleased with the length of adhesion which makes it particularly effective and efficient.”

Users’ experiences of the patch are reported in the journal Biomaterials, where the patch was found to adhere to the mouth for up to two-hours with no reported taste or irritation. The patch is beginning Phase II clinical trials in both U.S. and U.K. sites, including the Charles Clifford Dental Hospital in Sheffield. VT N READ MORE: http://rivelin.eu/innovation/pipeline/rivelin-patch/

BEVERLY HILLS RADIOLOGIST GETS 10 YEARS IN FRAUD CASE A radiologist from Beverly Hills, Calif., was sentenced to 10 years in prison in June after being convicted of 39 felony fraud counts related to charges that he paid referring physicians for imaging services such as MRI and ultrasound scans. He was arrested in 2015 and convicted in December of 2017.

Dr. Ronald Grusd received a 10-year prison sentence for involvement in a scam uncovered as part of an investigation dubbed Operation Backlash. Grusd’s companies, California Imaging Network Medical Group and Willows Consulting, paid referring doctors in San Diego and Imperial counties kickbacks for patient referrals to fraudulently bill insurance companies for more than $22 million in medical services, according to evidence presented at his trial.

The services included MRI and ultrasound scans, shock-wave treatments, toxicology testing, and prescription pain medication. Prosecutors charged that Grusd’s companies would fraudulently bill insurance payors for the services, concealing that kickbacks had been paid for referrals. Grusd allegedly paid $100,000 in kickbacks for the referrals.

HISTORIC CMS PROPOSAL WOULD CUT PAPERWORK, INCREASE TIME DOCTOR SPENDS WITH PATIENTS The Centers for Medicare & Medicaid Services (CMS) proposed historic changes July 12 that would increase the amount of time that doctors and other clinicians can spend with their patients by reducing the burden of paperwork that clinicians face when billing Medicare. Public comments on the proposed rules are due by Sept.10.

The proposed rules would fundamentally improve the nation’s healthcare system and help restore the doctor-patient relationship by empowering clinicians to use their electronic health records (EHRs) to document clinically meaningful information, instead of information that is only for billing purposes.

These proposals will also advance the successful Medicare Advantage program and accomplish a historic regulatory rollback to help physicians put patients over paperwork. Further, today’s proposed reforms to how CMS pays for medicine demonstrate the commitment of HHS to implementing President Trump’s blueprint for lowering drug prices. The ambitious reforms proposed by CMS under Administrator Seema Verma will help deliver on two HHS priorities: creating a value-based healthcare system for the 21st century and making prescription drugs more affordable. “Today’s proposals enable doctors to spend more time with their patients. VT N

AUGUST/SEPTEMBER 2018 < VEIN THERAPY NEWS

Veins aren’t always a straight path.

Neither is treatment.

Tortuous veins. Large veins. Small veins.

Recurrent symptoms. These ideal NTNT patients walk through your clinic every day. Treat them comfortably—and reliably—with Varithena®.

Now with favorable reimbursement, it’s an optimal tool for discerning vein specialists who want to treat the broadest range of anatomies.

Treat more with Varithena®.

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Now with 2 CPT codes 36465 and 36466

www.varithena.com INDICATIONS Varithena® (polidocanol injectable foam) is indicated for the treatment of incompetent great saphenous veins, accessory saphenous veins and visible varicosities of the great saphenous vein (GSV) system above and below the knee. Varithena® improves the symptoms of superficial venous incompetence and the appearance of visible varicosities.

IMPORTANT SAFETY INFORMATION The use of Varithena® is contraindicated in patients with known allergy to polidocanol and those with acute thromboembolic disease. Severe allergic reactions have been reported following administration of liquid polidocanol, including anaphylactic reactions, some of them fatal. Observe patients for at least 10 minutes following injection and be prepared to treat anaphylaxis appropriately. Intra-arterial injection or extravasation of polidocanol can cause severe necrosis, ischemia or gangrene. Patients with underlying arterial disease may be at increased risk for tissue ischemia. If intra-arterial injection of polidocanol occurs, consult a vascular surgeon immediately. Varithena® can cause venous thrombosis. Follow administration instructions closely and monitor for signs of venous thrombosis after treatment. Patients with reduced mobility, history of deep vein thrombosis or pulmonary embolism, or recent (within 3 months) major surgery, prolonged hospitalization, or pregnancy are at increased risk for developing thrombosis. The most common adverse events observed were pain/discomfort in extremity, retained coagulum, injection site hematoma or pain, common femoral vein thrombus extension, superficial thrombophlebitis, and deep vein thrombosis. Physicians administering Varithena® must be experienced with venous procedures, possess a detailed working knowledge of the use of the duplex ultrasound in venous disease and be trained in the administration of Varithena®.

For Full Prescribing Information visit Varithena.com © 2018 Biocompatibles, Inc., a BTG International group company All rights reserved NA-VAR-2018-0409 Varithena is a registered trademark and Varithena Solutions Center is a trademark of Provensis Ltd, a BTG International group company BTG and the BTG roundel logo are registered trademarks of BTG International Ltd

INDICATIONS AND USAGE Varithena® (polidocanol injectable foam) is indicated for the treatment of incompetent great saphenous veins, accessory saphenous veins and visible varicosities of the great saphenous vein (GSV) system above and below the knee. Varithena® improves the symptoms of superficial venous incompetence and the appearance of visible varicosities.

In Varithena®-treated patients, 80% of pain events in the treated extremity resolved within 1 week.

DOSAGE AND ADMINISTRATION Varithena® is intended for intravenous injection using ultrasound guidance, administered via a single cannula into the lumen of the target incompetent trunk veins or by direct injection into varicosities.

Proximal symptomatic venous thrombi occurred in <1% of patients treated with Varithena®.

Approximately half (49%) of patients with thrombi received treatment with anticoagulants.

Physicians administering Varithena® must be experienced with venous procedures, possess a detailed working knowledge of the use of the duplex ultrasound in venous disease, and be trained in the administration of Varithena®.

CONTRAINDICATIONS The use of Varithena® is contraindicated in patients with: • known allergy to polidocanol [see Warnings and Precautions] • acute thromboembolic disease WARNINGS AND PRECAUTIONS Anaphylaxis Severe allergic reactions have been reported following administration of liquid polidocanol, including anaphylactic reactions, some of them fatal. Observe patients for at least 10 minutes following injection and be prepared to treat anaphylaxis appropriately.

Tissue Ischemia and Necrosis Intra-arterial injection or extravasation of polidocanol can cause severe necrosis, ischemia or gangrene. Patients with underlying arterial disease, such as marked peripheral arteriosclerosis or thromboangiitis obliterans (Buerger’s Disease) may be at increased risk for tissue ischemia. If intra-arterial injection of polidocanol occurs, consult a vascular surgeon immediately.

Venous Thrombosis Varithena® can cause venous thrombosis [see Adverse Reactions]. Follow administration instructions closely and monitor for signs of venous thrombosis after treatment. Patients with reduced mobility, history of deep vein thrombosis or pulmonary embolism, or recent (within 3 months) major surgery, prolonged hospitalization, or pregnancy are at increased risk for developing thrombosis.

ADVERSE REACTIONS Clinical Trials Experience Because clinical trials are conducted under controlled but widely varying conditions, adverse reaction rates observed in clinical trials of Varithena® cannot be directly compared to rates in the clinical trials of other drugs or procedures and may not reflect the rates observed in practice.

A total of 1333 patients in 12 clinical trials were evaluated for safety when treated with Varithena® at dose concentrations of 0.125%, 0.5%, 1.0% or 2.0%, including 437 patients treated with Varithena® in placebo-controlled clinical trials.

Adverse reactions occurring in 3% more patients receiving Varithena® 1% than receiving placebo are shown in Table 1.

In the 1333 patients treated with Varithena®, the following venous thrombus adverse events occurred: common femoral vein thrombus extension (2.9%), proximal deep vein thrombosis (DVT) (1.7%), distal DVT (1.1%), isolated gastrocnemius and soleal vein thrombosis (1.4%).

Since Varithena® induces thrombosis in the treated superficial veins, D-dimer is commonly elevated post-treatment and is not useful diagnostically to assess patients for venous thrombus following treatment with Varithena®.

Neurologic adverse events (cerebrovascular accident, migraines) have been reported in patients following administration of physician compounded foam sclerosants. None of the 1333 patients in the Varithena® trials experienced clinically important neurological or visual adverse events suggestive of cerebral gas embolism. The incidence of neurologic and visual adverse events within 1 day of treatment in the placebo-controlled studies was 2.7% in the pooled Varithena® group and 4.0% in the placebo groups.

Skin discoloration adverse events were reported in 1.1% of the pooled Varithena® group and 0.7% of the placebo group in the placebo-controlled studies.

DRUG INTERACTIONS No specific drug interaction studies have been performed. There are no known drug interactions with Varithena®.

USE IN SPECIFIC POPULATIONS Pregnancy Pregnancy Category C. There are no adequate and well-controlled studies of Varithena® in pregnant women. Do not use Varithena® during pregnancy.

Labor and Delivery The effects of Varithena® on labor and delivery in pregnant women are unknown.

Nursing Mothers It is not known whether polidocanol, the active pharmaceutical ingredient in Varithena®, is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants, avoid administering Varithena® to a nursing woman.

Pediatric Use Safety and effectiveness in pediatric patients have not been established.

Geriatric Use Of the 1333 subjects in clinical studies treated with Varithena®, 9.1% (n=121) were ≥65 years of age. No clinically important differences in safety or efficacy were observed between older and younger patients in all studies.

OVERDOSAGE There are no known cases of overdosage with Varithena®. In clinical studies, total volumes of up to 60 mL of Varithena® per treatment session have been administered.

Table 1: Treatment-emergent adverse reactions (3% more on Varithena® 1% than on placebo) through Week 8 (n=588)

Manufactured for Provensis Ltd by: Biocompatibles UK Ltd Chapman House, Weydon Lane, Farnham, UK, GU9 8QL. Distributed by: Biocompatibles, Inc. Five Tower Bridge, Suite 810 300 Barr Harbor Drive West Conshohocken, Pennsylvania 19428 USA a Includes Varithena® 0.125%, 0.5%, 1.0%, and 2.0% from the placebo-controlled trials. b Retained coagulum. c Common femoral vein thrombus extension (non-occlusive thrombi starting in the superficial vein and extending into the common femoral vein).

Provensis Ltd, Biocompatibles UK Ltd, and Biocompatibles, Inc. are BTG International group companies Varithena is a registered trademark of Provensis Ltd. BTG and the BTG roundel logo are registered trademarks of BTG International Ltd

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NEWS

R&M adds P.A.D. market report divided by type through 2023 to its new offerings

10.8M women have P.A.D.,40M have CVD Speaking at the inaugural “Gender and Racial Disparities in Peripheral Interventions” session of the 19th annual New Cardiovascular Horizons (NCVH) meeting in New Orleans, THE SAGE GROUP President Mary L. Yost discussed the “Prevalence and Epidemiology Burden of Peripheral Artery Disease and Venous Disease in Women.”

“P.A.D. and venous disease are among the most prevalent women’s diseases,” Yost said. “Compared with breast cancer, peripheral artery disease (P.A.D.). afflicts more than three

Woman’s lower limb vascular exam suspecting CVD.

8

times more women while venous disease affects 11 to 17 times more women.”

“Yet the myth that P.A.D. is a man’s disease persists. Varicose veins, one of the most common forms of chronic venous disease (CVD), are dismissed as a cosmetic problem,” Yost said.

“While both P.A.D. and CVD are underestimated, underdiagnosed and undertreated in all patients, this is especially true in women. The result is unnecessary morbidity and mortality, as well as higher costs,” president of The Sage Group (thesagegroup.us) said..

Commenting on the costs of P.A.D. and CVD, Yost said, “P.A.D. and CVD are very expensive diseases. One of the reasons is that both are frequently not treated until the most severe stages, which are more complex and costly. An increasing percentage of P.A.D. patients are treated for CLI, which is characterized by rest pain, ulcers and gangrene.

CVD treatment commonly occurs only after progression to leg ulcers, rather than at earlier stages of venous insufficiency.”

