myAVLS 2019 Vol. 1

myAVLS

IT’S TIME TO CONSIDER THE FACTS ABOUT TREATING THE LYMPHATICS Conservative therapy plus Flexitouch® system reduces costly complications in patients with CVI and lymphedema (phlebolymphedema).1 $14,000 $12,000

69%

$12,253

$10,000 $8,000 $6,000 $3,839

$4,000 $2,000 $0

CONS ONLY

vs.

CONS + Flexitouch

(p=0.001)

Total phlebolymphedema- and sequelae-related costs* Published in Journal of Vascular Surgery: Venous and Lymphatic Disorders June 2018 *Per Patient Per Year Costs, CONS=Conservative Therapy

Flexitouch Plus is the only pneumatic compression device proven to stimulate the lymphatic system.2 With its comfort and convenience, patients are more compliant.

833.382.2845 (833.3TACTILE) tactilemedical.com

1. Lerman M, Gaebler JA, Hoy S, Izhakoff J, Gullett L, Niecko T, Karaca-Mandic P, O’Donnell T, Rockson SG, Health and economic benefits of advanced pneumatic compression devices in patients with phlebolymphedema. J Vasc Surg. 2018 June 15. pll: S0741-5214(18)30983-2. dol: 10.1016/j. jvs.2018.04.028 [Epub ahead of print] 2. Adams, K.E. et al. (2010) Direct Evidence of Lymphatic Function Improvement After Advanced Pneumatic Compression Device Treatment of Lymphedema. Biomed Opt. Express. 2010 Jul15; 1(1): 114-125 Caution: Federal (U.S.) law restricts this device to sale by or on the order of a licensed healthcare practitioner. © 2019 Tactile Medical. All rights reserved. 700816 Rev A 11/2019

Things Have Changed STEVEN ELIAS, MD, FACS, FAVLS CHAIR, 2019 AVLS ANNUAL CONGRESS

There was an FM radio show in New York City – Idiots Delight hosted by Vin Scelsa. Different. A real radio show with intent, a theme, and a vision each week. The show always began with Vin reciting:

presented by faculty, care is discussed and decisions are made by an audience response system. You decide on what to do. Practical takes place when we break up into individual sessions.

The faculty responsible for these have worked very hard to address the practical management of patients with venous and lymphatic disease.

AVLS has many courses throughout the year that teach the basics and the Sunday courses of this meeting will as well, but this annual meeting takes us to another level.

“What it comes down to is this: Respect the Elders.

Embrace the new.

Encourage the impractical and improbable, Without bias.

This is Idiots Delight.”

A good way to live one’s life, and a good way to think of structuring a meeting.

The next level of academic content has been achieved by our Abstract Committee. They have picked excellent podium and poster presentations of new ideas, new data, and new topics. The importance to the presenters and ourselves cannot be emphasized enough. Be there. We ARE the American Vein & Lymphatic Society: Advocacy, Research, Education. These sessions highlight our mission.

This year’s American Vein & Lymphatic Society (AVLS) meeting has many of these same elements. The meeting respects the Elders.

The time honored traditional elements of our meeting are still here but with a twist. No society should be stagnant as F. Scott Fitzgerald wrote, “So we beat on. Boats against the current, borne back ceaselessly into the past.” We need to embrace the new: our new name announced at last year’s meeting and our new logo premiered at this year’s meeting. We have taken a new approach, minimizing concurrent sessions and maximizing the time we all spend together. After all, we are all in this together.

We may find out that some changes turn out to be impractical or improbable, but we approached the changes without bias. We are glad you are here to enjoy the adventure of this AVLS meeting. While the theme is F:LIP, our goal is to achieve the most appropriate care of our patients. A lot of work has been done by a lot of people. Our program committee and administration has tried to:

The theme of our meeting is: F:LIP or Focus: Live, Interactive, Practical. Each day at the end of the morning, we all get together for an hour or so for One Big Thing, a topic that we think everyone needs to hear about. Live, the second part of this morning session involves live ultrasound imaging of patients with you helping to decide how to best manage these patients.

