Vein Therapy News by Digital Publisher

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OCTOBER/NOVEMBER 2014 Vol. 7 No. 6

AVF details 27th annual meeting 4 Memorial set for Brock Gebhardt 15 Stradis custom packs save money, time 20 Syris Scientific shines a new light 28

VEINTHERAPYNEWS.COM

JOHN KINGSLEY, MD Mind of a pioneer, passion of a healer, generosity of an educator, heart of a cowboy By Melanie Petro, MD John Raymond Kingsley, MD. , FACS, FACPh, RVT October 27, 1941 to July 29, 2014 The things you do for yourself are gone when you are gone, but the things you do for others remain as your legacy. – KaluNdukweKalu I am honored to be writing about the life and legacy of John Raymond Kingsley MD, FACS, FACPh, RVT. John fell on July 4th, suffered a traumatic brain injury and died on July 29th. It is hard to even imagine because he was bursting with vitality and energy, with a booming phebology practice. His legacy lives on through his children, Jennifer Holloway, Sarah and J.R. Kingsley, his grandchildren Emily and Jacob Holloway and, of course, through his patients and staff at Alabama Vascular and Vein Center. I have known John for the past seven years and working with him has left me in awe of his intelligence, unrelenting courage, compassion for those in need, passion to succeed, genuine “old timey” doctor ways, and especially his love of teaching. He has been the greatest teacher of my life, as well as training thousands of doctors worldwide. He never held back his knowledge and always gave credit to his teachers. “I am fortunate to know personally those in the world who really really know, after a lifetime of work and research, and I make my decisions and judgments based upon this type information. And I share everything with you, so you too have this knowledge.” It is with the deepest and most sincere passion that I write about a man whose faith in me, at times, surpassed my faith in myself. He was my mentor, my colleague, my son’s coach and tree house builder, and my biggest fan. The support he has given me over the years has been invaluable to me. He has taught me to believe in myself and to always have courage. His encouragement was always there when I needed it, and I seemed to believe him even when I did not believe myself. JOHN KINGSLEY continued on page 24

ACP details final 28th Congress plans Every year the ACP Annual Congress provides attendees with the latest research, technology and techniques. When the 28th Annual Congress convenes Nov. 6, the ACP will continue to provide innovative education and hands-on training for practitioners at all levels, whether just starting a vein practice or a veteran in the field. This year, the Congress will be held Nov. 6-9 at the JW Marriott Desert Ridge Resort in Phoenix, Ariz. The ACP Annual Congress is

the premier educational event for physicians and allied healthcare providers dedicated to the diagnosis and treatment of venous and lymphatic disorders. Attendees will engage with the latest science and techniques from nationally and internationally recognized vein care ACP PLANS

continued on page 27

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Disclaimer and Liability Statement The information contained in this publication, including text, graphics and images, is for informational purposes only, and is not intended to be a substitute for professional medical advice. Publications & Communications LP (PCI), Publications and Communications LP, and Vein Therapy News, via its Editors, Publisher, Editorial Board members, or staff, accept no responsibility for any injury or damage to persons or property occasioned through the implementation of any ideas or use of any product described herein. In consideration that great care is taken by the Publisher, Editors, staff, and Editorial Board to ensure all information is accurate, we recommend each reader seek independent verification of all product or drug usage, surgical techniques and clinical processes prior to their use or implementation. The opinions expressed in this publication and all related marketing or sales material of this publication are those of the authors and are not attributable to the publication, Publisher, Editor, staff, Editorial Board, advertisers, or sponsors. References made in articles may indicate uses of medical equipment or medical procedures, or of drugs at dosages, for periods of time, and in combinations not included in the current prescribing information. Inclusion of advertising material in this publication, or in reproduction of articles and pages, or in supplemental materials, does not constitute any representation or guarantee by Publications & Communications LP (PCI), Publications and Communications LP, and Vein Therapy News, via its Editors, Publisher, Editorial Board members, or staff, of the quality of such products, or of the claims made by the manufacturers. Trademarks are used in an editorial fashion with no intent to infringe. Reproduction in whole or in part of this publication is strictly prohibited.

Reader Services SUBSCRIPTIONS To subscribe or to purchase back issues of the magazine, please call 800-678-9724 ext. 344 or e-mail Beth Chorba at bethc@pcinews.com. For more information, please visit www.veintherapynews.com and click on the Subscribe link. ADVERTISING INFORMATION If you are interested in advertising in Vein Therapy News magazine, online or in our Marketplace, please contact one of our account executives: Gary Pittman, Jr., 512-637-0373, garypjr@pcinews.com, or Dennis Carter, 512-637-0371, dennisc@pcinews.com. EDITORIAL SUBMISSIONS Doctors, nurses, clinics, managers, vendors, patients, professors and others are encouraged to submit abstracts, white papers, writings, and ideas for editorial consideration. If you have a paper or story idea to submit, please e-mail larrys@pcinews.com UPCOMING EVENTS AND PRESS RELEASES Vein Therapy News would like to hear about your organization’s upcoming event, product launch, or announcement. Please e-mail press releases or event listings at least two months in advance to larrys@pcinews.com

Volume 7, Number 6

Editor Larry Storer larrys@pcinews.com 254-399-6484

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President Gary L. Pittman garyp@pcinews.com Publications & Communications, LP 13552 Highway 183 N, Suite A Austin, TX 78750 512-250-9023 • 512-331-3950 fax Vein Therapy News is published bimonthly by Publications & Communications, LP, Gary L. Pittman, President, 13552 Highway 183 N., Suite A, Austin, TX 78750 512-250-9023. Subscriptions are available for $45 per year. Payment must accompany orders. Copyright 2014 by Publications & Communications, LP. All rights reserved. Reproduction in any form without written consent from the publisher is strictly prohibited. Postmaster: Send changes to Vein Therapy News Circulation Department, 13552 Highway 183 N., Suite A, Austin, TX 78750.

NEWS 8 Covidien acquires Sapheon Covidien has acquired Sapheon Inc. and its Sapheon Closure System, a minimally invasive, single-use kit intended for the treatment of varicose veins and chronic venous insufficiency.

THE PRACTICE 12 The medium is NOT the message

When trying to attract new patients, don’t get the cart before the horse. The first step is to develop the message – why your vein practice is the best choice. Then decide on which medium – digital or print – should drive the message. Each medium has its pros and cons.

SECOND LOOK 1 Celebrating the life of John Kingsley

The life of John Kingsley casts a long shadow over phlebology the world over. He was a pioneer in venous treatment; an icon known around the world; an educator of hundreds of doctors who came to his Alabama practice to learn; a healing surgeon who was loved by his patients; and a friend to almost everyone he met. This cowboy who frequently rocked the establishment, said what he thought; and he will be forever missed by his family, his colleagues and the staff of Vein Therapy News.

20 Stradis custom packs save money

With a Stradis Custom Surgical Pack, a practice can fill out an online form and select exactly the items the surgeon wants in his or her specific custom pack.

28 Syris Scientific shines new light

Syris Scientific is replacing its v600 polarized hands-free headset light, which uses a halogen light, with the new v900L powered by an LED light.

30 UppLift eases sonographer’s pain

A Sioux Falls, S.D. phlebologist invented UppLift, an ergonomic lifting device for ultrasound patients that saves sonographers from having to contort their body during the evaluation process. It is offered exclusively by Total Vein Systems.

PRODUCT NEWS 41 FDA approves Varithena

Varithena (polidocanol injectable foam) is now available for use in the United States from BTG International. It is approved for treatment of the GSV, accessory saphenous veins and visible varicosities of the GSV system both above and below the knee.

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The Practice ACP Update

EDITORIAL 254-399-6484

VEIN THERAPY NEWS < OCTOBER/NOVEMBER 2014

12 22 3

NEWS AVF announces details for 27th Annual Meeting in Palm Springs The American Venous Forum (AVF) will hold its 27th Annual Meeting Feb. 25-27, 2015, in Palm Springs, Calif., at the Westin Mission Hills. The AVF Annual Meeting offers highquality scientific analysis to physicians, allied health professionals, residents, fellows and medical students interested in research, education and clinical investigation in the field of venous disease. After record attendance at the 2014 Annual Meeting in New Orleans, AVF looks forward to a successful program in 2015 that caters to a variety of vascular practitioners. The AVF is comprised of more than 750 members who are primarily physicians and surgeons in the treatment of venous and lymphatic disease. The AVF Annual Meeting continues to grow each year and this year AVF expect more than 700 attendees and associates from the United States and around the world. Attendees at AVF Annual Meetings include vascular and general surgeons, interventional radiologists, interventional cardiologists, phlebologists, plastic surgeons, physician assistants, vascular nurse practitioners, technicians, technologists and other medical professionals who are currently treating venous disease. This year, AVF gathers in Palm Springs, rich in history and blessed with gorgeous weather. Nestled at the base of the Mount San Jacinto Mountains, Palm Springs is known for its crystal blue sky, year-round sunshine, stunning landscape, palm tree lined streets and starry nights. SCIENTIFIC SESSIONS The Call for Abstracts opened in June and closed in September. Top-scoring abstracts will be organized into six Scientific Sessions featuring oral and quick-shot presentations. Scientific Sessions will be arranged by topic including Anti-Coagulation, Basic Science, Chronic Vein Obstruction, Compression/ Wound Care, Diagnostic Testing and Imaging, Lymphedema, Superficial Vein Disease, and Venous Thromboembolism/IVC Filters. The Annual Meeting will begin on Feb. 25, Wednesday, with the David S. Sumner Venous Summit, chaired by President Elect John Blebea, MD, MBA. This course is by separate subscription, so don’t forget to add the Venous Summit to your Annual Meeting registration. If you aren’t able to attend the David S. Sumner Summit, you’ll still want to arrive in time for the opening day of the Annual Meeting, which includes two Scientific Sessions and will close with a Welcome Reception in the Exhibit Hall.

This social event provides time for attendees to visit exhibit booths of leading companies in the vascular healthcare industry, peruse the nearly 70 poster displays, and catch up with colleagues to enjoy some leisure time after a busy first day. RIGOROUS EDUCATION Feb. 26, Thursday, opens with a special breakfast event for new AVF members to meet and greet with the Board of Directors. New members who joined in 2014 and early 2015 will be invited to network and speak one-onone with the leaders of AVF. Attendees who are not yet members of the AVF will have an opportunity to speak with the Membership Committee at the AVF booth to learn more about the benefits of membership and to begin a fast-tracked application process. Next, AVF will hold Scientific Session 3 concurrent with the Best Paper Session. The Best Paper Session features top scoring abstracts from the Society for Vascular Surgery, American College of Phlebology and Royal Society Venous Forum. Attendees are able to experience the best of our sister society annual meetings all in one session. Also on Thursday is the Villavicencio Symposium, co-chaired by Lowell Kabnick, MD, and Peter Lawrence, MD, and the D. Eugene Strandness, Jr., MD Memorial Lecture. Each year, the Strandness Memorial Lecture recognizes the significant contributions of an individual in research, education or clinical investigation in the field of venous diseases. Chosen by the president of the AVF, the 2015 recipient of this distinctive honor is Andrei L. Kindzelski, MD, PhD. Dr. Kindzelski is a medical office and program director in the Division of Blood Diseases and Resources at the National Heart, Lung and Blood Institute (NHLBI). After a morning of rigorous education, the AVF will open the afternoon with lunch in the exhibit hall followed by free time to enjoy Palm Springs independently or at one of the AVF outings. AVF is coordinating a series of social events, including a golf outing benefiting the AVF Foundation, tennis matches and other activities. Join your colleagues on the golf course, tennis court or wherever else Palm Springs draws you. Friday begins with Scientific Session 4 and flows into the 2015 President’s Session. The President’s Session will feature presentations from the 2014 Servier Traveling Fellowship award winners, Rafael Malgor, MD, and Adam Ring, MD, who presented their abstracts in Paris, France at the European Venous Forum Annual Meeting. The 2014 BSN-Jobst Grant recipient, Harry Ma, MD, whose research project focuses on the reliability, durability and quality of commercial compression stockings, will report on his research. The session will also feature updates on various AVF programs and initiatives with an introduction by AVF President-Elect John Blebea, MD, and the 2015 presidential address

by President Fedor Lurie, MD. Following the presidential address, AVF members are invited to attend the AVF member business luncheon. Friday afternoon finishes with two final Scientific Sessions and the popular Specialty Symposia Sessions. The Specialty Symposia have been extended in 2015 to provide attendees with in-depth information from leading experts in each specialty topic. Topics in 2015 include Superficial Venous Disease; Vascular Medicine & Thrombosis; Animal Models in Venous Research; Biomechanics & Bioengineering; Deep Venous Disease; Wound Care, Lymphedema & Compression; and a session on allied health hot topics. AWARDS The 2015 Annual Meeting will come to a festive close at the Forum Finale, an outdoor dinner event featuring live music, dancing and an awards presentation. Awards include the Servier Traveling Fellowship, which is open to residents and fellows and provides a travel grant to present at the 2015 European Venous Forum Annual Meeting, Best Paper award, and Best Poster award. The winner of the 2015 BSN-Jobst Research Grant will also be introduced. The BSN-Jobst Research Grant has doubled in value this year to provide a $100,000 grant for original, basic or clinical research in venous or lymphatic disease. The competition is open to residents, fellows in a vascular training program, as well as physicians who have completed their training within the past five years. AVF is truly excited to provide the BSN-Jobst Research Grant again in 2015. VTN READ MORE: www.veinforum.org