“Varicose veins progress to more severe venous categories, including skin changes and ulcers, at a 2 percent to 4 percent annual rate. Even in treated patients, recent ‘real-world’ studies have shown that 1 percent to more than 2 percent develop ulcers at one year,” she continued. “Women represented 75 percent of these patients.”

According to Yost, “Between 650,000 and 1.3 million women develop venous ulcers annually at a cost of $11 to $30 billion. We estimate the annual economic burden of P.A.D. in women is $128-$226 billion.”

“Earlier diagnosis and treatment of P.A.D. and CVD could significantly reduce costs and diminish patient suffering,” she concluded. VT N READ MORE: m3meetevents.com/ncvh/ AgendaAtAGlance.aspx?meeting=NCVH18

Research & Markets has added a new peripheral artery disease report to its offering: “Peripheral Artery Disease Market by Type – Global Opportunity Analysis and Industry Forecast, 2017-2023.”

Peripheral artery disease (P.A.D.) is characterized by plaque built up in the arteries carrying blood from heart to legs, arms and other limbs. P.A.D. in turn also increases the risk of other cardiovascular disorders such as heart attack, coronary heart disease, stroke, and ischemic attack.

P.A.D. is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs. When you develop P.A.D. your extremities – usually your legs – don’t receive enough blood flow to keep up with demand.

The disease is also likely to be a sign of a more widespread accumulation of fatty deposits in your arteries (atherosclerosis).

This condition may be reducing blood flow to your heart and brain, as well as your legs.

While many people with P.A.D. have mild or no symptoms, some people have leg pain when walking (claudication). Even with no symptoms, you should be screened if you are over 70; diabetics or smokers over 50; and under 50 for those who are diabetic, obese or have high blood pressure.

Claudication symptoms include muscle pain or cramping in your legs or arms that’s triggered by activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is the most common location.

If you have leg pain, numbness or other symptoms, don’t dismiss them as a normal part of aging. Call your doctor and make an appointment.

The global peripheral artery disease market generated $3,136,000 in 2016, and is projected to reach $4,980 million by 2023, registering a CAGR of 6.8 percent during the study period.

The growth in the geriatric population, coupled with an increase in incidence of P.A.D. are the major factors that drive the growth of the P.A.D. market. In addition, introduction of advanced interventional products such as drug coated balloons also boost the market growth. However, restenosis majorly restraints the market growth.

The global peripheral artery disease market is segmented on the basis of type and region. Based on type, the market is divided into peripheral angioplasty balloons, peripheral stents, peripheral catheters, inferior vena cava (IVC) filters, plaque modification devices, hemodynamic flow alteration devices, and peripheral accessories.

Key market players in working on treatments include: Abbott Laboratories, Boston Scientific Corp., Cook Medical, Cardinal Health Inc., C. R. Bard Inc., Medtronic plc, Terumo Corp., The Spectranetics Corp., AngioDynamics Inc., BIOTRONIK and B. Braun Melsungen AG. The report has a market overview, as well as the global P.A.D. market by type and by region. In addition, there are detailed profiles on the players in the market. VT N READ MORE: researchandmarkets.com/ research/td3ftr/global_peripheral?w=4

AUGUST/SEPTEMBER 2018 < VEIN THERAPY NEWS

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NEWS

WOUND CARE DRESSINGS

Global technology market growing 5% CAGR through 2022 The latest market research report by global technology research and marketing firm Technavio on the global wound dressings market predicts a CAGR of around 5 percent during the period 2018-2022.

The report segments the global wound dressings market by product (traditional wound dressing and advanced wound dressing) and by geography (the Americas, EMEA, and APAC). It provides a detailed illustration of the major factors influencing the market, including drivers, opportunities, trends and industry-specific challenges.

Some of the key findings of the global wound dressings market, according to Technavio healthcare and life sciences researchers are: • increasing prevalence of acute and chronic wounds: a major market driver; • increasing demand for combination dressings: a key market trend; • the Americas dominated the global wound dressings market with 44 percent share in 2017; and • Acelity, Coloplast, ConvaTec, Mölnlycke Health Care, Smith & Nephew and Integra LifeSciences are the largest players in the market Increasing prevalence of acute and chronic wounds is one of the major factors driving the global wound dressings market.

Other major factors include: the rising prevalence of acute wounds, such as surgical wounds; and traumatic wounds, such as abrasions, punctures, lacerations, and incision; and chronic wounds, such as venous ulcers, diabetic ulcers and pressure ulcers.

The increasing geriatric population is anticipated to increase the demand for wound dressings. More than 250 million acute wound cases, approximately 50 million traumatic wound cases, and more than 5 million burn cases are recorded and treated every year globally.

“In 2016, the global prevalence of surgical wounds was more than 135,000,” a senior analyst said. “The annual number of deaths caused by burns is more than 200,000 across the globe. Most of these deaths occur in low- and middle-income countries, particularly in Southeast Asia. Burn injuries are highly prevalent in countries such as India, Bangladesh, Nepal and the United States.

“According to the HCUP, in the United States, nearly 53,220 burn-related inpatient stays were recorded in 2013, out of which 4,070 patients had first-degree burns, 25,480 patients had second-degree burns, 11,055 patients had third-degree burns and 7,535 patients had unspecified burns.”

Acelity-Crawford eyes wound-care powerhouse

management of exuding wounds that currently leads the collagen dressing market, according to the San Antonio-based company.

Acelity also markets the Tielle range of hydropolymer foams with the proprietary LiquaLock technology for both non-exuding and exuding wounds and the Adaptic line of non-adhering knitted cellulose acetate mesh dressings. These dressing products are complemented by Acelity’s negative would pressure therapy tools. The company also sells products for open abdomen and incision management during surgery, epidermal harvesting, and animal health.

Crawford, a 15-year-old company historically focused primarily on supplying specialist dermatology products to the UK’s National Health Service, sells the KerraMax Care range of absorbent wound dressings, KerraFoam foam wound-dressing, and KerraCel antimicrobial gelling fiber. The company also sells KerraCel Ag carboxymethyl cellulose gelling fiber, the first wound dressing with silver oxysalt technology, which the FDA cleared in early 2017.

The global wound-care market is projected to be worth $22 billion by 2022, dominated by the North American market.

Acelity’s main competitors include Smith & Nephew PLC, Mölnlycke Health Care AB, ConvaTec Group PLC, Baxter International Inc., Coloplast AS, and BSN Medical GMBH. (Also see “Start-Up Spotlight: Pertinax Pharma, Closing In On Wound Care With Slow-Release CHX Tech. VT N

Acelity LP Inc. expects its acquisition of Crawford Healthcare to create the most comprehensive line of advanced wound-care devices available and consolidate leading positions in several rapidly growing sub-segments of that rapidly-growing market.

Terms of the June 8 deal were not disclosed. Acelity’s press release notes the deal includes Crawford’s R&D capabilities and manufacturing operations in Cheshire, UK, as well as its product lines. Crawford also has a office just outside Philadelphia devoted to marketing Crawford’s wound-management products in the United States. Crawford CEO and founder Richard Anderson will continue to lead the Crawford organization as the two companies work-out the integration plan throughout the rest of 2018.

“This transaction solidifies our ability to offer the most comprehensive line of wound care solutions and will enable us to create and consolidate leading positions in high-growth market segments, expand and strengthen our customer relationships, and enhance our innovation expertise for the benefit of clinicians and patients around the world,” Acelity CEO Andrew Eckert says.

Acelity’s advanced wound-care portfolio includes Promogran Prisma, a collagen and cellulose matrix indicated for the

10

THE AMERICAS

The global wound dressings market was dominated by the Americas in 2017, accounting for a share of more than 44 percent. It was followed by the EMEA and the APAC region.

The Americas accounted for the largest market share because of the high prevalence of acute and chronic wounds, high adoption of technologically advanced products, availability of advanced healthcare infrastructure, and increased healthcare expenditure.

But APAC is expected to have a faster growth rate during the forecast period due to the high patient base, huge untapped market potential, growing economy, increasing healthcare spending, rapidly improving healthcare infrastructure, and growing medical tourism.

KEY MARKET TREND

Antimicrobial agents such as silver, iodine and honey are increasingly becoming important in the global wound dressings market. Several advanced wound dressings are incorporating these antimicrobial agents to improve the outcome of the treatment of wounds.

These dressings comprise two or more types of chemical and physical properties to ensure optimum functionality. They are versatile and convenient to use in both partial and fullthickness wounds.

Many end-users are increasingly adopting combination dressings because of their various advantages such as easy availability and ease of use. These dressings combine physically distinct components into a single dressing to provide multiple wound care functions such as absorption, adhesion and protection from bacteria.

With over 500 specialized analysts, Technavio’s report library consists of more than 10,000 reports and counting, covering 800 technologies, spanning 50 countries. VT N READ MORE: technavio.com

VENOUS, DIABETIC ULCERS: Analysts say $350M in acute wounds will be treated in negative pressure care There is an increasing prevalence of acute and chronic wounds such as those caused by burns or venous and diabetic ulcers. It is estimated that globally up to 350 million acute wounds will be treated year, and an additional 5 million burns will be treated.

Technavio market research analysts forecast that the global negative pressure wound therapy (NPWT) market will grow at a CAGR of close to 8 percent during the period 2018-2022, according to a new report.

“Global Negative Pressure Wound Therapy Market 20182022” segments the global negative pressure wound therapy by product (conventional NPWT and single-use NPWT) by end-user (hospitals and clinics, ambulatory surgery centers and home healthcare). This report also presents a detailed analysis of the market’s growth in regions such as the Americas, Pacific rim and Europe.

NEGATIVE PRESSURE

continued on page 26

AUGUST/SEPTEMBER 2018 < VEIN THERAPY NEWS

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1 - Gifford, S.M. et al. Reflux in the below-knee great saphenous vein can be safely treated with endovenous ablation.

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Refer to Directions for Use provided with products for indications, complete instructions, warnings, and precautions.

INDICATION FOR USE: The AngioDynamics, Inc. VenaCure EVLT NeverTouch Procedure Kits are indicated for endovascular coagulation of the Great Saphenous Vein (GSV) in patients with superficial vein reflux, for the treatment of varicose veins and varicosities associated with superficial reflux of the Great Saphenous Vein (GSV), and for the treatment of incompetence and reflux of superficial veins of the lower extremity. This product should be used only with lasers cleared for use in the treatment of varicose veins, varicosities with superficial reflux of the GSV, and in the treatment of incompetent refluxing veins in the superficial venous system in the lower limbs.

CONTRAINDICATIONS: Patients with thrombus in the vein segment to be treated, patients with an aneurysmal section in the vein segment to be treated or patients with peripheral artery disease as determined by the Ankle Brachial Pressure Index with a value of <0.9 should not have their varicosities ablated.

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11

NEWS RADIAL TIP

“The 1470nm laser can also be introduced with a smaller catheter than the one required for the RF procedure. In addition, the 1470 is easier to manipulate compared to the RF.” Terrence Fitzgibbons, MD, FACS, who owns Fitzgibbons Vein Center in Los Angeles, said he has performed more than 4,000 procedures since 2004 with excellent results.

Approximately 80 percent were radial.

“The laser energy is directed to the vein walls very effectively causing the walls to shrink and collapse,” Dr. Fitzgibbons said.

“Blood flow is then able to migrate to other healthier veins.”

Michael Kassouf, MD and owner of Veinmedic with locations in Manhattan, Brooklyn and New Jersey, said he prefers the radial fiber with his more than 3,000 EVLA procedures since 2002.

continued from page 1

RF uses the energy generated by radio frequency to heat and collapse the walls of the vein. Blood flow will then be directed to other healthier veins.

Doctors find both procedures to be effective, minimally invasive, relatively pain free and highly successful at keeping the vein closed. While RF technology has changed some, various laser tips have made EVLA less painful and more flexible.

A GAME CHANGER

A proprietary atraumatic rounded-tip design sold exclusively

by Total Vein Systems has become what one physician described as a “game changer.” It changes the game, he said, because it is more efficient, it costs much less, there is less pain and bruising, and it outperforms RF technology.

In 2017, the “Comparison of Endovenous Laser and Radiofrequency Ablation in Treating Varices in the Same Patient” study concluded that “in terms of patient satisfaction, EVLA at a wavelength of 1470nm and using radial fiber is superior to RFA.”1 Previous studies that have given the edge to RFA have all used the low wavelength EVLA lasers. This study compared RFA to a 1470nm EVLA laser with a radial tip fiber in a legto-leg comparison: The two different ablation techniques were applied to different extremities in the same patient. The most important factor determining patient comfort is the sensation of pain, and this approach eliminated patients’ different reaction to pain.