Interactive occurs at the end of each afternoon session. Again we all get together. Cases are

Respect the Elders.

Embrace the new.

Encourage the impractical and improbable, Without bias.

We welcome you. Enjoy and let us know what you think.

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Letter from the President

MARLIN SCHUL, MD, MBA, RVT, FAVLS

PRESIDENT, AMERICAN VEIN & LYMPHATIC SOCIETY

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s you review the 2019 program, you will see some differences from previous years. The Chair of the congress is Dr. Steve Elias who has brought some interesting twists by getting LIVE and interactive. You will see sessions where we will come together for cutting edge content and find the scientific aspect to have reached a new level again this year. I hope you will find this format to be educational and fun. We look forward to your feedback.

updates this year as we work to keep you updated on matters that you should be aware of and the potential impact on our practices.

Some crazy changes Marlin Schul, MD, MBA, RVT, FAVLS in coverage have been positive, as Blue Cross Blue Shield of Alabama has transformed from one the most difficult policies to one that offers wide access to care.

As a member of the American Vein & Lymphatic Society, you should recognize the three pillars of our mission and vision; Advocacy, Research, and Education. These pillars are interrelated and touch the many stakeholders within our Society, the field and most importantly our patients. Let me bring you up to speed on what has happened over the past year and what you can look for in 2020. Let’s start with our Advocacy efforts.

The coming year will be busy. Relationships are evolving as more societies seek representation with the AMA, as we share so much common ground. We are building our bench for the CPT and RUC anticipating additional procedures that will likely fall under review. Advocacy for our society centers on 1). Assuring Access to Care; 2). Supporting reimbursement for wellestablished Saphenous Vein ablation techniques; and 3). Staying informed through AVLS newsletters and updated. If you would like to learn more about advocacy and how you can get involved, talk to any HAC member wearing the BRIGHT ORANGE ribbons to get details.

AVLS ADVOCACY IN ACTION The Healthcare Policy and Advocacy effort requires a village. The AVLS has a seat on the AMA House of Delegates along with seats on the AMA RUC and CPT advisory committees.

Our Advocacy Standing Committee has well over 60 years of experience, and we cannot possibly have enough. Advocacy success requires experience and relationships, and we have vastly grown this outreach in 2019. There are stakeholders everywhere, and we have addressed important issues with Medicare MACs [Noridian, Novitas, Palmetto, and Wisconsin Physician Services (WPS)], Independence Blue Cross, and have met with CMS administrators and the FDA. Our advisory committee is large and well distributed as to address payor and policy issues as they evolve. Hopefully you have noticed Advocacy specific messaging and

RESEARCH IS ROLLING FORWARD AND COUPLED TO ADVOCACY Big registry news as we have transitioned from ACP PRO VEIN 1.0 to AVLS PRO 2.0, allowing a platform better suited to address research questions being posed. Dr. Joe Jenkins and Michael Thompson, AVLS Director of Research have spearheaded the development and transition of our legacy data to the new platform with a query engine that allows immediate flexibility to address emerging threats and 4

Photo by Austin Neill on Unsplash

payor whims. CVD, CVR, and VCA are all providing data to the registry. We have exceeded 200 participating providers and many more are anticipated in 2020 as EHR barriers are overcome.

We have received commissioned research grants through the Foundation from Medtronic and Merit Medical. PICO questions have been developed for each technology to study specific features and impact on patient outcomes. PICO questions are merely structured questions involving a patient population, an intervention, a comparator intervention or placebo, and outcome. This is an opportunity for members and young investigators who want to participate on a writing group to come forward. We have dozens of projects that will advance simultaneously as critical data elements are captured and ultimately published.