AVF deadline for $100K grant from BSN-JOBST set for Oct. 27 The American Venous Forum has set Oct. 27 as the deadline for submission of applications for the BSN-Jobst Research Grant, which has been increased to provide a $100,000 grant for original, basic or clinical research in venous or lymphatic disease. The competition is open to residents, fellows in a vascular training program, as well as physicians who have completed their training within the past five years. The BSN-JOBST Research Grant provides $50,000 per year for two years, chosen through a competitive peer review selection process. (See Vein Therapy News above, page 4) Conrad Jobst dedicated his life and expertise to the development of gradient compression garments to better relieve the symptoms of venous disease. Jobst suffered from vascular disease, and his initial line of elastic “stockings” has now evolved into an extensive portfolio of advanced wound care and compression therapy

products for the treatment of venous and lymphatic diseases. In 1995, in association with the AVF, BSNJOBST initiated the BSN-JOBST Research Fellowship in Venous and Lymphatic Diseases to further Conrad’s legacy of innovation. For almost 20 years, the research developed by grant recipients has helped advance the understanding and treatment of vein diseases. The AVF and BSN medical invite those interested in applying for the 2015 Research Fellowship to submit an application for consideration. VTN READ MORE: veinforum.org/ avf-foundation/bsn-jobst-researchgrant-2015

ARDMS will change question type in its fall examinations The Registered Physician in Vascular Interpretation (RPVI) certification examination, administered by the American Registry for Diagnostic Medical Sonography (ARDMS), will feature a new Picture Archive and Communication Simulation (PACSim) items/questions on the Physicians’ Vascular Interpretation Examination. The new, patent-pending items are designed to simulate an interpretation workstation experience relevant to actual present-day medical practice. The PACSim items will first appear on the PVI examination during the fall, scheduled from Nov. 12 – Dec. 16. Applications for the RPVI exam must be submitted by Oct. 13. The PACSim questions will require examinees to read a clinical history of the patient, evaluate the existing image(s) and complete a diagnostic ultrasound report by selecting from the presented options. The PVI examination will remain four hours long and will now contain 185 questions comprised of multiple-choice and advanced item type (AIT) questions. The new PACSim items are the latest addition to AIT questions used by ARDMS. The purpose of AIT questions is to assess a candidate’s knowledge, skills and abilities in formats that closely relate to actual clinical practice; therefore, providing better measures of practical vascular ultrasound interpretation skills. The ARDMS has posted the following resources at www.ARDMS.org/pacs to assist applicants and candidates in preparing for the PVI examination: • Watch the Tutorial: ARDMS Presents ARDMS

continued on page 8

OCTOBER/NOVEMBER 2014 < VEIN THERAPY NEWS

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How to Answer a PACSim Question • View the PACSim sample questions • Review the PVI content outline. (The PACSim items are based on content area No. 4 – Integration of Data, of the outline.) • Review the PACSim User Guide. “The patent-pending picture archive and communications system is revolutionary, and allows examinees to demonstrate competency in a testing environment that closely relates to their clinical practice,” said Thomas D. Shipp, MD, RDMS and the chair of the ARDMS Board of Directors. VTN TO PREPARE: www.ardms.org/ pacs

TO REGISTER: www.ardms.org/ credentials_examinations/ physicians_vascular_interpretation_ pvi_examination/

Covidien acquires VenaSeal Closure with acquisition of Sapheon Inc. Covidien plc has acquired Sapheon Inc., a privately-held U.S. developer of venous disease treatments including the VenaSeal Sapheon Closure System, just ahead of the FDA approval of that product. Financial terms of the Aug. 28

announcement were not disclosed. VenaSeal is a minimally invasive, single-use kit intended for the treatment of varicose veins and chronic venous insufficiency (CVI). It uses a proprietary catheter system to deliver a specially formulated medical adhesive to embolize and close the saphenous vein, eliminating the need for surgery, thermal ablation, sedatives and tumescent anesthesia. The procedure is performed with a catheter technique under ultrasound guidance in an office or outpatient setting. In many cases, patients are able to resume normal activity immediately after the procedure. Additionally, the procedure requires no tumescent anesthesia, a technique that requires multiple injections to deliver local anesthesia, and often results in less bruising

than traditional thermal energy treatment. The VenaSeal system is currently limited to investigational use in the United States, but the startup has submitted a PMA to the FDA. It is currently approved in Canada, Europe and Hong Kong, and more than 2,000 patients have been treated with the system. Sapheon, based in Morrisville, N.C., has been preparing for an expected launch in the United States in 2015, according to an earlier statement by Don Crawford, president and CEO. VenaSeal successfully completed enrollment and follow-up of its VeCLOSE 1:1 randomized pivotal clinical trial in the United States and submitted documentation to the U.S. Food and Drug Administration in support of a Premarket Approval. VTN

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OCTOBER/NOVEMBER 2014 < VEIN THERAPY NEWS

Av No ail w ab le! This is not an actual patient.

Varicose vein foam therapy takes a leap forward The first and only FDA-approved foam for GSV system incompetence 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.

Connect with a Varithena® Territory Sales Manager by calling the Varithena Solutions Center™ at 1-855-971-VEIN (8346), Monday through Friday, 8 am to 8 pm ET. 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®. See Full Prescribing Information for Varithena®.

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NEWS ICD-10 testing dates set by CMS

Varithena® (polidocanol injectable foam), for intravenous use Initial U.S. Approval: 2013 Brief Summary of Prescribing Information. For complete Prescribing Information, consult official package insert. 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. Table 1: Treatment-emergent adverse reactions (3% more on Varithena® 1% than on placebo) through Week 8 (n=588) Adverse Reaction Pain in extremity Infusion site thrombosis b Contusion/injection site hematoma Limb discomfort Tenderness/injection site pain Venous thrombosis limbc Thrombophlebitis superficial Deep vein thrombosis

Placebo (N=151) 14 (9.3) 0 9 (6.0) 5 (3.3) 5 (3.3) 0 2 (1.3) 0

Varithena® 1.0% (N=149) 25 (16.8) 24 (16.1) 23 (15.4) 18 (12.1) 16 (10.7) 12 (8.1) 8 (5.4) 7 (4.7)

Pooleda Varithena® (N=437) 65 (14.9) 46 (10.5) 38 (8.7) 32 (7.3) 30 (6.9) 24 (5.5) 40 (9.2) 10 (2.3)

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).

7003_BTG_VarithenaPI_VeinTherapy_IM1.indd 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.

Manufactured for Provensis Ltd by: Biocompatibles UK Ltd Chapman House, Weydon Lane, Farnham, UK, GU9 8QL. Distributed by: Biocompatibles, Inc. 115 Hurley Road, Building 3, Oxford, CT 06478 Provensis Ltd, Biocompatibles UK Ltd, and Biocompatibles, Inc. are BTG International group companies Varithena is a registered trademark of Provensis Ltd. VVSymQ, BTG and the BTG roundel logo are registered trademarks of BTG International Ltd

9/10/14 11:55 AM

The Centers for Medicare & Medicaid Services (CMS) says approximately 2,550 volunteer providers will have three separate opportunities for ICD-10 testing. The goal of testing, officials say, will be to determine that providers can successfully submit claims with ICD-10 codes to the Medicare fee-for-service claims systems; to demonstrate that CMS software changes in support of ICD-10 will result in “appropriately adjudicated claims;” and to ensure that accurate remittance advice is produced. CMS lists the testing weeks as follows: Nov. 17-21, 2014; March 2-6, 2015; and June 1-5, 2015. The testing is designed to validate providers’ ability to meet “technical compliance and performance processing standards” during implementation, according to CMS. The testing weeks will help to generate awareness and interest for implementation, as well as instill confidence in the provider community. Testing will be conducted virtually and posted on CMS’ website, the Common Electronic Data Interchange website and each Medicare Administrative Contractors’ website. VTN

Surgeon gets more funds for needle puncture resistant gloves A surgeon who is developing a set of medical gloves to reduce the pain and potential danger associated with needle punctures has received follow-on funding from the New Jersey Health Foundation. According to Dr. Tomer Davidov, assistant professor of surgery at Rutgers Robert Wood Johnson Medical School, the glove is intended to mitigate the risk healthcare workers face of contracting viruses such as Hepatitis C or HIV. He has received a $20,000 grant from the New Jersey Health Foundation, which follows another grant he received last year. The challenge is to design a medical glove that offers enough protection without undermining flexibility or tactile sensation and dexterity. Analysts place the market for disposable medical gloves as high as $4 billion by 2017. Dr. Laura Fabris, an assistant professor in the department of materials science and engineering at the Rutgers School of Engineering, is collaborating on the project, adding her experience in nanoparticles. “While many types of gloves have been tested, there are none currently on the market that are puncture resistant yet flexible enough to provide surgeons with the dexterity they need during surgical procedures,” Davidov said. VTN

OCTOBER/NOVEMBER 2014 < VEIN THERAPY NEWS

NEWS CMS publishes final rule for MU flexibility The Centers for Medicare & Medicaid Services (CMS) has published a final rule for Meaningful Use (MU) flexibility. Stage 2 of the MU incentive program will be extended through 2016 for certain providers and Stage 3 will begin in 2017 for providers who first became meaningful users of electronic health records in 2011 or 2012. The rule, which was published Sept. 4 in the Federal Register, also allows eligible providers to use 2011 edition certified electronic health record technology (CEHRT), or a combination of 2011 and 2014 edition CEHRT to meet MU for an EHR reporting period in 2014 for the CMS EHR incentive programs. Eligible professionals, eligible hospitals and critical access hospitals must use the 2014 edition CEHRT in 2015. “Commenters questioned whether the options for the use of CEHRT extended to allowing for options for measure selection,” the CMS stated. “A few commenters suggested that we allow additional options for the use of CEHRT regardless of the edition of CEHRT the provider has implemented. These options included: allowing providers to attest to Stage 2 with exclusion of one or more core objectives; allowing providers to report on either Stage 1 or 2, using either the 2011 or 2014 edition CEHRT; allowing providers to choose between 2014 Stage 1 objectives and measures and the 2013 Stage 1 objectives and measures; and allowing providers to report on any version of CQMs.” To that end, CMS said it recognizes that affected providers will require “multiple factors” to determine options for which they’ll be eligible. “While we understand it may be cumbersome for providers to use a combination of 2011 and 2014 edition CEHRT to meet Meaningful Use in 2014, we expect the benefit of ultimately demonstrating Meaningful Use outweighs the complexity of using two CEHRT editions,” CMS said. The CMS does not specify if a provider must use 2011 edition CEHRT or 2014 edition CEHRT for a certain amount of time during the EHR reporting period; if a certain amount of modules in one CEHRT edition or another is required; or if a certain number of provider settings must have one CEHRT edition over another. “We expect there will be significant variations among practices based on the type of software used, the complexity of a provider’s total systems and the overall implementation timeline for 2014 edition CEHRT installation,” the CMS release stated. VTN READ MORE: http://cms.gov/ Newsroom/Newsroom-Center.html

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Internet Marketing Strategies for Success Looking for patients: The medium is NOT the message By Gregg Nell As a physician owning your own medical practice, you wear a lot of hats making sure that your patients receive excellent care and has a positive experience with your staff. With so Gregg Nell many responsibilities consuming your attention, attention to your marketing efforts doesn’t always make the top of the list. But it should, as it is important for maintaining the pipeline of patients and new consultations into your practice to ensure that you stay busy. When developing your marketing plan, should you focus on Internet marketing? Print marketing? Or should you achieve a proper balance of both? It might seem like it is all about digital marketing these days, but print is still king when it comes to producing the kind of marketing designs that make your audience pay attention to what you have to say. Computers, tablets or cell phones have not replaced the ritual of actually holding something in your hands and exploring it with all of your senses; until such a time when that experience can be reproduced digitally, there will still be plenty of opportunities to make an impact using your printed marketing materials. As technology continues to develop and change the way medical practices communicate with their target audiences, it would be a serious mistake to consider print a dead medium and online marketing the wave of the future because it requires a robust print medium. Nevertheless, the print industry is far from dead; in fact, print marketing has only continued to grow and evolve alongside the upsurge of new technology. According to a Pitney Bowes survey, 76 percent of small businesses say their ideal marketing strategy encompasses a combination of both print and digital communication.

MAGAZINE ADVERTISING

Magazines and newspapers are important print media used by companies to deliver advertising messages. While they share similarities as print media, the strengths and weaknesses of each medium are distinct. Newspapers tend to offer opportunities for the broadest range of advertisers, but magazines have strengths in helping you connect with a specific audience. Magazines are typically read by highly interested audiences because there are specific magazines for various topics. This allows you to reach an audience that has higher potential for persuasion if your message resonates with the audience. Magazines typically have glossy finishes and full color for strong creative design. People also tend to hold onto magazines longer than newspapers, which provides for possible repeat exposures to your ad over time. Magazines are more costly than newspapers. You typically pay several hundred to several thousand dollars for a placement, depending on the circulation. The reach is also minimal because there are so many publications. If your goal is to reach a large audience, magazines aren’t your best option. Long lead times are a challenge, as well. You normally have to submit your ad four to six weeks before publication. Extremely high resolution magazines can offer the benefit of displaying high-quality images represented with full color and gloss, sometimes giving consumers a better visual representation. In addition, many magazines target a specific demographic. By advertising in magazines within your community or health and wellness, you are almost guaranteed that your message will reach your targeted audience. Magazine advertising can be an effective part of your marketing campaign, which is a combination of advertising, promotions and publicity. To build customer awareness of your brand, magazine advertising requires you to plan and promote long enough to get the attention of your intended audience. Your best ideas will include the reach, placement and value for your budget.

Even if you are a small practice, you can advertise in the most widely read and distributed national magazines. National magazines often have regional versions of their magazines and/or sections dedicated to small businesses and specific locales. Magazines are typically kept for a longer period of time than newspapers because of their higher printing quality. Medical offices, for example, usually save magazines because they give people something to read while waiting for their appointment. A reader of a magazine may keep an issue if it contains particularly interesting information. If you put an ad in a magazine, it is possible that someone will, through some circumstance, pick up the magazine several months from its print date and see your ad. Your advertising budget needs to cover placement, size and frequency. The magazine back cover has the best ad visibility, but also has the highest price tag. You might be able to afford the back cover four times, but it depends on what you are advertising and when. If the magazine is quarterly, then four times is every issue. If you are advertising a new service or patient testimonials in a monthly magazine, four times might not be enough time to build awareness. Adjust the size of your ad to get the most frequency. Ask about other placement options, such as an ad next to a popular column.