The results of this study determined ablation rates of 100 percent in the EVLA group compared to 93.2 percent in the RFA group. Of these, postoperative pain and time to return to activity were statistically significant (P < 0.035 and P < 0.001, respectively).

Because high wavelength laser rays use water as a chromophore, they are better able to penetrate the vein wall than the RF procedure. In addition, the radial dissemination of rays permits a more homogeneous contact with the vein wall

The TVS radial fiber is a game changer! While both bare fibers and radial fiber equally achieve complete occlusion, my patients report significantly less discomfort and bruising with the radial fiber.

–Mehul Shah, MD

and reduces the incidence of perforation.2 “Comparing the two techniques in the same patient reduces patient-dependent factors to a minimum. Patient satisfaction between the two can thus be assessed more objectively.

In conclusion, EVLA and RFA have similar success rates.

However, in terms of pain and patient satisfaction, EVLA at a wavelength of 1470nm and using radial fiber is superior to RFA,” the researchers concluded.

12

In addition to the study, Mehul Shah, MD and owner of Vascular Medicine Center in King of Prussia, said, “The TVS radial fiber is a game changer! While both bare fibers and radial fiber equally achieve complete occlusion, my patients report significantly less discomfort and bruising with the radial fiber.”

While the exact specifications are proprietary to Total Vein Systems, the engineers did disclose that the radial tip fiber has a cone-shaped tip that is covered with a fused silica glass capillary. The radial fiber has a higher grade of low hydroxyl (OH) fused silica glass capillary instead of the normal silica glass capillary as the tip’s cover. By using this specific shape, the laser light reflects a full 360 degrees (radial direction).

According to the engineer, this is important because the heat is fully directed at the walls of the vein and is not dispersed “down the pipe,” so to speak. The walls of the vein then collapse and shrink.

He said the advantage with this selected capillary material is that it withstands higher temperatures; this special laser performs work inside of the capillary, providing an additional advantage in generating a perfect fit between the fiber and the capillary; and there are no sharp edges and a perfect space for bonding the fiber to the capillary.

Also, the radial fiber tip withstands pull tests up to 11kg on the capillary tip. No other fiber on the market can withstand those pull forces.

RADIAL TIPS IN THE CLINIC Due to the specific design of this device there is no pain or discomfort experienced by the patient. The procedure can be performed in the doctor’s office and takes around 30 minutes.

After the vein has been made to collapse and shrink, the laser fiber is then removed, and the wound site can be treated with a sterile dressing.

Over the last 15 years, J. Michael Leary, MD, has conducted more than 6,000 ELVA procedures in his clinic, California Vein Specialists in Newport Beach. For a time, he used the RF procedure until he began using the radial tip with his 1470nm laser three years ago and is now reporting phenomenal results.

“The 1470 radial tip fiber absolutely works the best, achieving an excellent closure rate,” Dr. Leary said, noting that his closure rate is higher than 98 percent.

Even though the radial tip allows him to direct the laser energy even closer to the vein wall, he said there are no hotspots.

Eliminating hotspots assures the patient will not receive pain, bruising or any other adverse effects.

“The radial tip fiber is unbelievably gentle, which allows me to limit inflammation,” Dr. Leary explained. “The radial head design performs better than the straight cut tip. The 810nm laser is an older design than the 1470, and it can create hotspots and form carbonization.

The radial tip fiber is unbelievably gentle, which allows me to limit inflammation.

The radial head design performs better than the straight cut tip. …In addition, the 1470 is easier to manipulate compared to the RF. –J. Michael Leary, MD “The radial fiber manipulates like a guidewire, is very visible under ultrasound, and achieves an excellent closure rate,” Dr. Kassouf said. “The radial energy can bypass to reach the apex of the vein. The energy can be directed even closer to the vein wall with the ultrasound, and it can minimize the risk of DVT. He explained that the atraumatic tip design can diffuse energy in a 360-degree radius, resulting in no “hotspots.” With no hotspots there are no adverse side effects, and no residual or acute pain.

“The energy delivery is 360 degrees with a continuous ‘pullback,’ rather than segmental pullback with RF. The size of the device is 400 microns, which allows it to go through a 4 French catheter as opposed to the much larger 7 French required for RF procedures.”

The key advantages of the radial fiber cited by the physicians include: • Easy navigation through a short sheath • Atraumatic rounded tip design • 400-micron core for maximum flexibility • Highly visible centimeter depth markings • $99.95 price from Total Vein Systems as opposed to up to $450 for radiofrequency catheters. VT N

CITATION 1

Bozoglan O, Mese B, Eroglu E, Ekerbiçer HC, Yasim A. Comparison of endovenous laser and radiofrequency ablation in treating varices in the same patient. J Lasers Med Sci. 2017;8(1):13-16. doi:10.15171/jlms.2017.03 2 Schwarz T, von Hodenberg E, Furtwängler C, Rastan A, Zeller T, Neumann FJ. Endovenous laser ablation of varicose veins with the 1470-nm diode laser. J Vasc Surg.

2010;51:1474–1478. doi: 10.1016/j.jvs.2010.01.027.

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NEWS ADVOCACY

continued from page 1

memberships, Dr. Pittman seems to be well-suited for this role.

Dr. Pittman has been active on the ACP Foundation board and was elected to the ACP board last November. He’s been a delegate representing the ACP since 2011, and he sees the organization making the right moves as a whole, and now it’s time to maximize those moves.

“There’s been a lot of changes at the ACP lately,” Dr. Pittman said, “We have a new director in Dean Bender and a very forward-thinking board that chose him to lead the organization. The organization has relocated to Chicago, which is a great place to be in the medical community. Over the past year Dean, under the guidance of the board, has put together a sturdy three-legged stool to start building a foundation on.”

Additionally, shortly after the annual AMA meeting in Chicago in June, the organization hired Robert White to serve as director of Healthcare Policy and Advocacy. In this role, White will provide expertise to the ACP leadership, committees and staff about health policy issues related to care delivery, financing and best practices for treating patients with venous and lymphatic disease.

In addition, White will be working directly with the AMA, policymakers, third-party payers, CMS, the medical device industry and others to advocate for improved patient care on behalf of ACP members, their patients who suffer from venous and lymphatic disorders and the venous and lymphatic community as a whole.

“White headed advocacy for the Society of Interventional Radiology for a number of years, and we’ve been quite fortunate to work with him,” Dr. Pittman said.

WHAT WE A.R.E.

The three-legged stool that the team is working on is what the ACP is calling A.R.E. —a platform of Advocacy, Research and Education to move the college into the next decades. As Dr. Pittman describes himself, he’s a “recovering detail guy,” and he’s ready to jump into real strategy moves.

“I can see the big picture, but I can get extremely granular into the details too,” Dr. Pittman said. “Success comes with how you use your resources, which are primarily time and money. And, what your goals are. If you don’t know what your

goals are and what you’re trying to achieve, you won’t know if you got there.”

The ACP has not focused much on advocacy before, so Dr. Pittman has a whole new world ahead of him. “We’d written letters, been involved with some reimbursement or payment issues, but we’re going to be an order of magnitude better than we’ve ever been,” Dr. Pittman said. “I’m extremely confident about the fact that we will shortly be the most relevant venous and lymphatic medicine organization in the country and certainly around advocacy.”

But, Dr. Pittman noted, advocacy is a team sport. He’s a team player, and he knows that for the most forward movement, you’ve got to have a lot of people rowing in the same direction.

ACP GOALS

The advocacy goals that the organization will set depend in large part on what the members want and need. To that end, Dr. Pittman wants more members involved in what the organization is doing. “We need to be relevant to our members,” he said.

“The thing that limits advocacy no matter what you’re talking about is literally time and money. Every entity has a limited amount of those, so we need to be as efficacious as possible with the time we get from our members who are interested in various advocacy issues. We need to get more members involved, but equal to that is, we need to meet their needs.”

The more relevant an organization is, the more loyal its members are, and the more members want to be a part of it; so, you not only retain members but constantly grow with new ones. “Success begets success,” he said.

Dr. Pittman is an independent doctor in private practice, and he knows that his needs and concerns will differ from doctors who are employed by a hospital or are part of a multispecialty group. He would like the organization to be powerful enough to meet the needs of everyone under the umbrella of the ACP. To do that he realizes that they need to better define exactly what those needs are.

Dr. Pittman urges members to become involved, attend meetings and focus groups and share their concerns. “We need more people at the meetings,” he said. “To meet the needs of our members we need to committee with them more, ask them their opinions and come up with a strategy that makes sense.”

Advocacy committee’s charge and purpose The Health Care Advocacy Committee is responsible for the oversight of issues relating to health policy, reimbursement and insurance industry relations. The committee monitors activities undertaken through the AMA (HOD, CPT and RUC representatives) and directs activities aimed towards relationships with policy makers, CMS and the insurance industry.

The committee’s responsibilities are: 1. Provide oversight and direction for health care policy related activities, including development of ACP policy positions, reimbursement issues, insurance industry relations and activities conducted through the American Medical Association.

2. Develop advocacy strategies to interact with officials representing Centers for Medicare and Medicaid Services (CMS) and other payers.

3. Represent the ACP in interactions with policy makers and officials from CMS and other government

14

agencies, Medicare Administrative Contractors (MACs), third party policy makers and other organizations and attempt to develop working relationships with them on behalf of the organization.

4. Facilitate the sharing of information between representatives of the AMA House of Delegates, CPT Editorial Committee and RUC panel.

5. Monitor and analyze the effect of proposed CMS, MAC and third-party insurance policies which affect access to venous and lymphatic care and develop ACP policy and advocacy actions in response.

6. Select, mobilize and direct Rapid Response Team members to address specific CMS or third-party payer issues as needed.

7. Respond to member inquiries on coding and reimbursement.

Number one for advocacy is to ensure that patients have access to care, followed by ensuring that they receive quality care. Dr. Pittman said that many payers are narrowing patient access to venous and lymphatic care by implementing rules and regulations that make little sense. Receiving great care means that the ACP must ensure that its doctors are well-trained, have access to top-level equipment and have enough of a profit margin to continue to stay in business and provide that excellent care.

KEY AREAS OF FOCUS

Another thing that Dr. Pittman sees as key to ACP member success is responding to the “sea change” that is coming in medicine: the switch from fee-for-service medicine to fee-forvalue medicine.

“Most of my colleagues are unfamiliar with what this means and that’s dangerous because most of healthcare is going to be ‘fee-for-value’ in the next 3, 5, 7 years and you have to be ready to understand it,” he said. “The ACP will have answers and instructions and education for our membership on the coming fee-for-value reimbursements in medicine.”

Our existing fee-for-service healthcare system is based on healthcare providers being reimbursed at specific rates by third-party payers for specific procedures. Fee-for-value service instead bases reimbursements on patient outcomes. In this system, reimbursement requires more of a coordinated approach with regards to all of the resources the patient accesses during their cycle of care.

The other coordinated effort is advancement of the ACP Patient Reported Outcome Venous Registry. Dr. Pittman said he believes that every specialty in medicine needs to aggregate and collect data from their patients, so they can prove to payers, patients and others that what they do actually helps patients.

“The way to do that,” he said, “is to aggregate patient population data where you can determine best practices, the best modalities to treat patients and these kinds of things.

You have to show beyond a shadow of a doubt that what we do works and has a return on investment for the patient and for those who pay. Participation in a registry or clinically integrated network is extremely important.”

PLANNING AND EXECUTION

Defining the goals is the first part of this important work.

The next part comes down to planning a strategy and executing that strategy. Dr. Pittman said he sees “nothing but blue sky” when it comes to the ACP defining, executing and meeting its goals. The organization has seen a recent surge in membership, which is encouraging. The ACP is actively soliciting more members, which means soon the ACP will have many doctors all over the country working toward the same goals.

One way the ACP has worked to make this easier is by embracing the cloud. Members have access to documents, spreadsheets and files in collaborative folders.

“No matter where we are we can all work simultaneously on behalf of the ACP and towards advocacy,” Dr. Pittman said.

“That’s an important tool that we brought to the ACP that’s really going to help us with quick responses to urgent items and advocacy in general.