Also critical to our future is the development of clinical guidelines that will further position the AVLS as the leading society dedicated to the field of venous and lymphatic disease. In 2019, we began the development of three key guidelines 1) C2 disease – Varicose Veins 2) Pelvic Disease and 3) Lymphedema with a research grant through the Foundation from Tactile Medical.

We plan to drive specific projects to support advocacy efforts and policy development with payors to support an intervention where the science takes us and to help build evidence-based standards in venous and lymphatic disorders. If you would like to get more information on how you can get involved in a writing group, please email me at mschul@acpmail.org or grab any of the research committee members wearing the RED ribbons.

CONTINUED ON P. 7

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2019 FUN RUN & WALK 5k Run & 1k Walk course options When: Nov. 9 at 6:00 am Where: Sunset Lawn JW Marriott Desert Ridge Resort & Spa Phoenix, AZ Register at: www.fvld.org/funrun

This event is made possible thanks to the support of

LETTER FROM THE PRESIDENT CONTINUED FROM P. 5

EDUCATION OPPORTUNITIES ARE ENDLESS What education opportunities are best for you and your staff?

Attending Annual Congress?

Online education on our Learning Management System?

What about Virtual Reality where your new Physician Assistant could train at home with 3D goggles and content targeting small vein or large vein sclerotherapy? Everyone’s time is important, and it is imperative that a continuing education event have content of value, peer-interaction, and a basis to retain the material to enhance a given practice.

Not only is this year’s program a new format, but also we have many opportunities online, a sclerotherapy program developed by Dr. Margaret Mann using virtual reality to deliver you a near-live learning experience, and regional symposiums that support credentialing and exam prep for ABVLM and RPhS. Although in its early phases, we will leverage our new website to offer web forums for members to ask clinical questions and build topic specific blogs to support our member needs. If you have a topic we should consider or work to emphasize to a greater degree, please let us know. Our education committee members are wearing TEAL Ribbons.

Grab one of us and let us know how you wish to get involved.

COMMUNICATION SPEAKS While Advocacy, Research and Education are the three pillars of the Society we must not forget the need to develop the information and tools to inform our peers, our colleagues and our patients about the advancements in venous and lymphatic care. This year we restructured our committees creating a new organization of Communication committees that will provide volunteers an opportunity to get involved in the development and implementation of our communications platform specifically targeting Professionals and Patients.

We have just launched a new approach to our web presence with three faces of our society. www.veinandlymph.org our primary face to healthcare professionals and those wanting to learn more about the mission and vision of the AVLS. www.myavls.org is a new face of the AVLS specific to our membership where you will find access to all the benefits and opportunities of membership in the AVLS. www.healthyveins.org provides our patients with the pertinent information they need to understand their venous and/ 7

or lymphatic disease and to provide them with access to a qualified practitioner.

If you see one of our members wearing the PINK Communications ribbon be sure to see how you can support the efforts going forward.

MEMBERSHIP MATTERS Our most important opportunity to serve the Society is to be involved. We need to see our membership grow and new committees focused on the retention of membership and recruitment of new members are fundamental to achieving the goals and objectives of our great Society.

In closing, our society is nothing without our members.

If you are not a member, I challenge you to become one. If you are a member, I challenge you to enrich your experience by getting involved with a volunteer committee(s).

Advocacy, Research, and Education cost time and money to be effective, and I challenge you to become a donor to the Foundation for Venous & Lymphatic Disease. It takes a village to be successful, and we are making great strides. But we cannot do it without you.