NEWSPAPER STRENGTHS

Newspapers offer affordable ad rates, which benefits a small medical practice on a tight budget. Local- to medium-size papers usually offer smaller ad spaces for $100 to $300 per issue. Lead times are much shorter than those with magazines. You can normally get your ad placed within a couple days, which improves the timeliness of your message. Newspapers tend to enjoy high credibility because of the generally objective nature of the content. Despite the fact that many offer color, newspaper design isn’t always as captivating as magazines. Reproduction quality diminishes on large copy runs. Newspapers are useful when reaching a broad geographic market,

but they are limited if you have a more specific demographic market. Newspapers have a short life, because most readers throw them out or recycle quickly after one read-through. Hundreds of ads in a typical publication also mean a cluttered environment. This limits your ad’s potential to be seen. Make use of strategies that suit your budget so every dime works toward developing your medical practice. If you don’t have the luxury of a large budget, ads in newspapers or magazines cost less than ads in other media, such as television and radio.

WEEKLY NEWSPAPERS

As big daily newspapers lay off personnel, cut area coverage and reduce page count, weekly newspapers are gaining ground. The news in many weekly papers is not as sophisticated as in large dailies or magazines, but it is local news about citizen’s children and local government, and is therefore of great interest to people living in that circulation area. If you are looking for patients in a particular locale, there is no more useful publication than the weekly paper. Advertising rates are low so it is possible to run your ad frequently, change the copy in a day and target the readership by zip code. The reproduction value of most weekly newspapers is not as good as the much higher cost magazine or the daily newspaper In addition to targeted local advertising, weekly newspapers will run your news releases much more frequently than will daily newspapers and magazines. What you may give up in reproduction values in a weekly, you will more than make up by putting your message in the hands of the exact people you are trying to reach.

PRINT HYBRID: A NEWS TABLOID

A newspaper-magazine hybrid has evolved in the print space in the last few years that capitalizes on the strengths of both the newspaper and the magazine – the news tabloid. The news tabloid usually has the reduced format of a newspaper, but has the high production

OCTOBER/NOVEMBER 2014 < VEIN THERAPY NEWS

THEPRACTICE value of a magazine and is printed on bright, glossy paper and in vivid color with exceptional detail. And like specific-interest magazines, news tabloids target your reading audience like a laser. You are not paying for a large distribution newspaper or magazine run – you are paying a lower price to be distributed only to people possibly interested in your practice. The cost of advertising in a magazine is higher than a news tabloid. A news tabloid, while maintaining production values equal to that of a magazine, is printed on comparable paper with comparable detail in reproduction. And like the weekly newspaper, editors of news tabloids are usually more interested in news local news that interest their readers than are daily newspapers and magazines. But the real advantage of any newspaper is the psychological effect of immediacy – the format itself promotes immediate readership. Magazines, on the other hand, have lengthy articles that take a longer time to read and the magazine usually takes its place on a table or a bookshelf for eventual reading. The shorter articles in a news tabloid, developed with the most important information at the top of the articles and lesser details toward the end, insure a faster read with higher retention values. Readership surveys show that articles with well-written headlines draw the reader into an article, and whether the reader is reading every article or just the headlines, the page layout of a news tabloid will direct the eye from the top headline on the page to the smallest ad at the bottom of the page. Because the half life of published knowledge in technology areas ranges from weeks to less than a year, retaining newspapers (or magazines) is a personal, but disappearing preference. Articles are rapidly updated in print publications, making hard copy paper collections of newspapers or magazines unnecessary and the saved back issues difficult to search. Newspapers and magazines now have online archives that make research possible and faster without having to go through a stack of dusty, old publications in a long search.

BROADEN AND UNITE YOUR MESSAGES

Whatever form of advertising delivery system you select, integrate it with the rest of your marketing initiatives. For example, if you are advertising dates for a complimentary vein screening, plan your print advertising along with announcements on your website and press releases to local media outlets. The best print ads are ones supported by multiple forms of communication. Keep your messages and branding consistent. However, you won’t garner much of your audience’s attention if you use the same old, dated design ideas that consumers have seen thousands of times before. To make a splash using printed materials in this digitalcentric world takes creativity, originality

and confidence in both your design and in the brand itself.

DIRECT MAIL MARKETING USED LESS

Many medical practices are competing online for page rankings in order to gain their audience’s attention. This makes it hard at times to stand out in the crowd. However, because online marketing tends to be the focus of many medical practices these days, a void is left in print marketing that needs to be filled. Compared with how often and how quickly you check your email, consider the daily ritual of going to the mailbox and checking your postal mail. You set aside a few moments to take the time to look at every piece of mail before going back to whatever it was you were doing before. That means your print materials are likely to receive extra attention – especially if they look unique. Research from the U.S. Postal Service indicates that most who receive direct mail advertising look at it, although briefly. Your message is read but not acted upon if the recipient does not have an immediate need for your product or service. No matter how crucial digital marketing becomes, there is still a large audience you can reach through print marketing and direct mail campaigns.

PRINT AND SOCIAL MEDIA

Social networking has become an integral part of the way medical practices reach potential patients and tell their story. The idea of networking has been around much longer than Facebook and Twitter. After all, isn’t a business card or practice brochure a social medium? When you hand a potential referring physician a business card, you’re making a social connection with that person and giving them the means to do the same with you. When working with print and social media, the two often share a symbiotic relationship: print media helps to draw attention to your social media sites, and your social media profiles can be used to strengthen your print campaign. By adding patient comments and testimonials from your social networking profiles to your print designs, you can make your print marketing that much more effective. In a world where the amount of digital information created and shared has escalated by more than nine times since 2005 – with more than 27 million pieces of content being shared every day, according to A.C. Nielsen – the bar has been raised for branded content experiences to capture consumers’ attention and resonate with them. Content can have massive reach and the power to influence purchase decisions. Just like print ads, your content must be applicable to your audience’s behaviors and interests. Good content marketing should create a meaningful exchange with your audience. To get to the right approach, ask your-

VEIN THERAPY NEWS < OCTOBER/NOVEMBER 2014

self these two questions: Why should people care and will they be inspired to share? Quality content marketing will move consumers to take the next step. The only constant thing in content marketing is change. We can’t control the rapid shifts happening in technology and consumer behavior. Physicians can no longer afford to take a wait-and-see approach. Every great content strategy should have room to pivot when needed.

SUMMARY

The key message in this article is about providing the right message, at the right time, to the right target audience… and this is not necessarily via digital media. With the plethora of emails and digital ads that we are exposed to on a daily basis, a piece of printed

media has something of a novelty about it. It is an unintrusive media that allows the recipient to choose if and when they want to look at it – meaning that if they do, they are more likely to be in the right frame of mind to understand the message and act upon it. Internet-based publications have unlimited space that can be filled, so they can run more stories and carry more information. Print publications have limited space, so if your practice is featured prominently, you’ve increased your chances of being a thought leader with your targeted audience. VTN Gregg Nell the director of Client Internet Marketing Strategies for Vein Specialists of America. He can be reached at (312) 550-9349 or Gregg@VeinBusiness.com.

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Trade group forms for healthcare IT professionals A recently launched nonprofit trade association is hoping to serve as a key voice on technology advancement for healthcare administrative technology professionals, with priorities including promoting streamlined operations for practice management systems. Tim McMullen, executive director of the Healthcare Administrative Technology Association (HATA), based in Southern California’s Orange County, says the practice management side of the industry needs broader representation and that it’s an important part of the overall healthcare landscape. It also aims to provide the tools to expand and build member’s client bases and networks. “Formal representation of such an important piece of the healthcare ecosystem is critical to the advancement of the industry,” McMullen said in a statement. “HATA is a key stakeholder in the $40 billion physician revenue cycle industry and will be an active and influential voice promoting the goals and values within the healthcare administrative industry and driving administrative efficiencies.” The association is specifically seeking to enlist the following types of organizations: • Any administrative technology company that creates and installs practice management systems – which may include scheduling, patient registration and revenue cycle management systems. • Affiliate members including payers, provider organizations, or other related industry professionals who contribute to the administrative technology industry. • Associate members including professional or trade associations and government entities. • Vendor member companies that provide products and services to principal members. McMullen said the association also hopes to have a voice in the ongoing discussions of interoperability, particularly among health information exchanges and patient data, and how it relates to the troves of financial data that practice management systems have amassed. That sort of data could be particularly valuable “as the new emerging payment models become more prevalent.” Brad Lund, CEO of the International Society and Association Management, said there are more than 500 (practice management) systems actively selling systems and serving healthcare providers and institutions. “We will measure our success by meeting our initial goal of attracting 150 members, Lund said. “Depending on the size of the (practice management) systems companies joining, it would be our expectation to be representing, from a size perspective, well over 50 percent of the entire industry. That will provide HATA the “strength in numbers” we need to represent the industry.” VTN

OCTOBER/NOVEMBER 2014 < VEIN THERAPY NEWS

THEPRACTICE Life’s Path Learning Center established as living memorial for Brock Gebhardt, 23

Brock William Gebhardt

A memorial has been established honoring the life of Brock William Gebhardt, son of Ron and Peggy Bush, who died Aug. 7 from injuries incurred in a car accident. A Life’s Path Learning Center will be dedicated to Brock in Haiti. The learning center will empower children in Haiti to learn, helping them overcome the obstacles of an impoverished life. Readers can carry

on Brock’s love of learning, leadership and compassion by making a memorial contribution to Life’s Path, changing one life at a time. Life’s Path is a 501(3)c not for profit organization that assists with the development of job opportunities and education to help alleviate extreme poverty through education, micro lending, and teaching job skills. Brock, 23, was born on April 19, 1991, in Peoria to Theodore W. Gebhardt and Peggy (Kortz) Bush. He is the son of Ron and Peggy Bush. Brock graduated with a bachelor’s degree from the University of Illinois at Champaign in 2013, double majoring in economics and political science. He was elected and served as student body president his senior year. He was a founding member of the U of I Chapter of Phi Sigma Kappa. He was also a member of the Association of Big Ten Students and the U of I UrbanaChampaign Illinois Board of Higher Education.

SAVE THE DATE

West Coast Vein Forum: Advancing the Treatment of Venous Disease — Addressing Challenges and Controversies in Vein Treatment

An aviation enthusiast, he enjoyed f lying a fourpassenger aircraft, receiving his pilot’s license at age 17. Conservative politics was another passion, having worked in the Republican House in Springfield, Ill., after graduation from college. Working hard on several Illinois campaigns, he was a key member for the election of Ryan Spain to the Peoria City Council. Most recently, he served as store manager for Central Pool Supply in Peoria and a marketing consultant for Vein Experts.org. Brock leaves his earthly life in the spirit of giving as an organ donor for the Gift of Hope. To make a donation to Life’s Path Learning Center in honor of Brock Gebhardt, you may donate through paypal at www.lifespathhaiti.org or you may write a check payable to Life’s Path and mail to: Brock Gebhardt Memorial c/o Life’s Path, 1334 N. Independence Court, Metamora, IL 61548. VTN

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• Create a heightened awareness of important considerations in the evaluation and treatment of venous disease. • Develop a community of practitioners who will deliver expert evaluation and treatment of venous and lymphatic disease in their own communities. Target Audience: Practitioners from diverse disciplines that include treatment of venous disease in their practice. Course Faculty: Faculty includes national and international experts in the treatment and evaluation of venus disease.

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Course Location: Westin Verasa Napa, located in the heart of downtown Napa and within walking distance to fifteen wine tasting rooms. Attendees can experience the cultural revolution of Napa’s transformation back into the dynamic center of the valley and take in the nearby attractions like The Napa Valley Opera House, The Napa Valley Wine Train and the Oxbow Public Market.

Course Objectives: • Provide state of the art knowledge on the recognition, evaluation, and treatment of patients with venous and lymphatic diseases.

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Course Description: The West Coast Vein Forum will offer clinicians providing basic treatment of venous disease a unique opportunity to expand their knowledge in recognizing and treating a broader scope of vein disorders. Participants will focus on challenges and controversies in venous disease treatment, with in depth discussion on how different experts manage difficult or unusual patient presentations in the absence of clear consensus.