“It’s like an electronic file cabinet that all of us can look into at the same time and work on and collaborate on without all having to sit in the same room together. I have experience managing a 50-member board for a Florida political action committee, and with these kinds of tools it allows extremely rapid responses to issues that come up. We’ve got leaders all over the country and even in different parts of the word so information technology helps us do what we do better and faster.” VT N

AUGUST/SEPTEMBER 2018 < VEIN THERAPY NEWS

THEPRACTICE

d n a R E B I LASER F T I K R E C U INTROD

!

E C I R P W O L for ONE

EMPATHY FORUM: Atrius forums raise satisfaction for all In medical practices, empathy – the ability to understand and share the feelings of another person – serves two purposes. It lets patients know their providers care about them, and it lets employees know their supervisors, co-workers and leaders care about them as human beings.

That’s why Atrius Health, which provides care for 740,000 patients and has 5,500 medical practice employees throughout the greater Boston area, decided to implement empathy forums. President and CEO Steven Strongwater, MD; Laurel Martino, director of organizational development and learning; and William Boyd, MD, associate CMO, authored a case study in NEJM Catalyst about their forums in 2016.

“Patients today assume that their clinicians know how to provide competent care,” the executives wrote “More important, most patients remember how their clinicians made them feel when they went to the doctor’s office for a visit. They want to know that providers are seeing things from the patient’s perspective and that they are cared for as human beings.

“Our learning about relationship-centered care, along with training from the Cleveland Clinic, indicated that clinical empathy can enhance patient satisfaction, increase adherence to treatment recommendations, reduce distress, and improve health outcomes.

“Furthermore, the benefits of empathy expand beyond the clinician-patient relationship to daily work within our organization itself. When employees feel that

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VEIN THERAPY NEWS < AUGUST/SEPTEMBER 2018

15

THEPRACTICE

Don’t be VEIN

Inbound calls have never been more valuable to your practice and how having a VEIN phone number can prevent you from getting patients

By Bruno Tabbi Don’t be VEIN: Why inbound calls have never been more valuable to your practice and how having a VEIN phone number can prevent you from getting them.

The phone is going through a bit of a renaissance. Even almighty Google concedes that inbound calls to businesses are worth more than web leads, hence their push toward clickto-call. A recent Harvard Business Review article noted that calls convert to new business 10 to 15 times more than web leads, which only convert 1 to 2 percent of the time.

My company’s data is in line with these findings as well. In addition to calls being more valuable, research shows 84 percent of consumers prefer to make first-time appointments by phone.

If you want to get more calls, it’s important to consider your phone number.

Many businesses make the mistake of trying to use a phone number they think people will remember. In vein treatment this usually means a phone number with the word LEGS or VEINS in it.

These types of numbers can diminish response rates by 75 percent and force people online because they don’t remember them. The proper way to generate substantially more calls and enhance your brand at the same time is to use a premium vanity phone number. Owning the right number can make you the most memorable vein treatment practice in your market.

WHY INBOUND CALLS WORK

The reasons why phone calls are so much more valuable today are numerous, but the biggest points include that they are more direct, quicker than typing and that people who call are more prepared to purchase.

In the same Harvard Business Review article, it was reported that Google found that 61 percent of callers are in the purchase phase of the buying cycle. When a consumer picks up the phone they are significantly closer to becoming a patient than one who fills a form out online.

Picking up the phone not only indicates a stronger interest in getting treatment but that the individual wants it done now rather than later. While consumers may prefer to chat with friends over text message, or to order food online, when faced with a complex purchase, like one involving their health, consumers want to talk to a knowledgeable staff member that can answer their questions immediately.

In addition, people don’t want to be inconvenienced. Humans speak approximately 125-175 words per minute but can only type 38-40 words per minute on a full-sized keyboard and significantly less on a mobile phone.

On your end, staff members whose job it is to follow up with web leads spend more time playing phone tag and replying to inquires that never convert into patients. This allocation of resources on low-quality leads can strain your budget and produce little business. Focusing on increasing inbound calls and training your staff to answer these calls is the best way to ensure a successful practice.

One of our clients, a vein practice with more than 20 locations, conducted an internal study to see which leads were producing the most patients. They wanted to see if advertisements directing people to call their phone number, 1-800-VARICOSE, produced more patients than ads presenting people with a web form.

Here’s what the study found; People who called were 14 times more likely to become patients than the web leads were. They also booked their appointments three times sooner, indicating a sense of urgency over the web leads. Finally, they found that callers were three times less likely to cancel their appointments as well.

To some, the idea of phone leads being more valuable may seem common sense, but with the incredible amount of noise about the latest digital trends it is easy to lose focus on what works.

Phone leads are incredibly valuable, but they are hard to get so it is vital that you have an unforgettable recall mechanism. With the uncertainty of what prospective patients encounter online it is paramount that you present consumers with a simple and easy to remember number.

Many practices have tried to do this by investing in phone numbers like 888-443-VEIN or 773-265-LEGS. These types of phone numbers are what our industry refers to as hybrids or partial mnemonics. These hybrid numbers are deceiving because they seem like they would be memorable but they actually end up hurting response rates dramatically.

This is because consumers remember the word/letter portion of the number but end up forgetting the digit portion.

Beyond the negative impact hybrid numbers can have on your response rates, they also pose a greater danger. If a consumer cannot remember your phone number then they are forced to go online where they will encounter you and all your competitors, along with directory sites, review sites and other distractions. Not to mention if you run AdWords you could end up paying for dozens of clicks every day from people who simply wanted to call you but couldn’t remember your phone number and clicked the first thing they saw with your practice name in it.

Even if your practice is mainly referral based and you rely less on advertising, hybrid numbers can affect you. If someone can only refer your practice name it forces the person receiving the referral to go online. And while nothing is stronger than a solid recommendation it is easy for someone unfamiliar with your practice to get confused with the various vein center listings that might pop up.

My company has done market studies over several DMAs to see the prevalence of hybrid numbers in vein treatment. In some markets as many at 68 percent of the vein practices held themselves out to the public using a hybrid phone number. Consider the difficulty of trying to brand your practice when you are ABC Vein Center competing against XYZ Vein Center and your practice uses 727-433-VEIN and the other uses 727-598-VEIN. Looking this similar makes it very challenging to stand out to unfamiliar consumers.

The best way to ensure you are driving as many calls as possible to your phone is to invest in a truly unforgettable phone number. One that makes you stand out and helps boost your practice’s brand like 1-800-VEIN-DOC, 1-800-VARICOSE, and 1-800-VEINS-GONE. Premium vanity numbers work incredibly well at increasing response. These numbers are shown to generate 58 percent more response than regular numbers on radio and 110 percent on visual media such as TV and billboards.

Imagine your practice is ABC Vein Center and uses 1-800-VEIN-DOC while your competitor, XYZ Vein Center using 727-598-VEIN. Which one would you remember? It’s the same one consumers would remember too.

There are several criteria that help determine what qualifies as a premium vanity phone number. We refer to this process as the Hierarchy of Phone Numbers. The first is having a complete word or term. They usually are industry terms or descriptors such as 1-800-DENTIST or 1-800-GOT-JUNK. Finding a number like this is no easy task. There are approximately 88 million toll-free phone numbers. Finding the few that work for vein treatment is highly unlikely but companies like mine specialize in these types of phone numbers and offer regionalized ownership of them.

Avoid terms that require context to make them mean something. For example, your advertising dollars would go much further with 1-800-VEINS-GONE than they would if your practice was called the Fulton Vein Center and you used 1-800-FULTONS. While the latter is a good number, it would require a sizable investment in advertising over a period of several years so that people would associate the term FULTONS with vein treatment. You are much better off with a number that tells people what you do or sell. Also, avoid abbreviations like 855-4UR-LEGS as these are confusing and hard to remember.

The second is that they are toll free. With cell phones, callers are no longer concerned about who pays for the call. The value of toll free is in the enhanced data that they offer over local

GET THE RIGHT NUMBER

So how can you make sure your practice gets more calls? By avoiding the wrong phone number and investing in the right one.

16

DON’T BE VEIN

continued on page 18

AUGUST/SEPTEMBER 2018 < VEIN THERAPY NEWS

SECONDLOOK Team finds VTE biomarker common for cancer patients Venous thromboembolism (VTE), which includes deep venous thrombosis and pulmonary embolism, is a common but underestimated complication for cancer patients. Once patients develop VTE, even when treated with anticoagulation, they are at high risk for a recurrent episode.

Clinical guidelines recommend extended low-molecularweight heparin (LMWH) monotherapy for up to six months, for instance, but studies have shown the chance of a second clot is still high – between 7 and 9 percent.

Alok A. Khorana, MD and director of Cleveland Clinic Cancer Center’s Gastrointestinal Cancer Program, and colleagues decided to look for a biomarker that would identify patients at high risk for recurrent VTE. Their analysis, which was recently published in the Journal of Clinical Oncology, is the largest biomarker study of cancer-recurrent VTE to date.

“We tested for a number of biomarkers and found at least one and maybe two significantly associated with recurrent VTE,” Dr. Khorana said. “One that was definitely associated

was high levels of circulating tissue factor (TF) at the time of initial thrombosis.”

TISSUE FACTOR

To find biomarkers, Dr. Khorana and colleagues analyzed blood samples from 800 patients who were part of the Comparison of Acute Treatments in Cancer Hemostasis (CATCH) trial evaluating different anticoagulant treatments for cancer patients with VTE. They found that higher levels of circulating TF at the time of the initial thrombosis were associated with a greater likelihood that patients would develop recurrent VTE. Tissue factor is a protein that plays a role in the process of blood clotting. They also found that C-reactive protein was borderline significant.

Tumor cells express TF and often activate the body’s coagulation system, says Dr. Khorana. “By increasing the level of circulating procoagulants and decreasing the level of anticoagulants, they change the body toward a more procoagulant state.”

VTE

continued on page 26

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17

SECONDLOOK

Study finds link between varicose veins and DVT

By Edward Boyle, MD and Andrew Jones, MD, A recent study published in the Journal of the American Medical Association (JAMA) found a significant association between varicose veins and deep vein thrombosis, and less clear potential associations with pulmonary embolism and peripheral artery disease.

The significance of this large, retrospective population study (more than 400,000 people) is that varicose veins are a common condition, but may be associated with increased health risks, especially for deep vein thrombosis (DVT). DVT, pulmonary embolism (PE), and peripheral artery disease (P.A.D.) are all vascular diseases with severe systemic effects and may be life-threatening.

DON’T BE VEIN

continued from page 16

numbers and that toll-free area codes are the most recognized by consumers, which ultimately makes them easier to remember.

Not all toll-free area codes are the same though. The 800 and 888 series are the best; 877 and 866 are of lower quality. Avoid anything that is 855 or lower (844, 833 and soon 822). These area codes are too new, and consumers have little to no recognition of them, so they tend to be forgotten or misdialed as 800 or 888. With people keeping their cell phone numbers the same as they move across the country, local area codes are less important than in the past and having a toll free number no longer means you are not local.

Premium vanity numbers are incredibly valuable with recent sales of top tier numbers such as 1-800-RECOVERY selling for more than $1 million and 1-800-ATTORNEY for $3 million.

But technology now allows us to regionalize numbers so that businesses can own one exclusively for the markets they need for a fraction of their acquisition cost. The ability to regionalize phone numbers has created an opportunity for many businesses to gain access to premium vanity numbers. The fact that this technology did not always exists also explains the prevalence of hybrid numbers.

Many practices would have selected better numbers if they would have had access to them but ended up with a hybrid because it was all they could get, and they thought it would do the job.

Another great feature that makes vanity numbers such a valuable lead source is that they often come with call tracking and call recording. You might seem overwhelmed with the amount of data you track online but with calls it’s very simple. You get a log of

18

Researchers looked at the health records of more than 425,000 adults over a 12-year period. The study concluded that more work is needed to understand whether varicose veins directly cause blood clots or whether the two conditions have a similar origin due to a common set of risk factors.

DEEP VEIN THROMBOSIS

DVT is a condition most people associate with blood clots in the legs. DVT occurs when a blood clot (thrombus) forms in the deep veins, most commonly of the legs, pelvis, or arms.