A new era of service by the AVLS to our HEALTHCARE POLICY AND ADVOCACY BROUGHT TO YOU BY THE AVLS, THE FOUNDATION FOR VENOUS & LYMPHATIC DISEASE, AND OUR VOLUNTEER MEMBERS STEPHEN F. DAUGHERTY, MD, FACS, FAVLS, RVT, RPHS CHAIRMAN, AVLS HEALTHCARE POLICY COMMITTEE

ROBERT WHITE DIRECTOR OF HEALTHCARE POLICY & ADVOCACY, AVLS

• A unified voice representing the specialty of venous and lymphatic medicine • • • • • • •

Engaging with stakeholders- Medicare, FDA, American Medical Association Comments on proposed policies Participation in the AMA CPT process Participation in the AMA Resource-Based Relative Value Update Committee Representation at the AMA House of Delegates where decisions do affect us Representation on the IAC-Vein Center Division Board of Directors Direct engagement with Federal government and Capitol Hill with written comments and personal visits to Capitol Hill and CMS

• Fair reimbursement and patient access for vein care • • • • • •

Putting the physician at the center of the care process The right treatment for each patient Development of Position Statements published on our website regarding the new vein technologies and support of new technologies and payment with multiple payors Harnessing data to prove the care we provide is appropriate and improves outcomes for patients supports our advocacy for FAIR payment Partnering with Medicare and other payors to improve medical coverage policies In-person meetings with CMS Medicare leadership and representing the AVLS on Medicare Carrier Advisory Committees and at open carrier policy meetings (First Coast Services Organization, Novitas, Palmetto)

• Leveraging our AVLS Guidelines Committee to ensure care standards support our Advocacy communications with other venous stakeholders • The future will be determined by what we do NOW to address the many challenges ahead.

• • • • •

Our current national payment and care delivery system will change - we need to understand how.

Fee for Service is going away - our future must be about quality of care and value.

Data informs all that we do - it helps us improve what we do, and it will support payment for value.

The AVLS PRO 2.0 Registry is central to the next decade. We must harness our data.

Venous & Lymphatic Medicine is our contribution to mankind, and we are all stronger with AVLS as our voice. We must continue to increase our efforts on behalf of our patients and our profession.

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members, our profession, our patients

T

he American Vein & Lymphatic Society (AVLS) Board Healthcare Policy Committee, with deep support from the volunteer members of the Advocacy Committee, continues to work for the professional interests of our members and their patients. Much of this work would not be possible without the financial support of the Foundation for Venous & Lymphatic Disease (FVLD).

Payment models are evolving, and we must keep up with them so our members can meet the many external challenges.

Data is key to influencing the policy makers and payors. We cannot expect decisions to be favorable to our patients or to us if we do not guide decisions. We must be able to show that we deliver high quality care that changes lives, and we must be able to show the value of the services we provide. Participation in the AVLS PRO 2.0 Venous Registry is key to developing the data. Our payors are asking for data, which we can best provide through the Registry.

The AVLS is working to present a unified voice for those who care for venous and lymphatic disease to policy makers, regulators, and payors.

We are the largest voice for patients as we fight for access to care and for fair payment policies.

Without fair policies, we cannot attract the skilled and talented professionals necessary to care for our patients in the future.

Funding for our policy and advocacy activity comes largely from FVLD grants. These grants pay staff salaries and support necessary travel expenses for staff and our volunteer members who give up valuable time from their practices to represent the AVLS. We can do more if we have the funding to monitor and manage our responses to proposed policies.

The Board Standing committee and the Healthcare Policy Committee set the direction and make the policy decisions. The majority of the work of accomplishing these goals is done by the Advocacy Committee. The members of the Advocacy Committee have been selected from the AVLS membership because each has special skills or knowledge and the ability to devote the substantial volunteer hours necessary to accomplish our goals.

EACH OF YOU CAN HELP BY:

Our primary goal is to educate stakeholders such as payors and policy makers about venous and lymphatic disorders, the unmet needs for care, and how they might help us to better care for our patients. Additionally, the committee comments on proposed and existing medical policies and strives to develop a constructive dialog with payors to improve medical policies and to provide patients with access to appropriate care. Collectively, our volunteers spend thousands of hours a year working for the interests of our patients and our members.

1.

Contributing generously to the Foundation for Venous & Lymphatic Disease

2.

Participating in the AVLS PRO 2.0 Venous Registry

3.