Visithttp://www.veinforum.org www.veinforum.org for more information. VEIN THERAPY NEWS < OCTOBER/NOVEMBER 2014

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THEPRACTICE

The case for hiring a physician liaison for relationship marketing EDITOR’S NOTE: In part one of a three-part series, a marketing plan for using a physician’s liaison as a strategy to help find new patients and achieve specific growth goals was detailed. In part one, we covered tailoring clinical and administrative operations to be more timesensitive and reliable than your competitors when dealing with referrals. Part one can be found in the Practice section of the August/September issue on the website at www.VeinTherapyNews.com. By David Schmiege The majority of doctors who retain Vein Specialists of America to market their vein practice want to communicate a caring and compassionate branding message that strongly differentiates David Schmiege them from everyone else. They want to grow by winning new doctor referrals, maintain current referral patterns and recapture referral sources that have slipped away. We know it’s vital to distinguish your brand and reputation in a way that builds trust and inspires patient and professional referrals. It’s increasingly important to reach men and women in the workplace, to ethically raise your visibility with direct-to-consumer marketing and to extend your presence in the medical community through the use of a physician liaison. FINDING THE RIGHT CANDIDATE Our experience in this area has taught us that if you are going to have a successful physician liaison, it takes more than finding someone with an outgoing personality. Your physician liaison needs to have the ability to listen and understand what your referring physician is truly saying. They should have great attention to detail and excellent organization and follow-through skills. They need to be problem solvers and be able to facilitate solutions, calling upon resources within your practice. And they need to have “conceptual” selling skills so they can be your communication eyes and ears. Can you get this from an entry-level hire? Perhaps, but it is going to take time, training and someone to mentor your new liaison, which in many cases practices cannot devote. Ideally you should be looking for someone that has been in a sales capacity in a physician

services environment and has already been through a variety of sales training programs. To hire a “marketing” versus a “sales” person or move a clinical person into a physician liaison role, is often a difficult transition for them due to their lack of experience making sales calls. SETTING OBJECTIVES FOR YOUR PHYSICIAN LIAISON One of the challenges for a physician liaison role, particularly if it is new to a practice, is staying focused on the job responsibilities. Inevitably what happens is that if something even has the slightest orientation to a sales and/ or marketing responsibility, most people in the practice will direct it to the physician liaison. As this continues over time, the physician liaison becomes engulfed in day-to-day “stuff” and is not able to get into the field, fulfilling what they were hired to do… calling on current and potential referral sources each day. To avoid this all too common situation, it is important to set clear, measurable and quantifiable objectives for your physician liaison so that they know what is expected of them. Some of the measurable goals that can be established for a physician liaison include: • Number of visits per week to referring physician offices • Number of meetings facilitated for practice MDs with referring physicians • Number of lunch and learns coordinated with referring practices • Number of social events scheduled with your practice and referring practices • Number of referral coordinator lunches scheduled • Number of speaking engagements/ community events coordinated • Submission of weekly activity report • Written documentation of all relationship marketing activities MENTORING YOUR PHYSICIAN LIAISON A challenge for many vein practices is what do you do with this person? For practices that have no experience with a physician liaison, the short answer is that you need to mentor them, provide them with an opportunity to succeed, give them clear direction, and monitor their activities not only through their reports but also by spending time with them in the field making calls on your referral sources. Giving them a list of your referring

physicians and telling them to make calls and deliver referral pads is potentially a recipe for disappointment. On a weekly basis you should meet with your physician liaison and review the planned activities for the week. Questions that you and the physician liaison should discuss include: • What are the objectives of your calls? • Who are you going to call on in the practices? • Who in the practices determine where referrals are sent? • What do you want to accomplish with the calls? • What have been their referral trends? • Have there been any problems expressed by these practices? In other words, you need to strategize with the physician liaison on their calls. Leaving them on their own to do this will likely not yield the results that you are looking for. TRACKING PHYSICIAN LIAISON ACTIVITIES On a weekly basis, the physician liaison should submit an activity report. The physician liaison should document what practices they visited, who they spoke to, what information they left with the practice, and any issues that were identified and follow up that may be required. TARGETING THE REFERRAL INFLUENCER While private practices are physician owned and controlled, the bottom line is that the physicians don’t necessarily always influence where the patient is sent for additional testing or consults. More often than not a referral coordinator, check out person or mid-level will play a key role in where the patient is referred. As part of the physician liaison’s role, they need to determine who coordinates referrals within these practices and then target them from a relationship building standpoint. INVOLVING PHYSICIANS IN THE “RELATIONSHIP MARKETING” PROCESS One of the most effective marketing initiatives is getting your vein physician(s) face-to-face, developing relationships with your current and potential referring physicians. Your physician liaison should be a conduit to facilitate these encounters. An

effective relationship building technique is to bring your physicians to referring physicians office for a “check in” with the physicians and staff regarding how your practice is performing on behalf of their patients. It does not need to be a formal, sit-down meeting, but the fact that you are showing them that you value your relationship will end up paying dividends. REPORT GENERATION As part of your physician liaison’s responsibilities, they should be the “goto” person for collecting, analyzing and disseminating reports related to referral activity. Some examples of tracking reports include: • Monthly referrals by referring physician • Monthly new consults by referring physician • Monthly referrals, new consults and total visits per office location • Source of self-referred patients by month (e.g. friend, print ad, direct mail, etc.) • New patients generated as a result of community screening programs. CONSIDERATIONS Implementing a physicians liaison program is a very viable initiative to enhance relationships, increase visibility and grow referrals for your vein practice. However, to have a successful physician liaison program and an overall effective marketing strategy, you first need to have a strategic marketing plan before you can “work the plan.” Marketing is a process rather than an event. To position yourself to “market,” you need to develop a plan, looking both internally to evaluate the current state of your practice and externally to analyze your market and define specific goals, tactics and action plans. VTN EDITOR’S NOTE: In the next issue, we will conclude this three-part series on making the case for a physician’s liaison for relationship marketing. In the next issue, we will conclude the case for hiring a physician’s liaison by comparing the results of five practices in 2011 and 2012 when they did not use a physician’s liaison to 2013 when they did. David Schmiege is the president and CEO of Vein Specialists of America Ltd. He can be reached at 630-638-0060 or at David.Schmiege@VeinBusiness.com.

OCTOBER/NOVEMBER 2014 < VEIN THERAPY NEWS

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SECONDLOOK

STRADIS HEALTHCARE Consolidating specific surgical products in one pack saves time, money, overhead By Larry Storer Stradis Healthcare, a custom surgical pack manufacturer, has been a valued partner in millions of surgeries and medical procedures over its 22 year history. Customer innovation and service are the hallmarks of the company’s value proposition. “It’s a matter of having the preferred surgical products available in one custom pack to provide optimal patient results as well as best overall value to the clinician,” said President and CEO Derrell James. Surgical procedure packs may have been around for years, but the use of pre-assembled custom packs is newer, and not always utilized by facilities specializing in the treatment of endovenous disease.

Kandy Hammond, RN, a veteran practice surgical nurse who also owns her own phlebology practice consulting company, Varicose Vein Consulting, said she always recommends Stradis Healthcare to her clients. “I’ve used the Stradis custom packs for more than 10 years,” Nurse Hammond said. “The high quality of their packs is excellent, and the cost is economical. That’s what you want for a new practice: high-quality, lowcost supplies that save time and money while meeting the specific needs of the practice and the patient. “I don’t ever recommend one vendor over another unless I personally know they will provide consistent high quality products at

an excellent price and in a timely manner. So I don’t hesitate to recommend Stradis,” she said. With a Stradis Custom Surgical Pack, a practice can fill out an online form and select exactly the items the surgeon wants in his or her specific custom pack. Within two weeks, a free sterile sample will be sent to the practice to evaluate. Stradis provides custom surgical procedure packs and disposable surgical supplies around the world. The company also provides a variety of contract packaging services. Stradis serves the phlebology market, as well as other specialties including ophthalmology, orthopedics, dental, ENT, Ob/Gyn, tissue banks, and general surgeries, among others. COST SAVINGS Custom surgical procedure packs can provide a 75 percent savings in setup time versus pulling sterile separates. Because time and overhead really equates to money, the custom packs prepared specifically for a practice offer a key approach to cost savings and waste reduction. Nurse Hammond said most of the practices that she is aware of use procedure packs. “It is so much more efficient because in prepping the room, the staff only has to open one package instead of having to open a large number of separately ordered sterile supplies. I encourage a client to select the items that he requires from a list, and he soon gets a free sample custom pack to try out. I believe that almost all of my clients now use these Stradis custom packs. Buying items separately is more time consuming and costs much more.” Ronald Bush, MD, FACS, said he has used Stradis custom surgical packs for more than eight years and has found Stradis to be reliable and prompt in delivering supplies. “It is reassuring to know that the company maintains sterility, quality and has prompt service.” Dr. Bush said. TIME, WASTE, OVERHEAD In order to appreciate the advantages of custom packs, it is helpful to focus on the measurement of a practice’s costs. The cost of supplies used during the procedure is easy to determine by checking invoices; however, the cost of labor, facility overhead, OR set up costs, and waste disposal is more difficult to

Stradis Healthcare is committed to producing and assembling the most complete, reliable and highest quality surgical products available in the marketplace. quantify. Trying to lower these costs is often overlooked because it is difficult to determine the monetary savings. Every time a disposable item is included in a custom pack rather than being handled separately, the facility saves the cost of the excess packaging, the labor to manage, inventory, and account for multiple part numbers, and the cost of disposing of excess packaging and unused materials. An endovenous procedure can involve as many as 30 disposable items or more. The labor associated with ordering and tracking the inventory levels takes time. It will take staff a significant amount of time to pull each separate item, instead of pulling one customized pack in just a fraction of that time. Overhead is virtually cut in half on room prep time alone, therefore creating more operating room time that could lead to more procedures each day. The unused items that come out of a general pack must be disposed through biohazardous methods, taking both time and labor, which increases a facility’s costs. These unused items are then added to the country’s waste facilities. “These efforts can be avoided with the use of one customized pack. The surgical staff opens one package instead of 30 separate items. The hidden cost associated with handling multiple items is then eliminated

Stradis works directly with each healthcare client to design a comprehensive surgical supply solution for their individual practices.

OCTOBER/NOVEMBER 2014 < VEIN THERAPY NEWS

SECONDLOOK and the environmental impact is lessened,” Stradis Product Manager Jessica Bennett said. Further, “some practices that purchase sterile separates do so because distributor representatives may not provide the complex portfolio of components needed. Other practices use general surgical packs that are sometimes referred to as custom, but are standard by specialty”. SURGEON’S TOOLS The third and most cost effective method is a truly customized pack that is specific to the surgeon. Only the components that are needed – the ones that he or she chooses – will be in the pack. The Stradis custom packs include any disposable item needed, eliminating the unnecessary waste. True custom packs have the facility name on them and are manufactured specifically for the surgeon from his list.

“The customized packs make it easy for physicians to use only what they need and at the same time keep the costs to a minimum,” Dr. Bush said. “I have changed the contents of my packs a few times and have found Stradis to be receptive to making the changes”. With the addition of a custom pack, the staff is available to increase patient throughput while improving the overall quality of the experience and clinical outcome for the patient. DEVELOPING GROWTH This has been a defining year for Stradis Healthcare. In February, Stradis Healthcare hired Derrell James as its new president and CEO. James joined Stradis from EMS Technologies, now Honeywell Defense and Space, where he held various roles including vice president of business development and

director of technical sales. Additionally, as an executive with broad healthcare expertise in general management and operations and a successful background in growing new revenue sources, James is guiding the company’s strategy as it expands further in the growing healthcare market. James said, “Stradis is committed to bringing the right tools, services, and support to the medical community to ensure the best possible surgical outcomes for our clients and the ultimate customer, the patient. Our goal is to be the best value, one-stop-shop for procedure packs by providing the broadest array of products and services possible”. VTN Eliminate waste by specifying only the items you want in a pack for your surgery.

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VEIN THERAPY NEWS < OCTOBER/NOVEMBER 2014

ACPUPDATE

ACP ONLINE EDUCATION CENTER Setting the standard for venous education

By Mike Armitage

So much of our life is online these days, from the news we see to the friends we interact with. Online resources allow us access to content on almost any topic at the click of a button and when it’s convenient to our hectic schedules. Where this has been especially compelling over the last few years is in the domain of continuing medical education (CME). It’s not news that online CME allows practitioners access to relevant content and experts from the comfort of their home

or between patients in their office. Most have been utilizing this for some time now. What has been improving over the last few years is the type and quality of that content. More and more providers have added content that addresses increasingly more specific topics, conditions and treatments. However, for those in the vein care community it can be difficult to find quality, accredited venous content. ACP ONLINE EDUCATION CENTER SERVES VEIN CARE COMMUNITY The American College of Phlebology (ACP) understood the need for comprehensive online vein care training in 2011, when it launched an Online Education Center dedicated to meeting the needs of not only its members, but also the larger community of healthcare providers involved in the diagnosis and treatment of venous disease.

“Very few online CME sites deal directly with vein care in a thorough way,” noted Dr. Robert Worthington-Kirsch, chair of the ACP CME Committee. “We are building a program that will promote best practices and extend our live activities to a broader audience in a way that will stand shoulder to shoulder with the online content of any other major specialty.” In order to ensure these standards are met, there’s a detailed vetting process for both educational relevance and compliance with standards set forth by the Accreditation Council for Continuing Medical Education (ACCME), which requires the ACP meet specific criteria as an accredited provider. Because of this rigorous process, all forcredit courses offered through the Online Education Center qualify for AMA PRA Category 1 Credit(s)™ . A COMPREHENSIVE VENOUS RESOURCE The ACP Online Education Center currently hosts one of the most extensive catalogs of venous related topics on the web, ranging from basic to advanced topics and covering both superficial and deep venous issues. More than 100 courses feature prominent experts from around the world selected from the ACP Annual Congress, the recent UIP World Meeting and smaller topical symposia. The courses have been specifically developed for physicians, nurses, sonographers and other healthcare professionals who wish to advance their venous disease knowledge, skills, strategies, and improve both practice performance and patient outcomes. The array of venous health courses currently online provides a f lexibility live courses can’t offer, allowing healthcare providers to take these courses at any time and at their own pace.

EXPANDING THE ONLINE EDUCATION CENTER The purpose of the Online Education Center is to provide the most up-to-date content and to teach the best practices in the field of vein care. With the inclusion of streaming content from live events and expanded allied health topics, the Online Education Center continues to expand the educational opportunities for the growing needs of the medical community. For instance, the ACP has been an advocate for certification and standards of care, and recently added the Phlebology Review Course, which provides a comprehensive lecture series reviewing the essentials of venous disease and its care for those preparing for the American Board of Venous & Lymphatic Medicine (ABVLM) exam. In addition, online Self-Assessment Modules (SAMs) have been designed to aid ABVLM Diplomates in the Maintenance of Certification (MOC) process, but can be utilized by any member seeking SAM c redits. “The intent of the Online Education Center is to provide those seeking quality, accredited venous disease education an option that augments more traditional learning,” stated Dr. Worthington-Kirsch. “When the online technology is combined with live educational offerings, the ACP provides superior vein care education unmatched by any other venous healthcare education provider.” Exciting offerings are continually added to the Online Education Center and can be accessed at education.phlebology.org. VTN Mike Armitage is the American College of Phlebology director of marketing & communications

American College of Phlebology

O N L I N E E D U C AT I O N C E N T E R To Access the Online Education Center http://education.phlebology.org If you are an ACP member, you can log in with your member user name and password.

Non-members can also access courses online by registering and setting up a user name and password.