Some DVTs may not have any symptoms but most cause dramatic pain, swelling, and warmth in the leg. If untreated, people with extensive DVTs are at risk of developing a pulmonary embolism, in which the blood clot breaks away and travels to the lung, which can be life-threatening.

the most valuable leads and the ability to listen to the calls to hear what callers are saying to your staff and how your staff is handling them. That is more valuable than any metric on screen time, click-through rates or impressions.

But even if a good amount of your business comes from online, a premium vanity numbers still has much to offer there as well. Online ads featuring a vanity number generate 33 percent more clicks than those with a regular one.

If you want to really grow your practice and invest in the future, then you should consider a premium vanity toll free phone number. Doing so will allow you to brand your practice better, increase response and make you less susceptible to Google and the other online giants. It will also make you easier to refer. VT N Bruno Tabbi Jr. has more than a decade of experience with premium vanity phone numbers for the vein treatment industry. He is president and co-founder of Ignition Toll Free, a company that specializes in premium vanity phone numbers and has brought 1-800-VEIN-DOC, 1-800-VARICOSE and 1-800-VEINS-GONE to the market.

Free Number Consultation

To receive a free consultation regarding your practice’s current phone number or to see if a premium vanity phone number is available for your market call 1-800-STRONG-SALES (800-787-6647 Ext. 2).

DVT is a common problem, especially after injury or trauma. We are committed to helping diagnose DVT in patients where this problem is suspected and help manage them through the process of recovery.

DVT occurs in up to two million people each year in the United States alone. PE – its potentially fatal complication – claims approximately 300,000 lives annually. This is more than breast cancer and AIDS combined.

VARICOSE VEINS

Varicose veins are swollen bulging veins under the surface of the skin that can be dark purple or blue in color. Although varicose veins can occur anywhere in the legs, they most often occur in the calves and behind the knees.

The function of veins is to bring blood back to the heart. Because the veins of the legs work against gravity, they contain one-way valves to prevent the blood from flowing backward as it travels back to the heart. If the one-way valve becomes weak, some of the blood can leak back down the vein, causing the veins to become congested. This causes what is known as vein reflux, or venous reflux.

In addition to causing veins to bulge and stretch, additional unpleasant side effects may include: • Heavy and tired legs • Aching and throbbing pain • Swelling • Itching • Leg cramps • Restless Leg Syndrome Heredity is a primary factor in in more than 80 percent of varicose vein cases. Other contributing factors may include pregnancy, obesity, hormone therapy, standing or sitting for long periods of time and injury.

We are committed to helping our patients understand their venous issues, and when indicated, treating them with the most up to date minimally therapies available to relieve their symptoms and reduce the potential for future problems.

TREATMENT

The treatments to eliminate varicose veins and all vein abnormalities have improved dramatically in recent years. Radio Frequency Ablation (RFA) is the standard thermal treatments for large varicose veins.

In this technique, a very thin radiofrequency catheter is inserted into the damaged underlying vein. This technique works by heating the inside of the vein, which causes it to seal shut and disappear. To perform the procedure, the doctor uses an ultrasound to map the vein, and then inject the area with local anesthesia.

The doctor places a needle into the lower end of the diseased vein, through which a small sheath is put into the vein. The radiofrequency catheter is then placed through the sheath and advanced to the upper end of the diseased vein. Local anesthesia is then delivered to the

entire vein. The radiofrequency catheter heats the inside of the vein as it is slowly withdrawn back down the vein.

Performing an endovenous ablation eliminates the abnormal saphenous vein, which is often the source of most varicose vein issues.

Advances in non-thermal venous ablation treatments have resulted in additional treatment options.

• Varithena treatment involves the injection of medicine into the vein with ultrasound guidance to direct the medication into the abnormal vein, which causes the veins to close.

• VenaSeal Closure System is the only procedure to use a medical-grade adhesive to close abnormal saphenous veins. The adhesive is inserted into the vein under ultrasound guidance via a small catheter and seals the vein shut.

• ClariVein is a specialty infusion catheter with a rotating wire tip designed for the controlled 360-degree dispersion of medication to the targeted saphenous veins. This process causes the malfunctioning veins to close down. VT N Edward Boyle, MD, has a career that spans clinical surgery, vascular research and medical innovation. After starting out his career specializing in cardiothoracic surgery, he now sub-specializes entirely in treating patients with vein and vascular disorders.

Andrew Jones, MD, is a board-certified general surgeon with a special interest in the management of venous disease.

Dr. Jones is a diplomat of The American Board of Phlebology and also serves on the International Affairs Committee for the American College of Phlebology. They can be reached at the Inovia Vein Specialty Center in Bend, Ore., at 541316-8600.

For even more of the latest industry news and features, please visit us online at VEINTHERAPYNEWS.com

AUGUST/SEPTEMBER 2018 < VEIN THERAPY NEWS

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SECONDLOOK

HEALING AT THE MID-LEVEL

Two mid-level practitioners discuss challenges, rewards, future of their profession

By Larry Storer Mid-level practitioners in the medical field include occupations of nurse practitioners, nurse midwives, nurse anesthetists, clinical nurse specialists and physician assistants, to name a few. In this article, I asked two mid-level practitioners from American Vein & Vascular Institute to share their thoughts on the occupation, its challenges, rewards and future.

On behalf of Vein Therapy News (VTN), I want to thank Angela Cole, MS, PA-C, and Janette Trent, APN-BC for taking the time to answer questions and share their perspective.

Angela Cole, MS, PA-C, is a phlebologist at American Vein & Vascular Institute. Cole earned a Bachelor of Science in Cell Biology and Neuroscience from Montana State University and a Master of Science in Physician Assistant Studies from Rosalind Franklin University of Medicine and Science. Before joining Angela Cole American Vein & Vascular Institute, Cole worked in the fields of internal medicine and bariatric surgery. She has been performing ablation procedures for the treatment of chronic venous disease since 2013. Cole is also a member of the Colorado Academy of Physician Assistants.

Janette Trent, APN-BC, is also a phlebologist at American Vein & Vascular Institute. Trent has been a phlebologist since 2001, having worked and trained with many pioneers in the field of phlebology. In her previous roles, Trent was instrumental in establishing and directing a training program that Janette Trent allowed aspiring phlebologists to complete a preceptorship, which prepared them to complete the rigorous requirements for attaining fellowship with the American College of Phlebology (ACP), and assisted them in establishing their own phlebology practices. Trent earned a Bachelor of Science in Nursing from Indiana Wesleyan University and graduated from the Women’s Health Nurse Practitioner program through the Indiana Family Health Council and Indiana University-Purdue University in Indianapolis.

VTN: Here is a “standard” definition for a mid-level practitioner. How accurate is it?

“Mid-level practitioners, also called assistant practice clinicians, are health care providers who have received different training and have a more restricted scope of practice than physicians and other health professionals in some states, but who do have a formal certificate and accreditation through the licensing bodies in their jurisdictions.”

COLE: It’s accurate only from a textbook standpoint. It doesn’t describe the quality and level of patient care we provide, by any means.

20

TRENT: This is not a reflective definition from a patient’s perspective. It doesn’t describe what we do. For patients, we are practitioners who diagnose, treat and also perform procedures.

VTN: What are the top challenges you face as a mid-level practitioner, and how do you overcome those challenges?

COLE: By far, my top challenge(s) are: Barriers to care due to issues of insurance reimbursement and electronic medical records (EMRs) which are designed to be efficient but are often the exact opposite.

The insurance reimbursement issues are well-known and hard-hitting to patients and their care givers. It is frustrating and oftentimes heartbreaking to find work-arounds to insurance barriers that still provide the level and quality of care needed for positive patient outcomes.

EMRs are created by people who don’t work in the field.

These systems are a massive investment by the physician group and basically, once an EMR is chosen and purchased, you’re stuck with it. If you determine it’s not an ideal fit for your practice, it’s too expensive to change and you have to adapt and live with it. The biggest challenge with EMRs is that they require massive amounts of documentation, and that documentation takes time away from the quality of care you provide to patients.

Let me be clear that my employer (American Vein) chose an excellent EMR system, allowing my colleagues and me to maximize the quality of care we provide to patients, while still properly documenting each case. Throughout my career, I’ve worked with numerous EMR systems and I have not always been blessed with good ones. There is simply no incentive for EMR companies to improve their services, so this will remain a challenge.

TRENT: One of my top challenges is the misconception surrounding mid-levels and our qualifications to treat patients.

When I began my career in the mid 90s, there weren’t many mid-level practitioners around and it was a real challenge to be accepted by patients. Today, the mid-level occupation is much more prevalent in the medical field, but I still sometimes encounter patients who are wary of the level of care midlevels will provide and they are willing to reschedule their appointments to be seen by a physician.

VTN: What do you find most rewarding about your position, and why?

COLE: My phlebology career has afforded me many joyful moments. Phlebology is rewarding because the results of care affect a patient’s life in profound ways. With proper treatment of their condition, patients can regain control in their life. They can resume walking their dog, exercising, sleeping soundly and so much more.

TRENT: Getting to know my new patients and establishing a relationship with them is extremely rewarding. When I first meet these patients, they are in significant amounts of pain and have lifestyle restrictions. I see them often in those first weeks of care and I get to see vast improvements in their quality of life. I meet them at their worst, and one or two months later, they are back to normal activities, nearly pain free.

As an example, Jack (not his real name) is a 48-year-old patient of ours (American Vein) who had leg pain, aching,

swelling and fatigue in his legs, particularly at the end of the day after standing all day at work. He works in sales, so he was required to be on his feet for several hours of the day. Because he had no visible varicose veins, it took him about two years after the onset of his symptoms to find his way to us for an evaluation.

In the meantime, his legs were hurting so badly that he had stopped playing golf because he was unable to stand long enough to play without significant leg pain. His initial ultrasound evaluation at American Vein indicated that although he had no visible varicose veins on his legs, he did have considerable venous reflux (faulty blood return out of the legs) in the veins underneath the surface.

We performed three procedures on Jack’s legs to correct this venous reflux, which he tolerated well with no downtime after his procedures. When he returned for his one-month posttreatment evaluation, he was already back to playing golf again without pain and could easily stand for several hours a day at work without pain. He was very happy to have his quality of life back and said that his only regret was that he didn’t know prior to seeing us that venous disease could exist without visible varicose veins.

VTN: How do mid-level practitioners benefit a business/ practice management group?

COLE: Having mid-levels in a practice allows more time for caregivers to spend with patients. A PA is an extension of the supervising physician, a resource that allows the physician to be more productive. The PA can diagnose and treat patients, consulting with the supervising physician as needed. The supervising physician is able to conduct more research on patient conditions and also consult with patients who have more severe care needs. We actually make each other more productive and efficient, thereby providing higher levels of patient care.

TRENT: Mid-levels bring convenience to patients. In my practice at American Vein, mid-levels work in close coordination with physicians. Oftentimes, we are able to see patients the same day they call, whereas, they may need to wait several days to see the physician. Because we work in close conjunction with the physician, we can call on them with any questions or challenges that may arise with the patient’s care.

VTN: What changes do you foresee happening in the mid-level practitioner career field over the next three to five years, and in the next decade?

COLE: I believe the occupation of mid-level provider will continue to grow as patients better understand the concept.

Patients will become more comfortable in the care of a midlevel provider and understand the important role we play within a provider organization.

TRENT: The scope of the mid-level practice is expanding and will continue to do so. For example, NPs are now able to perform in-office procedures. As the level of care we are allowed to provide expands, our education requirements will increase, as well. Currently, NPs are required to hold master’s degrees and eventually, I think we will need to have our doctorate degrees. VT N

AUGUST/SEPTEMBER 2018 < VEIN THERAPY NEWS

SECONDLOOK Global portable ultrasound units drive strong sales

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their supervisors, co-workers, and leaders care about them as human beings, it can lead to reduced stress, greater teamwork, and enhanced employee engagement; this also has the potential to support the compassionate care we strive to provide our patients every day.”

Doctors can improve communication with patients with simple steps, such as smiling when they greet patients and maintaining eye contact.

In 2016, Atrius conducted 251 empathy forums across its organization, training more than 4,000 medical practice employees or 92.3 percent of the staff in 90-minute sessions with the goal of integrating empathy into their daily work. The result was an increase in patient survey scores for “sensitivity to patients’ needs.”