OCTOBER/NOVEMBER 2014 < VEIN THERAPY NEWS

ACP 2014

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SECONDLOOK JOHN KINGSLEY

continued from page 1

“Getting to know and understand you is a virtual challenge, but one of sincere appreciation for your kindness, sensitivity, intelligence, and fierce challenge to become one of the very best. I can only respect and admire what you do and whom you have become, the world has never seen better. Your brilliant mind and thoughts have enabled our business to reach heights not thought possible, with improvements and advances yet to come. Your growth as a doctor and director of your cosmetic program has been a delight to observe. I am very very proud of you and all that you do and represent. You will indeed become very famous as the ultimate professional and cosmetic surgeon.” John had a perseverance that was unrelenting, especially with adversity. Being a pioneer in modern vein work he loved remembering those who doubted what he knew to be true. He was passionate and often outspoken in his intellectual debates; yet with his patients he was gentle, calm, and compassionate, never in a hurry and always behind. They loved him. He wore blue jeans and cowboy boots in clinics, wrote with a leather pen, and even wore denim scrubs, which are very hard to find… “Could you help find me denim scrubs? If not, something pretty nice, I would rather wear a belt than a draw string – would like scrub pants to have belt holders.” The love his patients have for him has never been more apparent than it is to me now as I have seen them for the past several months. As I tell them the story of how he fell from a ladder, suffered a traumatic brain injury and died, their tears fall and the loss of this man is almost unbearable. For we know that John Kingsley was one of very few physicians that still made house calls with his ‘doctor bag,’ gave his cell phone to his patients and yet managed to make it a priority to travel the world to further his knowledge, to teach, or even to find the very best compression hose… “Compression stockings are difficult to “ don”, put on and take off. Patients hated the hose. Therefore I obtained samples

Dr. Kingsley innovated many of the surgical practices that are standard today.

from every company in the world, and I wore them for three months – unknown to my staff. I changed company hose each day. The very best were Bauerfeind, not well known in the U.S. I flew to the manufacturing plant in the old Eastern Germany. Such a surprise. Terrific plant, very nice German people, and the most strict standards of quality I have witnessed in a long time.” His patients love that story, and the hose of course. John’s charisma and charm combined with a deep sincere compassion created a patient following that made his practice one of the busiest in the world. Whether performing endovenous laser ablation, sclerotherapy, or pushing a patient to the car, he loved every moment. He loved to take care of people. It was a core trait inside of him. It was his greatest pleasure. His patients knew it. It is this fundamental quality that stands behind his success. Maybe he knew that deep down, but never admitted it. I think it seemed to him as if it gave him too much credit. He always attributed his success and drive to a “tough childhood”. He has stories of working in a meat-packing warehouse in the snow, and of course walking uphill in the snow to get there for 25 cents an hour. His work ethic was driven by a passion that was deep embedded in his soul, and cannot be learned or taught. He may think it was his childhood, but it was inside of him well before his childhood began… “I was a strong kid who had a tough childhood. I lost my father as a teenager and, as a result, had no financial resources to fall back on. It didn’t take me long to get the picture: if I wanted to make something of my life, it was up to me to make sure I did it. I would have to take care of myself. This kind of tough appraisal of reality might be hard for some, but for me it was the catalyst that enabled me to be highly motivated from an early age. I also had a kind of idealism that spurred me on. I wanted to do something meaningful with my life, and I wanted to do well. The challenge was first to survive and become educated, the rest was a fierce desire to be the very best. Because of my tough early years, I still cannot rest on laurels, I continue to work and teach and learn to be the best. I still remember hungry days and not knowing the future, drives me foolishly perhaps.” Upon deciding to go to medical school, his school counselor recited to him all the reasons he should choose another path. Anytime there was a hint of doubt from anyone about anything something deep inside him was ignited, and it was “game on.” This was no different. He was determined to be a doctor, and the decision to pursue a surgical career was simple to him. Really, the profession chose him… “So, I worked hard and ended up putting myself through college and medical school. I also learned that being successful doesn’t mean having an easier life. In fact, the better you do in life, the more challenges you will continue to face.” He loved the challenges. He excelled in medical school and knew very quickly he wanted to be a surgeon. He always was quick to make decisions. Never a hesitation. The bigger the decision the better. A favorite cowboy quote of his: “Courage is being scared to death but saddling up anyway.” – John Wayne And “saddle up” he did over and over again facing life’s challenges with an energy and enthusiasm that never faltered. A “manly man,” fiercely independent, earthy, an “alpha male” and a yet a nurturing, gentle hero to those in need. “I have preferences for a lot of things. I am a true cowboy – just as per your definition of me. I like cowboy things, I like “brown” to a degree, I like horses and saddles, I like

rustic, these things are comfort to me and allow me to relax and work and play better. John earned his undergraduate and doctorate degree from the University of Florida in Gainesville, Fla. He then completed his surgery internship and residency at the Bethesda Naval Hospital in Bethesda, Md., while serving as the Navy general and vascular surgeon. He achieved the rank of commander in the U.S. Navy, and was awarded the prestigious honorable discharge upon his completion of service. Over the years, his peers and several professional societies bestowed upon him very well deserved honors. He was president of the Alabama Vascular Society, president of the American Society of Outpatient Surgeons, and chairman of the Surgery Department and director of the Vascular Surgery Division of the Carraway Medical Center in Birmingham. He was a Fellow of the American Society of Vascular Surgery and the Southeastern Association of Vascular Surgeons, and he was also awarded the Top Surgeons in America distinction by the Consumer Research Council of America for many years. In 2007, he was selected to the Australasian College of Phlebology as an Emeritus Fellow. He authored more than 100 publications and presentations on vascular and vein surgery methods and techniques. Of all his publications he was most proud of his research in intra-operative autotransfusion as a surgical resident, this research led to the

OCTOBER/NOVEMBER 2014 < VEIN THERAPY NEWS

SECONDLOOK development of cell saving technology used in autotransfusion throughout the world today. John has participated in the introductory and complex training of more than 350 physicians and allied staff from around the world, including Australia, Japan, Canada, London, Dubai and nearly every state in the United States through Alabama Phlebology Training Institute… “My colleague, Jim Ingram, MD, and I founded the Alabama Phlebology Training Institute in 2003. The idea is to pass on what we know works…to enrich the specialty. Physicians and staff in training get to observe and participate in a full time phlebology specialty practice. They come for a week or two. Approximately 50 endovenous laser ablation operations are performed each week, and numerous related procedures are happening simultaneously or at separate times. We designed our training programs to fit the needs of physicians seeking advanced knowledge in the field of phlebology. The training doctors and staff are taught what to look for when they’re evaluating candidates for certain types of treatment, and they witness procedures being done using the most advanced techniques and equipment to correct vein disorders. John believed strongly in sharing his knowledge to promote the specialty he loved, phlebology. He even travelled to Japan and would beam with pride when he talked about the Tokyo Vascular and Vein Clinic as it was modeled after his Alabama Vascular and Vein Center. He enjoyed Japan and wished we could be more like them… “Wish we could adopt the Japanese mindset and sweetness – thousands of cars on the road coming from the airport, not a sound, no horns, no road rage, just soft talk and smiles. Think about what a pleasant atmosphere with such, smiles all day long.” John loved Telluride, Colo., and decided to start his own meeting there. Unlike any meeting, as the wine was poured the discussions were animated and real. “Phlebology Colorado” was very important to him because the format was unlike any other meeting. He considered obtaining CME credits, but when he reviewed the regulations and structure required for such he absolutely refused, as it would destroy the spirit of the meeting… “The meeting is held at the Peaks Hotel in Telluride, a particularly scenic location both at the hotel and on the mountain. This is my favorite ski resort and get-away spot in the U.S. The format is to simply bring a case to discuss, more than one if any of the attendees wish. About 5 minutes are allowed for the presentation, and the entire audience of attendees may then ask questions or comment – give advice, critique, whatever. The camaraderie is terrific, and the information shared is priceless.

“I obtained samples from every company in the world, and I wore them for three months – unknown to my staff. I changed company hose each day.

Teammates John Kingsley, MD, and Melanie Petro, MD This is the only conference held where attendees can freely discuss problems, complications, difficult situations, tricks, ideas, etc. without fear for reprise, and usually with an “attaboy” response, keep trying. “Many like myself are in the trenches every day, not in the university setting where “research” and “cerebral” activities are rewarded. We get our rewards from the good results our patients enjoy. Sharing that information is also a good reward.” John enjoyed skiing, especially with his children; tennis; riding horses; everything blue; and cars, his favorite superhero was Batman, because he loved the car… and he loved his work and his patients. Gifts from his patients overfilled his office, and it was always with great sincerity that he described each of them. If I had one wish for him it would be that he had spent more time writing. He had a way of expressing himself with such elegance, yet relentless passion that was unmistakably behind every carefully chosen word. I sent everything I wrote to him for suggestions, and only wish I could send him this. He especially loved to write for Vein Therapy News… “…a refreshing publication for the phlebology business! It’s the one resource where I actually look at nearly every page.” When he was adamant about something, he always turned to writing. Here is a piece of an email he sent to Larry [Storer, editor} and about the last article he wrote. Far too many “money mills” setting up across the country, and your publication might be the best place for me to vent my frustration over these doctors. They are hurting the vein work terribly by treating patients poorly and by causing a huge increase in cost. I can write something, will irritate many of them I am sure, but needs to be exposed.”

VEIN THERAPY NEWS < OCTOBER/NOVEMBER 2014

An end to this seems too final, for a man with so much more to do and share. His story will never end for me and those he shared his life with. Ironically, he loved the 4th of July. “I am a bit of a patriot this time of year having done my eight years in the Navy and taking care of many marines and navy men injured during the war times.” His fall on July 4th of this year will be a tragedy in my mind for a lifetime; yet, he will live on through the hearts of his family, friends, colleagues and especially his patients whom I know will always remember the doctor in the cowboy boots who pushed them to the car himself after their procedure. I will remember everything about him, everyday of my life. My appreciation for him is immeasurable. Issac Newton described it best: “If I have seen further than others, it is by standing upon the shoulders of giants”. John Raymond Kingsley, MD, you are a giant in every way. Your contributions to this world shall never be forgotten. When I think of you, cowboy, I will imagine you riding your favorite horse, “Frisky” bareback through the pastures of the sky, finally writing the book you talked about, and of course making “house calls” in the clouds. It seems you lived the quote that hung on your wall, just way too soon: `“Life’s a journey not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out, shouting ‘Holy shit…what a ride!” – Hunter S. Thompson Melanie L. Petro, MD, is board certified in otolaryngology, cosmetic surgery, and is certified by the American Board of Venous and Lymphatic Medicine. Dr. John Kingsley trained her in phlebology, and together they developed a program combining aesthetics and vein treatments. Petro Cosmetic Surgery and Alabama Vascular and Vein Center are adjacent to each other in Birmingham, Ala., and share an AAAHC accredited office-based surgical center. VTN

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SECONDLOOK Thrombectomy device extracts a long clot Lee Butterfield MD, interventional cardiologist with Palmetto Cardiology in Columbia, S.C., was the first to use a new mechanical thrombectomy (blood clot removal) system to extract a 1-inch long blood clot from a saphenous vein to coronary artery bypass graft. The patient presented with a long blood clot in an aged saphenous vein bypass graft diagnosed during a cardiac catheterization procedure. Dr. Butterfield used the combination of a protective filter, the new ASPIRE RX-LP6 Mechanical Thrombectomy System, and a stent to remove blood clots and dilate the stenosis. “Compromised bypass grafts may include long viscous blood clots and emboli making them particularly difficult to treat,” Dr. Butterfield said. “The ASPIRE RX-LP6 System allowed us to create continuous thrombectomy force and remove a long blood clot from the patient’s vein graft. Once the blood clot was removed, we could better define a culprit lesion and deploy a 3.5mm diameter stent.” The ASPIRE Systems allow clinicians to instantly start, stop, increase, decrease, pulse or maintain thrombectomy force during the procedure. ASPIRE Mechanical Aspirators also aspirate up to 280ml, almost 10 times more than basic syringe systems, without multiple messy and time-consuming catheter connections, disconnections and re-connections. Shawn Fojtik, CEO of Control Medical Technology, said the ASPIRE RX-LP6 Mechanical Thrombectomy System is a natural extension to the ASPIRE platform. “Thousands of ASPIREs have been sold and used in procedures from the ankle to the elbow.” VTN READ MORE: www.CONTROL MEDTECH.com

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rofessionals. Some of the compelling topics p this year include: • The Future of Regenerative Therapy • How to Distinguish Venous Skin Changes from Others • The Orphans of Phlebology: Venous Pain, Restless Leg Syndrome, Venous Entrapment and Nerve Compression, Vascular Malformations, Nonvenous Lower Extremity Ulcerations, CCSVI Update • Special Interest Sessions: Complications in Sclerotherapy, Swollen Limb, Thrombophilia, and Venous Stents • Politics and Your Medical Practice: What Does the ACA Mean to Phlebology, Reimbursement Trends in Venous Interventions, Strategies to Help Phlebology Practices Anticipate and Adapt to Future Change To view the preliminary program, see www. acpcongress.org. VTN

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SECONDLOOK

SYRIS SCIENTIFIC SHINES A NEW LIGHT LED polarized technology: Light so unique it must be experienced

By Larry Storer For more than 17 years, the Syris Scientific polarized hands-free headset lights have been the Gold Standard for providing enhanced visualization for vascular procedures, as well as other treatments that benefit from seeing below the surface of the skin. In September, the new v900L was released; taking advantage of improved light-emitting diode (LED) polarized technology. The v600 workhorse, which is still the industry’s visualization leader using a halogen light source, is being discontinued when current stock is exhausted; only due to the fact the new v900L LED technology is equal to or better than its predicate. Syris Scientific engineers have incorporated not only the LED light source, but other suggestions made by medical professionals over the years,” said Pam Wilkinson, general manager of Syris Scientific. The Syris Scientific v600, v300 and the new v900L Visualization Systems all provide visualization 1mm below the skin’s surface, making it essential for dermatology, plastic surgery, general surgery and phlebology. According to Wilkinson, the three systems reduce reflective glare from the skin, which ultimately can minimize stress, eye fatigue and potentially reduce future eye complications. The Syris headsets have been said to increase accuracy and reduce procedure times with vascular laser procedures such as sclerotherapy, resurfacing, hair removal, hair transplantations, plastic surgery and general dermatologic procedures. Kevin C. Smith, MD, FRCPC, from Niagara Falls, Ontario, views the v600 as an essential tool. Dr. Smith is a board certified dermatologist in Canada and the United States, and is a consultant, researcher and speaker for leading aesthetic and laser companies. He acts as a reviewer for medical journals specializing in surgical and aesthetic medicine, and is a consultant and expert for the College of Physicians and Surgeons of Ontario and the Canadian Medical Protective Association. “I’ve had Syris v600 headsets, developed under the supervision of Dr. Rox Anderson, in both of my laser rooms since 2001,” Dr. Smith said. “We use them every day because they help us to do better, safer work and to reduce operator fatigue. “We are eagerly awaiting the rechargeable, LED-illuminated Syris v900L! With a run time of four hours, I might want one in each of my procedure rooms, and perhaps also as an upgrade for my Syris v600s.”