To teach employees to practice empathy, the authors recommend leaders co-facilitate the sessions along with an organizational development and learning or human resources consultant. Sessions should be interactive and engaging for employees.

Atrius provided a three-hour train-thetrainer session for practice leaders where they practiced for the forums using a script, videos and other resources and materials. Two weeks before the forums, participants received prework to introduce them to the session. The sessions themselves included a presentation about communication skills and a video with Atrius’ own doctors and employees. The organization follows up with coaching and feedback to employees during one-on-one meetings, team meetings and huddles. VT N

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A new Research and Markets report, “Portable Ultrasound Devices Market: Global Industry Analysis, Trends, Market Size and Forecasts up to 2024,” predicts the global portable ultrasound devices market will grow with a CAGR of 8.50 percent over the forecast period of 2018-24 Portable ultrasound machines are being adapted to meet the rising business demands due to its portability. These machines offer great benefits, eliminates the stress of patients having to wait hours to receive a check up or having them constantly move from one room to another where devices are available.

Increased use devices offer a range of benefits that helps to drive the ultrasound market. It helps in instant diagnosis and does not require dedicated space that helps during serious medical environments such as the emergency room and intensive care unit. VT N

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SECONDLOOK POLIDOCANOL

continued from page 12

The sclerosing agent is also ideal for patients who have been previously treated with thermal ablation but still have refluxing veins. In addition, I use microfoam sclerosant therapy to shut down refluxing veins and varicosities contributing to stasis dermatitis and venous ulcers.

Not only does polidocanol microfoam expand the types of difficult venous problems I can treat, the procedure is much more comfortable for patients; one stick with a 22-gauge needle and one injection of endovenous microfoam is often all that is required to shut down a refluxing vein.

Microfoam sclerosant therapy has allowed me to significantly decrease the number of phlebectomies I perform.

Technically, administering polidocanol microfoam is a very simple procedure, requiring less skill to acquire venous access than laser or radiofrequency ablation, and there is no tumescent anesthesia to administer.

But because the procedure is duplex ultrasound-guided, it requires the assistance of an ultrasound technician.

The primary complication risk of microfoam sclerosant therapy is deep venous thrombosis, and the key to preventing this is good technique with occlusive pressure at the junction of the attachment to the deep venous system. None of the more than 1,000 patients in the VANISH-1 and VANISH-2 clinical trials experienced clinically important neurological or visual adverse events suggestive of cerebral gas embolism.2,3 In addition, Varithena contains only trace amounts of nitrogen (< 0.8%), greatly reducing the risk of gas embolic adverse events reported with physician-compounded foam mixed with room air.

The new CPT code for Varithena simplifies reimbursement and has created a quantum leap in the number of insurers who cover the procedure, although I would like to see coverage expanded to lesser saphenous veins (LSV). In my practice, I’m striving to use polidocanol microfoam for every patient with venous insufficiency except those with perforator veins.

CASE STUDY

“Andy,” a 77-year-old retired factory worker, had severe venous disease. He also had life-limiting arterial disease with chest pain, shortness of breath, bilateral limb pain, and edema – and smoked 16 cigars each day.

After we treated his arterial disease with bilateral SFA revascularization procedures, we addressed his long-standing venous disease.

Despite more than a dozen laser ablation treatments and multiple phlebectomies, Andy continued to have significant reflux from partially thrombosed veins. One of Andy’s greatest joys was to fish for paddlefish in

22

the Mississippi, which he could no longer do because his venous disease made it impossible for him to stand for prolonged periods.

Additional laser ablation treatments were not possible, because the veins were partially occluded and tortuous. I worried that Andy’s chronic venous insufficiency would progress and that he would require long-term analgesic medication for leg pain. Polidocanol microfoam was the only option to treat Andy’s venous insufficiency, and it was successful.

When I first met Andy in 2011, he had lifelimiting claudication with bilateral superficial femoral artery (SFA) stenosis and severe venous insufficiency with cramping at night and an inability to stand for extended periods of time. Lower extremity venous duplex showed that his right GSV was partially thrombosed and also fed large varicosities, the right anterior tibial vein (ATV) had incompetent perforators, as did the left ATV. He had severe reflux in his left GSV, which was also partially thrombosed and led to large varicosities. His LSVs were also noted to be incompetent.

We initially performed his arterial revascularizations and observed a resolution of his arterial claudication symptoms. Despite this intervention, Andy continued to have bilateral limb pain and cramping in his calves at night and heaviness in his legs. This marked the beginning of multiple attempts at treating his venous insufficiency with laser ablations and his varicose veins with phlebectomy.

We initially tried to wire the partially thrombosed GSV veins. We were able to enter and laser portions of the veins but ultimately were unsuccessful because we were unable to place a sheath and laser across the length of the vein because the partially thrombosed areas did not allow the sheath and laser to pass. We even tried – unsuccessfully – to use an angled stiff glide wire in an aggressive attempt to traverse the thrombosed areas in the vein. We were, however, able to ablate his LSVs bilaterally.

Subsequently, Andy had laser ablations of his anterior accessory veins bilaterally and had a repeat arterial revascularization of his right and left SFA. Despite these interventions Andy continued to have issues with severe venous insufficiency that interfered with his daily activities, including sleep disturbance but, most importantly, his ability to catch paddlefish and gather their caviar.

A lower-extremity venous ultrasound showed bilateral bulging varicosities with severe reflux. Andy’s right GSV and left GSV had severe reflux and were partially thrombosed throughout the veins and had scarring from chronic thrombus. Varithena had recently become available, and in June 2017 we ablated Andy’s left varicose vein with percutaneous endovenous microfoam.

Prior to the procedure, we mapped the major varicosities into the GSV as well as the location of perforating veins, both competent

Patient presents with bilateral bulging varicosities

Images detail left medial calf and medial knee bulging varicosities. Measuring 4mm and showing reflux for 1.2 seconds

Images details right posterior calf bulging varicosity. Measuring 4mm and showing reflux for 1.9 seconds and incompetent. Using ultrasound guidance, we inserted a 23-gauge needle with a winged infusion set through the skin into Andy’s left varicosity. Once the tubing of the infusion set was filled with venous blood, we administered 10cc of Varithena through the winged infusion set into the varicose vein to fill the varicosity with the drug. We manipulated the ultrasound probe to assist with the evacuation of blood from the target veins to improve vein filling with the drug.

During intravenous access into the varicosity, Andy was asked to dorsiflex his ankle to limit flow of the drug into perforating veins. Once spasm had been confirmed in the treated veins, the mapped and treated veins

were once again scanned extensively with ultrasound to confirm vascular spasm. We removed the winged infusion needle and the vascular catheter from the leg and applied light pressure over the puncture sites for hemostasis. We evaluated the common femoral and femoral veins for flow and compressibility prior to placing the dressing. We placed a short stretch wrap on Andy’s leg from the distal foot up to the groin. Andy walked for 10 minutes after the procedure.

A week later, Andy underwent a second polidocanol microfoam procedure for the problematic partially thrombosed right GSV and, subsequently, the left GSV. Microfoam sclerosant therapy successfully ablated

AUGUST/SEPTEMBER 2018 < VEIN THERAPY NEWS

SECONDLOOK Andy’s varicose vein, right GSV, and other varicosities. Andy was now able to stand for hours without discomfort and resume his passion of fishing.

Polidocanol microfoam offers a new and valuable tool in the armamentarium to treat venous insufficiency, and, for patients such as Andy it is essential to complete treatment.

As applied to the treatment of venous insufficiency in the general population, Endovenous microfoam sclerosant therapy offers multiple technical advantages including ease of use, decreased technical difficulty, and increased patient comfort.

Microfoam sclerosant therapy can also treat a wide range of vein shapes and diameters as well as CEAP clinical class C2-C6 without incisions or wires or thermal injury risk to skin, nerves or surrounding tissues. VT N

“If you are not buying from TVS… you are paying too much!”

Ajit Naidu, MD, is CEO of the Cardiovascular Institute of the Shoals in Florence, Ala., and is a speaker at vein and heart conferences, including the just completed International Vein Congress in Miami. In addition to being a published author, Dr. Naidu has served as an investigator for multiple national clinical trials. He was the first physician in the Shoals to offer radial artery cardiac catheterizations and coronary interventions, laser varicose vein ablation, and advanced techniques in peripheral vascular intervention.

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CITATIONS 1

Fowkes FG, Evans CJ, Lee AJ. Angiology.

2001; 52: Suppl 1: S5-15.

2 King JT et al. Eur J Vasc Endovasc Surg.

2015; 50:784-793.

3 Todd KL 3rd, and Wright DI. Phlebology.

2014; 29(9):608-618.

Surgical Supplies Compression Hosiery

Venclose closes Series B financing for growth needs Venclose Inc., a San Jose, Calif.-based medical technology company developing next-generation solutions for the treatment of venous reflux disease, closed a Series B round of financing to be used for new product development, expansion of manufacturing capabilities and general corporate purposes.

Venclose is commercializing the successful VENCLOSE Radiofrequency Ablation System, which is designed to close damaged veins and restore healthy blood flow in patients with venous reflux disease, a progressive medical condition which is often associated with varicose veins. To date, more than 4,000 patients in the United States and Europe have been treated with the VENCLOSE system.

Jeffrey G. Carr, MD, FACC, FSCAI has joined Venclose as chief medical officer. VT N READ MORE: venclose.com

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PRODUCTNEWS

Ronald, Peggy Bush publish first book about facial veins “A Guide to Treating Facial Veins,” a new “one-of-a-kind” book illustrating the safe treatment for all facial veins using anatomical principles, has been published by Ronald Bush, MD, FACS, and Peggy Bush, APRN. The book made its debut at the CVC Arterial & Venous Endovascular Conference in July.

Online sites will be announced soon.

“Prominent veins of the face present an undesired cosmetic issue for many patients,” Dr. Bush wrote in the introduction. “Veins that represent cosmetic concerns are predominantly on the frontal, temporal and suborbital regions.

Facial veins are thin-walled and contain no valves for the most part.

“Facial veins may dilate from increased drainage through the scalp veins or from non-pathological but physiologic compression.

Examples may include laughing, straining or may occur with the patient in the recumbent position. Over time, the respective vein may become more pronounced.

The book is a labor of love for both Dr. and Mrs. Bush, highlighting recent research.

Dr. Bush, one of the nation’s foremost specialists in venous disease, has co-founded and is the medical director for Vein Experts, a national group of professionals specializing in the care and treatment of venous disease.

He has published numerous peer-reviewed journal articles and is an innovator of many techniques utilized in the treatment of venous disease. He is board certified in vascular surgery. He trained at Indiana University School of Medicine and Walter Reed Army Medical Center in cardio thoracic surgery.

For the past 20 years, Dr. Bush has devoted his practice solely to the treatment of venous disease. Areas of research currently are devoted to the manifestations of cutaneous venous hypertension. Dr. Bush has developed a targeted approach to the treatment of venous ulcers and has published his technique in various journals.

Peggy Bush, APRN, has more than 30 years of professional experience in nursing.

She earned her Bachelor of Science in Nursing degree from Bradley University in Peoria, Ill., and her master’s degree in nursing from Saint

Francis Medical Center College of Nursing in Peoria.

Board-certified by the American Nurses Credentialing Center, she has devoted the last nine years to the study and treatment of venous disease. In the clinic setting, she has worked alongside Dr. Bush, and has co-authored papers on the care and treatment of venous pathology, and she is president of dermaka skin care products. VT N READ MORE: aesthetic veint r aining.com / uncategorized/a-guide-to-treatingfacial-veins-by-ronald-bush-mdfacs-peggy-bush-aprn/

Pressure-responsive fibers could lead to color-changing wound bandages Engineers at MIT have developed photonic fibers that change color in response to pressure.

The innovation could lead to color-changing bandages that allow clinicians to easily know if they’re tight enough or too tight.

Compression stockings and bandages are a common treatment for venous ulcers. However, it can be difficult to tell if an optimal level of pressure is being applied by a bandage. “Getting the pressure right is critical in treating many medical conditions including venous ulcers, which affect several hundred thousand patients in the U.S. each year,” said Mathias Kolle, a researcher involved in the study.

The MIT researchers have as their ultimate goal the development of a pressure bandage that a doctor can easily apply to the correct pressure, and then easily monitor to see if it maintains that pressure over time.