The v900L’s superior LED light needed to be engineered so the polarization for glare reduction did not affect the quality of the light output. Finding the right components allowed for the elimination of the optical barrel, thus making the unit lighter. LED’s also allowed for increased battery time due to less draw for energy. With the user requested component of being lighter, the new v900L has a 4-hour initial battery run time, is hands-free and is un-tethered, which allows for complete mobility without cables plugged into the wall.

Syris v900L and components All of the light sources reduce exam times for pigmented lesions and other conditions, and patients benefit because the light increases accuracy resulting in less tissue damage from overlapping or difficulty in identifying vascular structures or hair follicles. “The best part of all of the Syris products is that they are totally hands-free, allowing the medical professional to perform their treatment without being compromised with having to hold a device, and it also can eliminate the need to have that second person assist you,” Wilkinson said. DERMATOLOGY, AESTHETICS The v600 was initially developed and is primarily used for vascular laser procedures with IPL Lasers. Because of the need to wear dark goggles for eye protection, the optical barrel was developed to channel the halogen light into a bright spot to be able to visualize with the goggles. The technology behind the systems combines illumination, polarization and magnification. All devices come with a No. 3 diopter lens, which is suitable for most medical professionals; No. 4, and No. 5 diopters are available for changeable magnification options. A diopter, is a unit of measurement of the optical power of a lens or curved mirror, which is equal to the reciprocal of the focal length measured in meters; the approximate focal length with No. 3 lens is 14 inches. The v600 has a defined 2-3 inch uniform bright in the focal area. The new v900L spot size is 4 inches. “The v900L’s custom optics delivers unprecedented optical performance and breakthrough lux uniformity in a

collimated beam angle,” Wilkinson said. “The concentrated light is necessary when wearing the darker laser goggles for procedures. Laser goggles are necessary to wear and ample room is provided behind the visi-shield.” NON-LASER PROCEDURES The v300 was later developed recognizing that the goggles were not necessary for some procedures, thus eliminating the optics and reducing the cost. It is an excellent visualization system for sclerotherapy procedures with facial telangiectasia and spider veins on the legs, and has been used for examination of pigmented and vascular lesions. In most cases the Syris v300 is used not only for sclerotherapy, but other procedures such as hair replacement, tattoo removal, Botox or filler applications, and general dermatology procedures. The v300 can be used with laser procedures, as well. The v300 provides 6-8 inches of diffused light in the viewing area. Decision on which system to use is a matter of which procedure is primarily done in the office and eye preference. With the introduction of the thermo-coagulation devices, the v300 is a great complement for the devices and should be integral part of the procedure. LED AND THE v900L As LED technology improved, Syris Scientific management and engineers believed it was time to implement the LEDs into the v900L. While the halogen light of the v300 and v600 still provides a superior white light, Syris decided to engineer the same quality light using the LEDs.

EVOLUTION In July of 1991, R. Rox Anderson, MD, described the use of polarized light in dermatology in an article in Archives of Dermatology called “Polarized Light Examination and Photography of the Skin.” (Archives Dermatology July 1991; volume 127:1000-1005) It’s been 17 years since Dr. Anderson and Bill Farinelli developed the first patented polarized hands-free headset. In 1997, it was originally known as the Seymour Light. In 2000, Syris Scientifics’ engineering and manufacturing team assisted the evolution of the Seymour Light into the v600 and the v300. Since that time Syris Scientific, located in Gray, Maine, has provided medical professionals in the dermatology arena with a “Made in the USA” product that provides enhanced vision for vascular procedures, as well as other ancillary procedures that benefit from seeing below the surface. The visualization enhancement technology is the combination of illumination, polarization and magnification combined with engineering that has allowed the medical professional to continue to use the product after all these years. Some of the original Seymour Lights are still being used and are working fine. Medical professionals in the dermatology field have benefited from the Syris technology for many years, allowing them to perform their procedures more effectively and efficiently. Syris’ markets are worldwide, covering the European nations, Middle East, Pacific Rim, South Africa, South America, Canada and Mexico. “We take pride in all our quality products and our service; it is our testimony and the reason why we still are in business for over 17 years,” Wilkinson said. SYRIS SCIENTIFIC

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OCTOBER/NOVEMBER 2014 < VEIN THERAPY NEWS

SECONDLOOK CMS could penalize for more VTE imaging The Centers for Medicare & Medicaid Services (CMS) has long used venous thromboembolism (VTE) rates to determine hospital care quality, but a report finds this measure may not indicate care quality. According to Anesthesiology News, rather than reflecting quality, a provider’s VTE rates indicate the frequency with which it conducts imaging tests – in short, hospitals that look harder for VTE are more likely to find it, according to research presented at the 2014 annual meeting of the American Surgical Association. “Hospitals may be unfairly deemed a poor performer for the outcome VTE measure if they have increased vigilance for VTE by performing more VTE imaging studies,” said study author Mila H. Ju, MD, MS, a clinical scholar with the American College of Surgeons (ACS) and a vascular surgery resident at Northwestern University in Chicago, after presenting the study at the 2014 annual meeting of the ACS. Dr. Ju and her team analyzed 2009-2010 ACS National Surgical Quality Improvement Program data from 208 hospitals on patients undergoing 11 major procedures associated with increased VTE. Their findings were consistent with earlier research that found a correlation between a hospital’s VTE rates and frequency of imaging studies. VTE is a controversial quality-of-care measure included in many quality improvement programs and public reporting initiatives. The CMS deemed VTE a “never event” that will not be additionally reimbursed after certain operations. Beginning in 2015, VTE occurrence will be tied to financial penalties through the CMS Value-Based Purchasing Initiative. But clinicians have criticized the VTE outcome measure, arguing that these events do not reflect poor hospital care. Some evidence backs up this argument. A previous study from the Surgical Outcomes and Quality Improvement Center at Northwestern University reported in JAMA 2013 found that hospitals with higher rates of VTE perform more imaging studies than other hospitals. That report, however, was criticized for its use of Medicare administrative data, which provide limited information about preoperative risk factors and exclude VTE events that occur in the post-discharge period. Administrative claims data also have higher false-positive and false-negative rates. Dr. Ju and her colleagues designed the new study to overcome problems in previous studies. The analysis by Dr. Ju and her colleagues confirmed the previous study’s finding: VTE events in the first 30 days after surgery occurred more often at hospitals that performed more imaging studies. VTN

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SECONDLOOK

UppLIFT from Total Vein ends sonographer’s fatigue, pain By Larry Storer A Sioux Falls, S.D., f amily doctor found that when he bent over and twisted while doing sonography exams of his patients’ lower extremities that he developed nagging back pain. It may have been Plato who first observed that necessity is the mother of invention, but Lornell E. Hansen II, MD, actually demonstrated it. From his painful predicament, he developed the UppLIFT, an ultrasound patient positioner so that he could evaluate his patient’s venous insufficiency without having to contort his body in the process. Dr. Hansen’s UppLIFT is a new ergonomic lifting device that is being offered by Total Vein Systems (totalvein.com) in Houston. Physicians currently do not have an ergonomic patient lift other than a conventional bed for sonography, or they simply have the

patient stand on a wooden box or stairs. Patients have to be in a standing position for duplex ultrasound evaluation for both deep and superficial venous insufficiency. Current beds on the market, not made specifically for the evaluation of venous insufficiency, have been adapted by phlebologists for use but really do not fulfill their needs, and definitely are not ergonomically friendly for the sonographer.

THE STORY BEHIND IT

“If I were to sit down and do a couple of ultrasounds on a patient in the current beds available, the width of the bed would require me to sit next to the bed and have to rotate over and use my right arm to gain the appropriate access for the sonogram; but by my second vein map, my middle and lower back was getting sore,” Dr. Hansen said. “And my staff would complain that their necks, shoulders and arms were getting sore from the same task. We knew these complaints were caused by poor positioning of the sonographer during exams of the lower extremities whether the patient is on a box,

stairs or currently available beds. Then we started trying to look at a way in which we could get rid of some of those problems.” Dr. Hansen discussed what he needed with his friend Marc Bogue, who owns an engineering company in nearby Deresford, S.D. “We knew we wanted a bed that was standing almost straight up and down; and we wanted it designed to allow the ultrasound technician to move in close. “There is a chair that is available with it so that they can rest their arm and not get all the fatigue in their neck and shoulder, and with the ultrasound right there and the patient inches in front of them, there is no twisting and raising of the arm which causes the fatigue and pain in the shoulder and back.” Some hospital beds can stand the patient up, but then when they are in the reclining position, the beds take up a lot of room. The UppLIFT, which has a very small footprint, was designed specifically for ultrasound technicians. It can stand in the

corner of a small exam room and it works very well. The lift is 76.34 inches tall, 33.5 inches wide and 34.65 inches deep, and in Dr. Hansen’s practice, it is in a 6-foot by 8-foot room. Wherever it is placed, it operates quietly, using the latest in lift technology. The lift capacity is 550 pounds, and UppLIFT can be operated with a programmable control unit for up to six users. It is covered with medical grade padding for easy cleaning. Bogue engineered it so well that they have been unable to tip it over. “Even when it goes up as high as it can go, we have not been able to tip it over. We had two of us on it – the equivalent of 400 or so pounds – and we were swinging it back and forth and we could not get it to tip over.” UPPLIFT

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SYRIS SCIENTIFIC

continued FROM page 28

TESTIMONIALS PAST AND PRESENT “I never perform any laser procedures without the Syris light-it has replaced all of the OR lights in my office,” said Eric F. Bernstein, MD, MSE, at Main Line Center for Laser Surgery. “The Syris light’s cross-polarizing technology allows me to see every laser target I am trying to treat, by eliminating (reduces) surface reflection. For tattoo removal, the Syris light is critical, and allows me to clearly see every color, so I can choose the appropriate device for the job. Like most great inventions, the Syris light is simple, indispensable, and obvious.” “Now that I’ve seen and used it – I only wish I thought of it myself.” The headsets are of value to any practice. Eliot F. Battle Jr., MD, CEO and president of Cultura Dermatology & Laser Center in Washington, DC, states, “The Syris vision enhancement system has been a crucial element in my center’s success. I can’t imagine treating a patient without it. Rather if you are treating moles or veins or just examining the skin, the glare free, polarizing enhancement Syris system provides you with a perfect clear environment and view of skin regardless of the patient’s ethnicity or skin color.” P. Nicholas Van Loan, MD at Aesthetic Medicine of New Hampshire uses the v300

Syris v900L battery control box

Syris v900L every day for treating spider veins on the lower extremities. “Polarized light allows me to identify and canulate vessels I would previously had a problem treating. I have no complaints or problems with the equipment.” Jeffrey S. Dover, MD and director of the Cosmetic Surgery and Laser Center at Beth Israel Deaconess Medical Center and associate professor of Clinical Dermatology at Harvard Medical School, said they use the Vision Enhancement System regularly for visualizing pigmented and vascular lesions. “It is a great asset in many cutaneous surgical procedures.” Mark D. Forrestal, MD, agrees. “Visualization of patterns of venulectasia and telangiectasia is critical to sclerotherapy—the v600 gives the necessary insight for effective treatment.”

Two widely respected plastic surgeons who are also inventors of various lasers, Mitchel P. Goldman, MD, and Robert Weiss, MD, use the Syris units in their practices. Dr. Goldman practices at Dermatology Associates and Cosmetic Laser Associates of San Diego County Inc. “My associate physicians and staff, as well as myself, are amazed at the increased clarity which one can see the superficial vasculature with these devices.” He goes on to say about the v900L, “Allows more accurate visualization of treatment targets (blood vessels) to enhance therapeutic efficacy of lasers and sclerosing solution and minimize adverse effects from these procedures.” Dr. Weiss is an assistant professor of dermatology at Johns Hopkins Medical School, said the v300 allows much sharper demarcation and delineation of sun dam-

aged skin and allows clearer identification of lentigos. Phlebologist and cosmetic surgeon Henry J. Pearce, MD, who is medical director of Edmond Laser Institute, Edmond, Okla., believes his practice would be crippled without the v600. “We have found it (the v600) extremely useful in sclerotherapy and laser ablation in the treatment of varicose veins and telangiectatic vessels,” Dr. Pearce said. “We also, however, have found this (the v600) to be quite helpful in assessing the depth of penetration and surface topography while performing skin resurfacing procedures on the face. “We would be severely handicapped without this now that we have grown accustomed to having this available for these procedures.” VTN

OCTOBER/NOVEMBER 2014 < VEIN THERAPY NEWS

SECONDLOOK UPPLIFT

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SECONDLOOK Dermatologist puts beautiful skin book series on Kindle Robin Fleck, MD, founder and medical director of Body Oasis Laser Aesthetics and Southwest Skin & Cancer Institute (www. rejuvadoc.com), has announced that her series of six “Recipe for Beautiful Skin” books are now available on Amazon’s Kindle. Dr. Fleck is a double-board-certified dermatologist and internist, recognized by the American Board of Dermatology and the American Board of Internal Medicine. She is a fellow of the American Society of Laser Medicine and Surgery and the American Academy of Dermatology.