Their proposed solution involves a dressing that would change color under pressure, so a doctor could check the color against a chart and determine if the bandage is at the correct pressure.

To achieve this, the research team proposes to use a dressing threaded with photonic fibers.

They have developed the fibers using transparent rubber, that they roll into layers, like those in a jelly roll. The fibers are ten times thicker than a human hair and reflect light at the interface between the thin layers.

Reflections at different layers interact with each other to reinforce some colors in the visible spectrum, resulting in different vibrant colors

depending on the thickness of the layers. The same principle is at work in the colors that are visible in soap bubbles and in the colorful swirls visible in oily puddles.

The team incorporated the pressure-sensitive fibers into pressure bandages and tested them on student volunteers. Applying the bandages to each other, the students compared them with conventional bandages. With the help of a color chart, they were able to more easily apply the color-changing bandages with an optimal level of pressure, compared with the conventional bandages.

At present, the researchers are working on ways to scale up their production of the fibers, so that they can be produced more cheaply. VT N READ MORE: on l i nel i br a r y.w i le y.c om /doi / full/10.1002/adhm.201800293

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We accept information ranging from press releases to product spec sheets, and you can include sales contact information. We also are happy to run product photos.

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PRODUCTNEWS NEGATIVE PRESSURE

continued from page 10

Surgical and traumatic wounds comprise of abrasions, punctures, lacerations and incisions, while chronic wounds include venous ulcers, diabetic ulcers, and pressure ulcers, which are a significant burden on patients, healthcare professionals, and the healthcare system.

Venous ulceration is the most common type of leg ulceration, and diabetic ulcers are responsible for most of the foot and leg amputations in the United States.

It is estimated that on an average, approximately 17.5 million diabetic patients globally develop foot ulcers every year.

Approximately, 8 million to 9 million pressure ulcers occur in hospitals every year.

“The increasing global prevalence of acute wounds such as surgical and traumatic wounds and chronic wounds is expected to drive the market during the forecast period,” a senior Technavio analyst said.

“The introduction of portable NPWT devices and single-use NPWT devices facilitates the early discharge of patients from hospitals and allows them to continue with the required care in outpatient settings.”

Based on end user, the global NPWT market is segmented into hospitals and clinics, ambulatory surgery centers and home healthcare. Hospitals and clinics account for the major market share in the global NPWT market.

They are followed by ambulatory surgery centers and home healthcare. The high market share of hospitals is due to the high adoption of NPWT devices in hospitals, high awareness about the clinical benefits of NPWT, the increasing incidence of acute and chronic wounds, favorable reimbursement scenarios, and the focus of key vendors on hospitals.

The Americas was the leading region for the global negative pressure wound therapy market in 2017, accounting for a market share of 54 percent.

Technavio’s sample reports are free and contain multiple sections of the report such as the market size and forecast, drivers, challenges, trends and more. VT N READ MORE: technavio.com/ report/global-negative-pressurewound-therapy-market-analysisshare-2018?utm_source=t10&utm_ m e d i u m = b w & u t m _ campaign=businesswire

CurveBeam’s tiny InReach CT scanner gets FDA approval CurveBeam‘s InReach point-of-care extremity CT system received FDA clearance for use in scanning the arms, hands, wrists, and elbows, as well as the feet and legs.

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Patient extends arm into InReach CT scanner This is one of the smallest CT scanners out there, giving a detailed 3D view of the extremities that digital X-rays can’t provide.

The device doesn’t need any additional shielding and is small enough to be kept in a corner with other equipment and used as necessary.

InReach’s bore can be moved up and down to level with the patient’s arms or legs and once a scan is initiated, it takes less than 30 seconds to complete. The height of the gantry can be vertically adjusted to a patient’s height.

The unit can scan a non-weight bearing leg, knee or foot.

The InReach Lite Dose protocol reduces dose by 56- 65 percent of the InReach standard protocol for the average adult patient The InReach comes with its own visualization software called CubeVue that does slices, 3D reconstructions, and all the typical manipulation features that come with larger CT scanners. VT N

Post surgical scan sagital view READ MORE: http://www. curvebeam.com/products/inreach/

Canon releases two new Aplio ultrasound units Canon Medical Systems USA Inc. is offering its Aplio i800, the industry’s only 24 MHz transducer on an ultra-premium ultrasound system that can image over a wide range of clinical applications.

In addition to showing the product at the American College of Phlebology Congress in Austin in 2017, it was shown again at Premier Inc.’s 2018 Clinicians and other health system members of Premier selected Canon Medical Systems’ Aplio i800 to be showcased at the Innovation Celebration with its industry’s only 24 MHz transducer on an ultra-premium ultrasound system that can image over a range of clinical applications.

The system can help clinicians expand to new applications in venous treatment, dermatology, rheumatology and orthopedics.

The Aplio i800 also offers superb resolution of minute vessels and extreme lowvelocity microvascular flow using exclusive Superb Microvascular Imaging technology.

Additionally, the Aplio i800 features iSense technology to optimize workflow and productivity during daily routine and complex exams.

“Canon Medical Systems is opening the door to new territories in ultrasound by providing imaging clarity and definition across a wide range of clinical applications,” said Dan Skyba, director of the Ultrasound Business Unit at Canon Medical Systems USA. “The Aplio i800 is an example of how we continue to innovate and enhance our systems so that our customers have the tools they need to get to their diagnostic answer quickly and with confidence.”

APLIO I600

Canon Medical has also recently unveiled its FDA-cleared Aplio i600 ultrasound system. It’s intended for both diagnostic and interventional procedures, featuring tools that make setup quick and intuitive. An imageguide interface helps to move the clinician through the imaging exam.

Skyba said the Aplio i600 provides intuitive ergonomics to help boost productivity during routine and complex exams thanks to its small and light iSense design which makes it easy for clinicians to adjust the console to virtually any scanning position.

Skyba touted the ergonomic design of the Aplio i600 that allows the console to be positioned in just about any way with respect to the patient. The cables were made extra flexible for easier manipulation of transducers.

As far as image quality, the same high-end transducers are used as on the Aplio Platinum Series and the company’s iPerformance technology works to minimize clutter, improve signal and produce a crisp, high quality image.

The Aplio i600 uses the same transducers from the current Aplio Platinum Series, making migration to this new system even easier.

ApliPure+ compounding helps to improve contrast while lowering speckle noise. The superb micro-vascular imaging (SMI) helps to see blood flow through tiny vasculature that was previously very difficult to examine.

As far as diagnostics, Skyba said the Aplio was designed to increase efficiency, the system’s lightweight transducers feature

Canon Aplio i800 outstanding clinical versatility, ergonomic shapes and thin, super-flexible cables. Aplio’s transducers deliver superb image quality and respond with high flexibility to the widest range of clinical applications.

“The Aplio i600 was designed to expand the clinical utility of ultrasound by delivering outstanding image quality that allows health care providers to feel confident in every diagnosis,” Skyba, said. “The cost-effective solution also improves productivity with an intuitive user interface that enhances workflow and reduces training needs.” VT N READ MORE: https//us.medical.canon

VTE

continued from page 17

ANTICOAGULATION THERAPY

Measuring TF is somewhat controversial.

“We don’t quite know the best way to do it,” says Dr. Khorana. His team used the commercially available assay ELISA so their study could be more easily repeated.

There are ongoing trials to determine the best anticoagulation treatments, and Dr. Khorana and his team hope such investigations either confirm or refute their findings.

Pinpointing biomarkers for recurrent VTE is important because the condition can be deadly. Some researchers have proposed using the Ottawa score, a clinically based riskassessment model, but studies have shown it is inconsistent in predicting recurrent VTE – thus the need for more definitive predictors or biomarkers.

“You want to patients at risk for recurrent VTE on a more intense anticoagulation treatment or a longer period of treatment,” he says. “If clots occur or recur they can be life-threatening, especially pulmonary embolism. Hence the need to manage this VT N very carefully.”

This study was presented for discussion through the Cleveland Clinic Consult QD (consultqd.clevelandclinic.org).

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PRODUCTNEWS Cleveland Clinic Florida replaces ICU curtains with frosted glass to control infection Privacy curtains were as commonplace as respiratory monitors in Cleveland Clinic Florida’s medical and surgical ICUs. But then Nadia Cuff, BSN, RN, CCRN, director of nursing in the ICUs, started to think more about how they affected patient care.

Each of the 23 ICU rooms had curtains at the entrance (along with sliding glass doors) and curtains around the toilet. Curtains were laundered after every contact isolation discharge, but only once a quarter if patients weren’t in contact isolation.

Although hand-hygiene protocols were well established in Cuff ’s ICUs, was there more her critical care teams could do to protect patients?

“Sometimes we’d touch the curtains to enter the room and, once inside, wash our hands or use antibacterial foam,” says Cuff.

“But other times we’d foam outside the room, and then touch the curtain when entering. We were following proper protocols, but we never thought about the order of hand-sanitizing and curtain-touching.”

A critical care task force and infection prevention committee found studies that indicated privacy curtains could harbor pathogens that cause infections. For example, one study determined that curtains can become rapidly contaminated with pathogens.

Another study found that healthcare workers can pick up bacteria by touching privacy curtains.

While contaminated curtains hadn’t been linked to infections at Cleveland Clinic Florida, Cuff decided to be proactive.

Cuff and the committee brainstormed seven options, which Cuff presented in 2017 to Cleveland Clinic Florida administration.

1. Purchase an extra set of curtains for each room and change curtains after each discharge. However, the cost of the curtains would be significant, not to mention the ongoing expenses for laundering and maintenance staff.

2. Convert to disposable curtains. But that would incur an expense for each curtain change, plus additional staff to continually replace curtains.

3. Use partition screens instead of curtains. The cost was minimal, but the surface would require regular disinfecting.

The screens were cumbersome and not aesthetically pleasing.

4. Install blinds. However, blinds would cost more than curtains and still require disinfecting.

5. Frost existing glass doors. That would require spraying a coating, and fumes could negatively affect patient experience.

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6. Install frosted glass. But cost was prohibitive.

7. Install frosted window film. This idea seemed promising.

To install frosted window film, the onetime cost would be less than the current monthly cost of occasional curtain changes.

Administration immediately offered funds for Cuff to make the switch.

“Removing all curtains and installing window film on the doors will save Cleveland Clinic tens of thousands of dollars per year on laundering and manpower,” says Cuff.

The film was installed quickly – in one day.

It frosts only the top panel of glass on room doors, allowing ambient light to shine through the bottom panel.

“Nurses were dissatisfied with the curtains, not just because of potential contamination issues, but also because changing curtains was disruptive to patient care,” Cuff said.

“And finding staff to change curtains during overnight hours was difficult.”

Frosted film has alleviated those concerns and changed the standard for Cleveland Clinic Florida. When the hospital’s new tower opened in July, all 48 new ICU rooms have frosted window film instead of curtains. VT N

R&M details central venous catheter market analysis The “Central Venous Catheters Market (By Design; By Product Type; By Property;

By Material; By Application; By End User, Hospitals, and Specialty Clinic): Global Industry Analysis, Size, Share, Growth, Trends, and Forecast 2016 - 2025” report has been added to Research and Markets’ offering.

The central venous catheters are alternatively known as central venous access devices or central lines catheter. It is a thin, long, hollow plastic tube which is inserted through an internal jugular vein, femoral vein, and subclavian vein. With the help of the catheter, nutrients and medications are given and it is also used for collecting the blood samples.

The global central venous catheters market was valued at around $740 million in 2016 and is expected to reach around $1.140 million by the end of 2025, growing at a CAGR of 4.9 percent between 2017 and 2025.

The central venous catheters are used for measuring the central venous pressure, monitoring the hemodynamic variables, chemotherapy, and in hemodialysis. Patients suffering from cancer, gastrointestinal diseases, and other chronic diseases require parenteral nutrition which is provided through catheters thus increasing its sales. The increasing number of cancer and cardiovascular patients, aging population, and people suffering from various chronic disorders are the factors that are driving the central venous catheters market.

AngioDynamics, Becton and Cook Medical are among the top 18 companies detailed in the report. VT N READ MORE: researchandmarkets.com/ r e s e a r c h / h n 8 r 9 g /c e n t r a l _ venous?w=4

Cagent Vascular raises $11.87 million in Series B Funding Cagent Vascular, a Wayne, Penn.-based developer of angioplasty balloons using proprietary serration technology, completed an $11.87 million in Series B funding.