in Your Teens,” “A Dermatologist Shares Her Secrets for Having Flawless Skin in Your Twenties,” ““A Dermatologist Shares Her Secrets for Having Flawless Skin During Pregnancy,” “A Dermatologist Shares Her Secrets for Having Flawless Skin in Your Thirties,” “A Dermatologist Shares Her Secrets for Having Flawless Skin in Your Forties,” and “A Dermatologist Shares Her Secrets for Having Flawless Skin for a Lifetime.” VTN READ MORE: www.rejuvadoc. com or www.amazon.com Also a contributing author to Vein Therapy News, Dr. Fleck is founder of Vein Specialties (www.prescottvein.com) in Prescott, Ariz., and is a member of the American Venous Forum and the American College of Phlebology. Subtitles of the books are “A Dermatologist Shares Her Secrets for Having Flawless Skin

Esaote MyLab Six OK for U.S. sales The Esaote North America’s MyLab Six ultrasound system has received 510(k) clearance

from the U.S. Food and Drug Administration and is now available for sale in the United States. MyLab Six is a compact ultrasound with a unique profile to improve ergonomics for sonographers scanning in a seated position and can be configured with a complete suite of applications, making it ideal for shared ultrasound services in busy clinical settings. The modular application structure of MyLab Six gives the flexibility to configure its system with the clinical applications needed at time of purchase, then add more capabilities as needs change or as they expand into new services. Each application package provides full measurement and report capabilities uniquely suited to the specific application. VTN READ MORE: www.esaoteusa.com

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SECONDLOOK

ACCUVEIN AV400 A good look before, during and after sclerotherapy, phlebectomy By Larry Storer One of the critical factors in a successful venous procedure is vein location – being able to see the veins before any treatment or procedure is performed. Knowing immediately which veins are feeding other veins can help achieve better results with more targeted injections. Many surgeons, including Ronald G. Bush, MD, FACS; Steven M. Elias, MD, FACS, FACPh; and Antonios P. Gasparis, MD, use the AccuVein AV400 for aiding in sclerotherapy and phlebectomy. The AccuVein AV400 digitally displays a map of the vasculature on the surface of the skin in real-time, allowing surgeons to verify vein patency and avoid valves or bifurcations. Weighing in at less than 10 ounces, the AV400 is handheld and lightweight, and easily converts to hands-free with the use of an optional wheeled or fixed stand. The medical grade design allows the AV400 to be easily wiped clean, bagged for use in isolation and it does not require calibration as it is permanently aligned. Physicians can hold the AV400 in any direction above the vein being viewed. Universal and inverse modes make the AV400 useful on a variety of patient types. With a centerline accuracy to the width of a human hair, the AV400 can detect veins up to 10mm deep.

DR. BUSH

Dr. Bush said AccuVein provides vasculature details that he wouldn’t otherwise have. “Now I know immediately which veins are feeding spider veins and can achieve better results with more targeted injections. I use it on all sclerotherapy and transdermal laser procedures, and it is an invaluable tool and one that I see makes a difference to patients’ treatment. Dr. Bush founded and is the medical director for Vein Experts, a national group of venous specialists specializing in venous disease. He is the author of numerous scientific papers and holds patents for surgical instruments. For the past 20 years, Dr. Bush has devoted his practice solely to the treatment of venous disease, and training physicians from around the world.

Many of the new procedures now performed in the ambulatory treatment of varicose veins have originated in part from his clinical studies. “When I do sclerotherapy for the treatment of spider and reticular vein complexes, I use the AccuVein AV400 because it allows me to accurately map the reticular veins in association with the spider complex,” Dr. Bush said. “Some reticular veins cause high pressure in the cutaneous network and others act as draining veins from high-pressure areas. “Using a simple technique, I can delineate which is the pathologic vein. The technique is somewhat difficult to explain, but involves compressing and releasing pressure on veins near the complex to determine which one actually fills the spider complex. The AccuVein AV400 allows an accurate depiction of all veins in the vicinity. Dr. Bush said that when liquid and/or foam sclerotherapy is injected into the reticular vein, it’s possible to see the length of the vein treated by observing the clearing of the vessel as the sclerosant is injected. “This gives you an excellent idea on the level of cannulation that is necessary in the next step of the treatment. “When doing microphlebectomies in combination with sclerotherapy and/or 940 laser, I mark the reticular veins using the AccuVein AV400 wherever a mild dilatation may occur in the reticular system. At these previously marked areas, a phlebectomy is carried out using tumescent solution.” As an adjunct in treating venous ulcers, Dr. Bush said this device allows him to utilize in many instances the technique of percutaneous foam sclerotherapy.1 “This technique allows for rapid healing of ulcers and the AccuVein AV400 can illuminate the small venules close to the ulcer margin and this is the target for injection.” Bush said he can work hands-free with the AccuVein. “I hold the AccuVein AV400 to assess the vasculature and then, in order to keep the device on for the procedure and have my hands free, I place the device into an AccuVein handsfree accessory,” he explains “It is a wheeled stand with a mobile arm that contains a cup to hold the AccuVein device.”

DR. ELIAS

Dr. Elias performs a number of procedures using the AV400. He is director of the Columbia Vein Programs in the Division of Vascular Surgeries at Columbia University in New York; and director of the Center for Vein Disease at Englewood Hospital & Medical Center in Englewood, N.J. Dr. Elias is also an assistant professor of clinical surgery at Columbia and an associate professor in the Division of Vascular Surgery at Mount Sinai School of Medicine in New York. “I use AccuVein for aiding in sclerotherapy, mostly of the reticular vein and some smaller varicose veins,” Dr. Elias said. “I will use AccuVein to see the full extent of the disease and to document that I’ve gotten the solution into all varicosities and all the veins. “So with AccuVein, you can not only see all the veins you need to access and treat, but you can confirm that you have treated the full network of abnormal veins. This is much more than you would see just visually because with your eyes you can’t really appreciate seeing all of the veins in the area that is visible. The goals of sclerotherapy are not only to treat the veins you can see with your eyes, but to treat the underlying feeding veins that are connected to the veins that are visible to your eyes. “Prior to doing any procedure on the veins that we see, we scan the area to identify the feeding veins that are going into the area of concern. So that’s how we use AccuVein in pre-treatment. “And during treatment, we use it to better access to the veins because we can see them better; and then we use AccuVein to confirm that we have put our sclerosing solution into all the veins that are in the area that we’re treating. AccuVein is also used in post-treatment to see the changes that can be seen in the veins. After sclerotherapy, for instance, the outline of the vein displayed by AccuVein looks different posttreatment than it did pre-treatment. “Sometimes patients will say to you, ‘Did you treat this vein?’ ‘Did you also treat this vein?’ You can show them, and confirm for yourself, that yes you did treat it, or you can say, ‘No, we didn’t treat that vein and now we can treat it.’”

DR. GASPARIS

Dr. Gasparis said he often uses the AccuVein AV400 in microphlebectomies. He is a professor of surgery at the SUNY Stony Brook, Stony Brook University Hospital, and director of the Stony Brook Vein Center and the Stony Brook Wound Center. Ambulatory phlebectomy (also called microphlebectomy) is an outpatient procedure that removes superficial veins through small, slit-like incisions in the skin. This is the preferred treatment for large varicose veins visible on the surface of the skin. But, according to Dr. Gasparis, there is almost always underlying venous reflux disease which causes these varicose veins. For this reason, ambulatory phlebectomy is usually performed after the underlying reflux has been corrected with a different procedure such as endovenous laser ablation (EVLA), he said. “I use the AccuVein to accurately localize and mark the veins that need to be removed,” Dr. Gasparis said.

DAVID MARTIN AND VEININNOVATIONS

Atlanta-based VeinInnovations, which has been providing comprehensive vein treatment since 2002, currently has the exclusive rights to AccuVein in that area. David Martin, RN, CRNFA, and founder of VeinInnovations, says this new tool literally “outs” the root cause of a circulatory issue that, for a big portion of the population, takes the joy out of wearing summer’s shorts and bathing suits. Martin received his degree in nursing in 1980, and since then has worked primarily in the field of cardiovascular medicine. After 10 years in intensive care units and emergency rooms, he became board certified as a registered nurse first assistant, and went to work with heart and chest surgeons as a first assistant both in the operating room and on the wards. In 1994, he became the first in the State of Georgia to do this using a scope rather than the traditional open incision method. This method has become the standard of care in Georgia and is now used in virtually every operating room in the country.

The two lasers are aligned to strike the same point on the body (left). This creates a permanently aligned system with high positional accuracy. High-speed mirrors scan the lasers into a rectangular pattern and the output of the laser is modulated so that it is dark over the vein positions and lit over the non-vein positions (right).

OCTOBER/NOVEMBER 2014 < VEIN THERAPY NEWS

SECONDLOOK In 2002, Martin founded VeinInnovations as the first facility of its kind in Georgia to offer treatment of venous insufficiency and varicose and spider veins. Through the summer of 2014, VeinInnovations’ four board certified surgeons had an exclusive partnership with AccuVein, using it with patients during sclerotherapy in treatments for telangiectasia or spider veins. “With the AccuVein, we can pinpoint exactly where to place the medication used to close and eliminate spider veins,” Martin said. “We have done the procedure successfully for years without the AccuVein, but now, with it, we will know immediately which veins are ‘feeding’ spider veins, and achieve better results with more targeted injections. “Too, we will get more done in less time, leading to a better outcome, fewer appointments, and happier patients.” AccuVein has been used for several years to identify the location of the best veins to use for IVs, infusion therapy, and blood draws; but using it to identify veins for sclerotherapy is a relatively new practice. Children, the elderly and the rest of us who find ourselves on the business-end of a needle for blood draws or IV solutions appreciate those technicians who hit the vein the first time. But we also remember the ones who poked four or five times unsuccessfully before getting someone else to do it with an additional stick. AccuVien ends that anxiety. Joe Niamtu III, MD and an international facial cosmetic surgeon in Richmond, Va., uses

the AccuVein for a number of cosmetic facial surgical-related procedures, but he also uses it to start an IV. “I just used it to start an IV a couple of minutes ago on an elderly patient who is a difficult stick,” he said in an August interview. “I was able to visualize a good vein, and make the stick in one try. The patient was very happy.” Dr. Bush said cosmetic specialists have told him that AccuVein is helpful in cosmetic procedures for vein identification during filler and neurotoxin treatment. “In these procedures it’s helpful to avoid veins because vein punctures are a cause of bruising.” An additional application for the device includes aiding in vein graft harvest. AccuVein allows for more accurate placement of incisions for vein graft harvest and saves time by allowing more focused dissection. Dr. Niamtu said there are many uses for the AV400, including as an educational tool. “So really, the AccuVein is great for starting IVs, placing Botox or fillers, and for diagnostics,” Dr. Niamtu said. “But it’s also nice to use to teach students anatomy so they can identify the veins and actually see them, and I show it to the patients too, and they appreciate the technology. VTN

RESOURCES 1

Bush R, Bush P. Case Study: Percutaneous foam sclerotherapy for venous ulcers. Jour of Wound Care 2013;22(10):S20-S22.

Making the perfect stick Much of the success of the AccuVein is based on the technology. PROPER VENIPUNCTURE

Sticking the centerline of the vein lumen is proper venipuncture technique. Therefore, the correlation between the actual centerline of a vein and the projected centerline of that vein is the critical measure of operational accuracy. Based on AccuVein testing, the centerline accuracy of the AV400 projection was calculated to be accurate within 0.05 mm – about the width of a human hair. Non-contact optical vein detection systems can show veins slightly larger than the actual width of the vein. This effect may vary based on the distance from the patient’s body. However, this functionality has the positive benefit of making it easier for the clinician to see the vein location, much like the difference in regular type and bolded type. The AV400 can detect veins up to 10mm deep according to tests performed by AccuVein using ultrasound to confirm depth of penetration. As would be expected, the depth of veins detected can vary from patient to patient, but the AccuVein can be used in various positions based on different patient types.

HOW IT WORKS

Using the AccuVein Viewing System for sclerotherapy. Left: Lateral calf veins in room light. Right: Lateral calf veins with Accuvein.

The AccuVein is an interesting bit of technology, but the basic physics are very simple. It uses an invisible 830nm infrared laser to detect hemoglobin and a very visible 630nm red laser to project the vein pattern. That specific infrared wavelength was selected because it is absorbed to a greater degree by hemoglobin than by the surrounding tissues. Two photo detectors are filtered to see only the infrared laser and sense the changing reflection as the laser scans over the body. The amount of signal it has to work with is quite small and there’s a lot of noise it has to contend with. Structures such as hair, variation in skin coloration and subcutaneous fat all contribute to noise. The system uses advanced digital signal processing to cut through the noise and find the veins. The two lasers are aligned to strike the same point on the body. This creates a permanently aligned system with high positional accuracy. High-speed mirrors scan the lasers into a rectangular pattern and the output of the laser is modulated so that it is dark over the vein positions and lit over the non-vein positions. The eye then integrates this into a vein pattern. It works on all skin types, and is

especially useful on darker skin where it is more difficult to see veins.

SAFETY ISSUES

The AccuVein AV400 was tested and classified as a Class 2 laser device in accordance with international laser safety standard IEC/ EN 60825-1. This is the same stringent safety standard that is used by laser-based bar code scanners commonly seen in retail stores that are safely used by store clerks and consumers every day. For comparison, those laser systems commonly used in healthcare that require interlocks and clinician eye protection are Class 3 laser systems. The Class 2 AV400 doesn’t require these precautions. AccuVein meets this standard through a design that carefully monitors the intensity of the laser output and the movement of the mirrors. If any issues arise, the lasers are immediately shut off, and all critical safety systems have two or three levels of redundant protections. The AV400 includes two lasers, a 642nm wavelength red laser operating at 45mW and a 785nm or an 830nm wavelength IR laser at 25mW. These lasers are scanned and there are 114 scans per second with 10.7 µs per scan line. AccuVein takes a very conservative position when it comes to patient and practitioner safety. As part of the safety analysis, engineers considered not only the “pass/fail” aspects of the laser safety standard as was required, but they went above and beyond simply meeting the standard. They considered potential uses and misuses of the AV400 and how they could affect patient safety. The display light comes from two lowpower lasers. For subjects with ordinary blink reflexes, these Class 2 lasers are safe because the blink reflex limits exposure and prevents eye damage. When scanning patients with reduced blink reflexes, the use of eye protection is recommended. Eye protection is only required when the patient has diminished bright light aversion response and there is a chance that they might look directly into the laser beam. No eye protection is required for the clinician.

VTN

–Larry Storer

READ MORE: http://learn. accuvein.com/avoiding-nervesduring-venipuncture/

Using the AccuVein Viewing System for sclerotherapy. Left: Lateral thigh veins in room light. Right: Lateral thigh veins with Accuvein.

VEIN THERAPY NEWS < OCTOBER/NOVEMBER 2014

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PRODUCTNEWS Polidocanol injectable foam Varithena OK for use in U.S. Varithena (polidocanol injectable foam) is now available for use in the United States. BTG International Inc. has treated the first varicose vein patient with Varithena, the only FDA-approved foam for the treatment of incompetent great saphenous veins (GSV), accessory saphenous veins and visible varicosities of the GSV system both above and below the knee. Varithena improves symptoms related to or caused by varicose veins, and the appearance of varicose veins, and is proven

to reduce the five symptoms patients consider most important – heaviness, achiness, swelling, throbbing and itching (HASTI symptoms). Marlin Schul, MD, MBA, of the Lafayette Regional Vein & Laser Center in Indiana, and who conducted the first Varithena procedure, said, “I am proud to now be able to offer Varithena as a new treatment option for my patients with varicose veins. “Varithena is a convenient, minimally invasive treatment and patients can return to normal activities shortly after treatment.” Paul McCubbin, head of Varithena at BTG, commented, “Varithena is the first and only FDA-approved comprehensive treatment that improves the symptoms and appearance of varicose veins. “We are delighted that this clinically proven product is now commercially

available to qualified physicians.” Varithena is a uniform, low-nitrogen, polidocanol microfoam, dispensed from a proprietary canister device. The physician injects a small amount of Varithena into the malfunctioning vein through a small tube (catheter) or a needle. It displaces the blood from the vein to reach and treat the vein wall; the diseased vein collapses and blood flow is diverted to healthy veins nearby. Vein specialists practicing in the United States who are interested in using Varithena can connect with a BTG territory sales manager by calling the Varithena Solutions Center at 855-971-8346. VTN READ MORE: www.varithena. com or at www.btgplc.com

Covidien opens new CCI in Brazil Covidien has opened the Covidien Center of Innovation (CCI) in Sao Paulo, Brazil. The 3,000-square-meter facility will serve as a hub for training healthcare professionals on the latest medical technology. It has the capacity to offer 120 courses and educate up to 2,000 clinicians per year. The new CCI contains a surgical lab equipped for minimally invasive surgeries using electronic and computer simulators in addition to silicone models, a clinical scenario simulation lab equipped with a human patient simulator, a lab for educating in medical and hospital procedures, an Anatomage touchscreen table, an R&D lab and a 160-person auditorium. VTN

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What is covered in the RPhS exam? The following illustrates the general distribution of questions and the relative weight or emphasis given to a skill or content area on the exam. A detailed outline can be found at www.cci-online.org. Content Category A. Maintain Information, Facility, and Safety B. Patient Diagnosis C. Performance of Diagnostic Testing D. Conservative Treatment / Therapy of Patients E. Minimally Invasive & Invasive Treatment of Patients Total

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VEIN THERAPY NEWS < OCTOBER/NOVEMBER 2014

Photo courtesy of Morrison Vein Institute and Compudiagnostics

PRODUCTNEWS Startup speeds PE diagnosis; seeks FDA OK Peripheral artery disease (P.A.D.) affects about 8 million people in the United States alone, according to the American Heart Association, and it can lead to strokes or heart attacks. Diagnosis is often inaccurate and time consuming, and many people who have the problem are asymptomatic. A Doppler ultrasound and the Ankle Brachial Index (ABI) scale are standard diagnostics for peripheral artery disease (P.A.D.). But they can take up to 30 minutes of a doctor’s time to administer. Blood pressures are taken one limb at a time, which leads to less accurate data. MESI was founded in November of 2010 to make it easier to identify this condition. The

founders developed an ABI measuring device, the ABPI MD, which allows a physician to take all three blood pressures required for the ABI measurement at one time, in about 3 minutes. The results can then be printed and stored for documentation purposes. The idea for improved ABI diagnostics was first recommended by co-founder Matjaz Span, MD, who has extensive experience in cardiovascular medicine. He was using the Doppler ultrasound method in his daily practice, but became dissatisfied with the method because it was time-consuming, inaccurate and subjective. He teamed up with now CEO Jakob Susteric and CTO Tomo Krivc, both electrical engineers, to create the ABPI MD product. “In the future, we want to bring the technology from consumer electronic devices to medical diagnostic devices,” Susteric said. “An example would be having one display unit

that is connected to all other measurement devices wirelessly.” ABPI MD has been selling since 2012. On a recent interview with New Wave Health Care, Susteric said that MESI’s ABPI MD generated 300,000 Euros last year with projections to reach 750,000 Euros this year. They will also be launching other products later this year. The company is based in Slovenia and has distributors in 13 countries in Europe and the Middle East. MESI’s product is not available in America but the company is in the process of getting FDA approval. MESI is currently raising $5 million in venture capital. They are raising money by participating in health/tech start-up events and competitions like the Health Tech Summit, the Qualcomm Tricorder XPRIZE and the QPrize. VTN READ MORE: www.mesimedical. com/home/

Covidien launches new P.A.D. stent Covidien plc has launched its EverFlex Self-expanding Peripheral Stent with Entrust Delivery System in Australia and New Zealand. The latest version of the EverFlex stent features the new Entrust Delivery System, which enables physicians to consistently place stents with accuracy, while providing the ease of a one-handed device. The Entrust Delivery System deploys the EverFlex stent, which is used to re-open narrowed (stenotic) regions of the superficial femoral and proximal popliteal arteries that supply blood to the legs. Narrowing of these arteries is associated with a condition known as peripheral arterial disease (P.A.D.), where plaque builds along lining of the arteries, blocking blood flow to the legs. VTN

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OCTOBER/NOVEMBER 2014 < VEIN THERAPY NEWS

PRODUCTNEWS GE perfects ultrasound at point-of-care GE Healthcare has introduced the Vscan with Dual Probe with the first of its kind 2-in-1 probe to give healthcare providers more uses for pocket ultrasound. This pocket-sized ultrasound tool houses two transducers in a single probe, allowing clinicians to see both shallow and deep views of the body without changing probes. This latest innovation enables efficient triage and fast workflow, which may lead to time and cost savings in many point of care settings. “We’re excited to unveil Vscan with Dual Probe — a first-in-market dual probe ultrasound device,” Ajay Parkhe, general manager of primary care ultrasound for GE

Healthcare, said. “It builds on our experience in the global pocket ultrasound market to solve our customers’ biggest clinical and economic challenges. “With this latest edition to the Vscan family, our pocket-sized ultrasound technology provides both deep and shallow scans to help healthcare providers make confident decisions quickly, affecting both cost and time. Just like the current Vscan, this new device is ultraportable very easy to use, has excellent image quality and allows the clinician to take a quick look, non-invasively, inside the patient. In addition, the Dual Probe version combines the sector probe with a linear probe in one device to conduct most of the standard ultrasound scans within minutes.” Vscan with Dual Probe adds clinical value in a variety of resource-constrained environments with a pocket-sized device that covers many point of care ultrasound procedures as identified by

the American College of Emergency Physicians. For emergency care, this includes inserting central or peripheral lines (IV line inserted into a large vein) or completing focused heart and lung assessment exams. For hospital environments this includes bedside cardiac evaluations on rounds and efficient assessment at admission and discharge. Additionally, for obstetric areas, this includes visualization of fetal heartbeats, and quick assessment of fetal position or maternal status. Vscan with Dual Probe puts ultrasound capabilities in clinicians’ pockets to give them convenient access—when and where they need it most. Further, as ultrasound becomes a standard part of medical education, many physicians may be using it at the point of care, and will appreciate the high image quality and portability that the Vscan family of products provides.

This launch furthers GE Healthcare’s longstanding efforts to provide access to innovative ultrasound solutions for patient care, and assist healthcare systems in driving efficiencies with relevant diagnostic tools in the fields of cardiology, primary care, women’s health and emergency medicine. Anders Wold, president and CEO of GE Ultrasound, said the past five years have demonstrated that miniaturized, portable ultrasound technology like Vscan can have a tremendous effect on the practice of healthcare in developing and developed nations. “We hope with our new Vscan with Dual Probe we have made the use of ultrasound at the point of care, simple and fast all the while helping healthcare providers improve access to impactful medical technology.” VTN READ MORE: healthcare.com

www.Vscan.ge

acox@precisionmedbill.net http://www.precisionmedbill.com VEIN THERAPY NEWS < OCTOBER/NOVEMBER 2014

PRODUCTNEWS

SIGVARIS celebrating 150 years in 2014

SIGVARIS, a family-owned Swiss company that manufactures medical and sports compression garments and stockings, is celebrating its 150th Anniversary this year. SIGVARIS’ North America headquarters is located in Peachtree City Ga., and the company recently held an event at the Westin in Atlanta to mark the occasion. A similar event was also held at the Montréal Science Centre in Québec, Canada. Both celebrations included a historical exhibit showcasing the company’s history as well as a dinner and artistic expression performance that took event-goers through the process of creating graduated compression products.

SIGVARIS HISTORY

SIGVARIS got its start in the 1800s, and for more than 100 years, the company produced rubber elastic textiles, which sold in both Switzerland and abroad. Between 1958 and 1960, company leaders partnered with Dr. Karl Sigg and the SIGVARIS brand

was born. Today, 90 percent of SIGVARIS’ graduated compression products sold in North America are manufactured just south of Atlanta in Peachtree City. Socks and hosiery that feature graduated compression are designed to be tightest at the ankle and decrease in pressure going up the legs. Graduated Compression garments help improve circulation and revive tired, achy legs. They also help with the treatment and prevention of varicose veins. Today, SIGVARIS offers three categories of products: SIGVAR IS MEDICA L, SIGVARIS WELL BEING and SIGVARIS SPORTS.

EVERY DAY A STEP FURTHER

Approximately one-third of all men and women between 18 and 79 suffer from swelling of the legs or veins. In fact, venous disease can affect anyone, particularly if there is a family history,” said Judith Brannan, education and medical affairs manager for SIGVARIS North America. “Other risk factors include an age over 40, obesity, pregnancy, sedentary lifestyle, prolonged sitting or standing, surgery or trauma, infectious disease or use of hormone medications.” Scot J. Dubé, president and CEO of SIGVAR IS North America, said that because leg health problems are prevalent medical conditions that are often underdiagnosed, SIGVARIS has been taking steps to help improve leg health on a global level and this remains a core focus for the organization today.

Scot Dubé, president and CEO of SIGVARIS North America, left, and Stefan Ganzoni, representing the owners and members of the Board of Directors. “Around the world, many individual’s legs are in a critical condition. As a company we are committed to taking steps to change how people think about leg health with a new generation of compression garments and stockings,” Dubé, said. “Forward thinking and forward moving has been a big part of our philosophy over the last 150 years, and we are taking steps to continue to improve leg health for future generations. “SIGVARIS offers fashionable compression options designed to fit any lifestyle. For tips on how to keep your legs healthy or to find your perfect pair visit www.sigvarisusa.com. VTN READ MORE: www.sigvarisusa. com/en/our-history

ABOVE: Anniversary celebrations were held at the Montréal Science Centre in Québec, Canada; and at the Westin in Atlanta. BELOW LEFT: SIGVARIS

The events included a historical exhibit of the company’s long history.

OCTOBER/NOVEMBER 2014 < VEIN THERAPY NEWS

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compression products were on display at the galas. BELOW RIGHT: SIGVARIS’ North America headquarters is located in Peachtree City, Ga.

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VEIN THERAPY NEWS < OCTOBER/NOVEMBER 2014

PRODUCTNEWS SIGVARIS adds Mulberry shade to fall collection

This fall, SIGVARIS is offering what spokeswoman Melissa Gwozdon says is one of the season’s hottest, on-trend shades in the SOFT OPAQUE hosiery collection. “Mulberry is the perfect way to makeover any wardrobe.” SIGVARIS strives to give women fashionforward hosiery options designed to match their lifestyle. SOFT OPAQUE looks and feels like designer fashion tights and helps keep legs healthy. It features graduated compression, which helps improve circulation and aids in the prevention of varicose and spider veins.

The new limited edition Mulberry color is available in the 15-20mmHg and 20-30mmHg compression levels in calf length, thighhighs and pantyhose. It’s a popular compression option among women who have the early stages of chronic venous insufficiency, a problem that affects onethird of all women. In addition to Mulberry, the entire popular collection is available in Midnight Blue, Espresso, Graphite, Black and Nude. Mulberry in the SOFT OPAQUE hosiery collection

SIGVARIS MEDICAL compression hosiery promotes leg health and is universally recommended for both the surgical and non-surgical treatment of venous disorders. VTN READ MORE: www.sigvarisusa. com

U.S. vascular market to grow to $5B by 2020 The U.S. Vascular Access Market, which was valued at $3.7 billion in 2013, is expected to grow to over $5 billion by 2020, according to a new report published by Research and Markets. This growth is fueled by government safety and reimbursement policies created to reduce

infection and injury rates, according to U.S. Vascular Device Market 2014. As a result, hospitals are taking steps to reduce injuries by increasing the use of safety products such as pivoting needles, shield safety products retractable syringes and catheter securement technologies. The rise in demand for vascular access devices is proportional to the addressable patient population, including oncology, ICU and diabetic patients. In 2013, approximately 90 percent of patients who were hospitalized in the United States received some sort of vascular access treatment during their stay, including the use of IV catheters and syringes. VTN READ MORE: www.research andmarkets.com/research/x7s6fk/ u_s_vascular

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OCTOBER/NOVEMBER 2014 < VEIN THERAPY NEWS

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