Co-founded by Carol A. Burns, president and CEO; Peter Schneider, MD, a vascular surgeon, and the CMO; and Robert Giasolli, vice president of R&D, Cagent is advancing The Serranator, an angioplasty device with serrated metal strips embedded on a semicompliant balloon.

The Serranator’s technology is designed to create multiple longitudinal lines of interrupted micro-serrations within the luminal surface to aid in arterial expansion with the result to have predictable and controlled lumen gain.

The company’s first device, the Serranator Alto, received FDA 510(k) clearance and CE Marking in 2017 and is indicated for the treatment of diseased femoral and popliteal arteries, dysfunctional AV access grafts and AV fistulae.

The company intends to use the proceeds to scale manufacturing and initiate a limited launch of Serranator Alto, support development efforts to build upon existing confirmatory data, expanding indications, and receiving additional regulatory clearances.

The next product in the Serranator family of PTA serration balloon catheters will be the Serranator Bass, for use in infrapopliteal arteries.

The financing round was led by two strategic investors including one that participated in the Series A financing. Additional participants included Balestier Investments, Ben Franklin Technology Partners of Southeastern PA, Synergy Ventures, and other private investors. VT N

Software firm shows notable 2017 MIPS data Specialty-specific health information technology company Modernizing Medicine announced that providers who submitted data through the company’s Qualified Registry appear to have earned an average score of 77.5 points for 2017 performance data submitted to the Centers for Medicare and Medicaid Services (CMS) for the Merit-based Incentive Payment System (MIPS).

While CMS announced that final scores and feedback were to be available July 1,

virtually all of Modernizing Medicine’s submissions appear to have exceeded the 3-point minimum threshold to avoid the 4 percent negative payment adjustment in 2019. Other estimated data show that more than half of the submissions earned more than 70 points, making them potentially eligible for a positive payment adjustment and the exceptional performance bonus in 2019.

While not everyone submitted each category, almost all unique clinicians or groups submitted some data. Modernizing Medicine’s clients submitted an average of 8.56 Quality measures. CMS recommends that individual participants report up to six Quality measures and groups submit 15.

“Modernizing Medicine’s team worked diligently to create software to make registry submission easy for our clients, help advance public health and demonstrate high quality of care,” Michael Sherling, MD and co-founder at Modernizing Medicine. He is also chief medical and strategy officer.

“Submitting MIPS data was a matter of pushing nine buttons in EMA. Not only did we save our clients time and make the experience relatively hassle-free, but also the success of our clients’ submissions speaks to our software’s efficacy.” EMA is Modernizing Medicine’s electronic health record (EHR) Physicians using EMA entered patient data into the native iPad application at the point of care, and EMA calculated the measure data automatically. Clients who preferred additional support participated in the MIPS Advisory Services program. This gave them access to live support from Modernizing Medicine’s team to develop a MIPS project plan for the practice, analyze MIPS performance data and identify workflow changes that could improve their MIPS performance score. Early estimates indicate that 99.9 percent of MIPS advising clients met their score goals.

The MIPS program took effect as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program (QPP). MIPS awards payment adjustments for Medicare Part B claims based on four performance areas: Quality, ACI, Improvement Activities (IA) and Cost (beginning in 2018). Modernizing Medicine’s Qualified Registry reported participating providers’ MIPS data (measures and/ or activities) for the Quality, ACI and IA performance categories to CMS for the 2017 performance year.

Modernizing Medicine’s suite of products and services includes its award-winning EHR system, EMA, as well as Practice Management, Revenue Cycle Management, Analytics and more for surgical and medical specialties including dermatology, ophthalmology, orthopedic surgery, otolaryngology, plastic surgery and urology. VT N READ MORE: modmed.com/mips

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ADVISORYBOARD

Dr. Aggarwal

Manu Aggarwal, MHSA, MD, is a board certified family physician and ABVLM certified physician at the Vein Care Center Laser Specialists. Since 2007, the VCC has been an IAC-accredited vascular laboratory. In 2015 the VCC was one of the first 50 practices in the country to also be Vein Center accredited. The VCC has been dedicated to venous disease and laser treatments since 2004, and is located in Lima, Ohio, with a satellite office in Celina, Ohio. She may be contacted at www. yourveincarecenter.com.

Ronald Bush, MD, FACS, is one of the nation’s leading specialists in venous diseases. He founded and is the medical director for Vein Experts, a national group of venous specialists specializing in venous disease. He is Board Certified in general vascular surgery; and was also certified in cardio/thoracic surgery, having trained at Walter Reed Medical Center and Indiana University Medical Center. Dr. Bush is the author of numerous scientific papers and holds patents for surgical instruments. For Dr. Bush the past 20 years, he has devoted his practice solely to the treatment of venous disease and one of the first in the nation to do so. Physicians throughout the world have visited and have been trained by Dr. Bush. Many of the new procedures now performed in the ambulatory treatment of varicose veins have originated in part from his clinical studies.

Dr. Chuback

John Chuback, MD, FACS, chief medical officer at Chuback Medical Group in Paramus, N.J., is involved in teaching, entrepreneurship, writing and philanthropy.

He is also co-founder of BiosupportMD and Chuback Education. Dr. Chuback is an author of numerous articles and books and is a lecturer throughout the United States.

He practiced cardiac surgery for the first six years of his professional career and then launched a successful private practice focused on venous disease and cosmetic procedures.

Dr. Ellis

Laura Ellis, MD, is founder of the Laura Ellis MD Skin Care & Vein Centre PLLC (formerly named the Asheville Vein Center and Medical Spa) in Asheville, N.C. She one of the first members of Vein Affiliates, a national venous surgery organization of surgically trained vein specialists committed to quality care, ongoing education, and research in the field of venous disease; and she is also on the faculty of the Bush Venous Lectures.

Lowell S. Kabnick, MD, FACS, FAC Ph and director of the New York University Vein Center, is a world-renowned surgeon-teacher who provides a patientcentered approach to vein care, enabling the creation and improvement of many of today’s most advanced non-invasive vascular surgery techniques. Dr. Kabnick is recognized by his peers as an international authority on the diagnosis and treatment of venous disease. He was the first vascular surgeon in the United States to perform Dr. Kabnick the VNUS Closure (radiofrequency ablation) and the VenaCure EVLT (endovenous laser) procedure — two breakthrough technologies for treating the underlying causes of many varicose vein problems. Dr. Kabnick is president of the American Venous Forum Foundation; a Fellow of the American College of Surgeons as well as the American College of Phlebology, serves on the Board of Directors for the American College of Phlebology, and is president of the Intersocietal Accreditation Commission for Vein Centers.

Dr. Mackay

Edward Mackay, MD, RVT, RPVI, is a co-director of the International Vein Congress, a major conference for vascular specialists in Miami that is attended annually by more than 500 physicians annually. He was the first physician in the state of Florida to offer VNUS Closure in 1999, and in 2001 the first in the bay area to offer endovenous laser treatment (EVLT). He has offices in St. Petersburg and Palm Harbor, Fla. Deborah Manjoney, MD, opened the Wisconsin Vein Center and MediSpa in 2002, and in 2004 she left her 18-year practice in cardiovascular and thoracic surgery to devote herself to fulltime practice of phlebology. She offers a broad range of non-invasive and minimally invasive services, and she was one of the first in the area to add the “medispa” concept to her practice.

Dr. Manjoney

Dr. Miller

Dr. Rosenblatt

Dr. White

shweiki.com Dr. Wright

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Jeffrey H. Miller, MD, is the founder and CEO of Miller Vein, with five locations in Southeast Michigan. Dr. Miller has received numerous awards and honors in his field, including being named one of Hour Detroit Magazine’s “Top Docs.” His multi-site company has received numerous accolades including Coolest Place to Work by Crain’s Business Detroit, Novi Chamber of Commerce’s Customer Service Excellence Award and several Corp! Michigan’s Economic Bright Spots Awards.

Mel Rosenblatt, MD, FACPh, is past-president of the board of directors of the American College of Phlebology (APC). He is owner and medical director of Connecticut Image Guided Surgery in Fairfield, Conn. His clinical expertise lies in endovascular surgery and interventional radiology. Rosenblatt has held positions at the Yale-New Haven Hospital and Memorial Sloan-Kettering Hospital and has taught at Yale University Medical School.

James E. White, MD, FACS, who is board certified in general surgery, phlebology and cosmetic surgery, owns Advanced Surgical Concepts, in Chattanooga, Tenn., a practice in phlebology and cosmetic surgery. He was graduated Magna Cum Laude from the Medical College of Georgia in 1990. He then completed a General surgery residency at the University of Tennessee, Chattanooga in 1996. He is a Diplomat with the American Board of Phlebology and the American Academy of Cosmetic Surgery.

J. Gordon (Jay) Wright, MD, FACS, RVT, is the founder of the Midwest Vein Center in Chicago and practices out of the Downers Grove office. His special area of expertise in phlebology is in the treatment of venous stasis ulcers and combined arterial and venous problems. With Maged Mikhail, MD, Dr. Wright is the co-inventor and co-developer of VeinDraw EMR. The ACP elected him chairman of its AACME Committee and the College’s Preceptorship Committee. VTN

AUGUST/SEPTEMBER 2018 < VEIN THERAPY NEWS

PRODUCTNEWS

SAVE THE DATE!!

Spring and Fall Residents & Fellows Courses 2018 Spring Residents and Fellows Course May 18-20, 2018

2018 Fall Residents and Fellows Course December 7-9, 2018

Englewood Hospital and Medical Center 350 Engle St, Englewood, NJ 07631

University of Texas San Antonio San Antonio, TX

OVERVIEW

MEETING ATTIRE

The Residents and Fellows Course in Venous Disease is presented for the benefit of Fellows and Residents within the specialty of vascular surgery, interventional radiology, cardiology, vascular medicine and associated programs.

Dress is casual including dinners.

The goal of the course is to educate and update the Fellows and Residents regarding the latest theories and developments in the clinical practice of vein disease management. Residents and Fellows will gain an overall understanding of vein disease to allow them to successfully incorporate venous knowledge, skills and techniques into their overall practice as they make the transition from training to the clinical practice.

FEES Residents and Fellows in an accredited training program, do not pay registration fees to attend. In addition, the AVF provides a travel stipend, hotel accommodations, and meals while at the Course. “Attendees must provide a credit card to hold their hotel reservation. If registration is not cancelled three weeks prior to the event, the credit card will be charged for one-night hotel”

ADDITIONAL BENEFITS OF ATTENDING By attending the 2018 Courses you will receive complimentary registration to AVF’s 2019 31st Annual Conference scheduled to take place at the Westin Mission Hills Golf Resort and Spa in Rancho Mirage, CA from February 19-22, 2019.

You will also receive one-year complimentary Resident/Fellow membership to the American Venous Forum, and all of the membership benefits associated with an AVF membership. (Please note that the complimentary conference registration and membership are nontransferable or redeemable for cash).

FELLOWS GRANT - TRAVEL REIMBURSEMENT The courses are funded through a Grant Program that covers registration and travel expenses. To be eligible for the grant, all participants are required to attend the entire course. Each will receive two nights of lodging at the designated hotel, transportation to and from the airport, and food and beverage supplied during the course. AVF will reimburse travel expenses up to a total of $550. This includes travel to and from the course (i.e., coach airfare, gas mileage, train ticket, etc.), parking and nominal food and beverage purchases on days of travel. Please note that our policy is that all travel reimbursements must be submitted within 30 days of the completion of the course.

NOTE: Alcoholic beverages will not be reimbursed. A travel reimbursement form will be provided. Each Resident and Fellow must complete their own reimbursement form and forward it to the AVF office along with itemized receipts to receive reimbursement. Failure to provide completed form will delay reimbursement.

NOTE: Failure to attend the entire course will result in forfeiture of any travel reimbursement.

http://www.veinforum.org VEIN THERAPY NEWS < AUGUST/SEPTEMBER 2018 For more information regarding the Spring and Fall Residents and Fellows Courses or anything AVF related please contact the AVF office at (727) 350-1580 or email us at info@veinforum.com, or www.veinforum.com, or check us out on social media.

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AUGUST/SEPTEMBER 2018 < VEIN THERAPY NEWS