Forwarding information and concerns about policy and advocacy issues to Robert White at rwhite@acpmail.org

4. Participating in research that answers clinical questions Thank you for your gracious support through your time, dues, Foundation contributions, and your membership in our dynamic Society.

The work we are doing is critical to our specialty.

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Improving Wisely Study Highlights Utilization in Vein Care WHAT ARE THE KEY TAKEAWAYS SO FAR?

In 2018, the American Vein & Lymphatic Society partnered with the Improving Wisely collaborative at Johns Hopkins University and the Robert Wood Johnson Foundation to undertake a national review of publicly available Medicare claims data on vein ablations. The AVLS spoke with our two members who are serving as Principle Investigators for the Improving Wisely project - Margaret Mann, MD, FAVLS, FAAD and Marlin Schul, MD, MBA, RVT, FAVLS. AVLS: Dr. Mann, Dr Schul – congratulations on the publication of the Phase I Improving Wisely paper. Please share some insight as to why the AVLS undertook the Improving Wisely project?

Schul: Absolutely. As we all know, perceptions of procedure over-utilization in venous care have been around for years. We know that, but doing a data-driven analysis of that hypothesis has been the challenge. It’s not enough to just speculate, we need to address this issue and let the findings inform all of us as to our own practice data, and how our Society might address these trends in terms of education and awareness. We know that defining care guidelines and appropriateness is our collective future, and this is a step in that direction.

Mann: When the Society’s Board decided to make this investment in Improving Wisely, I was very pleased. As a Mohs surgeon, my data was part of the American College of Mohs Surgery’s own Improving Wisely project, and I was impressed at how the project impacted Mohs surgeons. The key to Improving Wisely is that it is a peer comparison, quality improvement project. When providers see their data compared to peers, they get a sense of whether their own practice patterns are in line with national averages, or if they might be above the median in terms of numbers of procedures. I

want to emphasize, a higher provider utilization does not automatically equate with “overuse,” but shows how you compare to other vein providers. The Improving Wisely program is based on the concept that transparency through peer comparison reduces unnecessary variations, which in turn leads to improved patient safety and quality of care while also reducing costs.

AVLS: At a high level, what do the numbers show from Phase I of the study?

Mann: Using 2017 data, we had 2,462 NPIs in our study. The majority (96.4%) of patients underwent 1-5 ablations, 3.3% underwent 6-10 ablations, and 0.3% underwent ≥11 ablations. The median and mean physician ablation rates were 1.6 (IQR 1.3-2.2) and 1.9±0.8 ablations per patient annually, respectively. 106 physicians (4.3%) had an ablation rate ≥3.4, which is ≥2 standard deviations above the national mean.

Schul: As in any study, we needed to make adjustments in our analysis and addressed those. Overall, our median ablation number is in line with other studies that have been done, such as Baber, et al. and Crawford, et al. I want to emphasize, while this study is focused on defining a national ablation median, I also think we as the vein community need to be mindful of vein care underutilization as well. We know 10

Margaret Mann, MD, FAVLS, FAAD

Marlin Schul, MD, MBA, RVT, FAVLS

Schul (con): the patients we see, and how interventions result in a better quality of life for our patients. Moving towards generally accepted standards of care is something that AVLS is working on across several of our Committees. We know we have knowledge gaps, and payors will only demand that we address those gaps.

AVLS: What is next for the Improving Wisely project, and how might the Society use these national findings to support, say, Guidelines and Advocacy?

Schul: On an almost weekly basis, we are engaged with both Medicare and private payors on vein coverage policies and LCDs. Having this data supports those efforts, as it shows that AVLS is committed to doing our part to ensure that each patient gets the right care they need for their clinical presentation. I’m excited to see our new PRO 2.0 Registry get up and running, as it will also serve as a powerful data source to move us towards data-driven care approaches and best practices.

Mann: Using the same metrics, but more recent claims periods, we will repeat the Improving Wisely analysis in 2020. NPIs will once again receive a confidential data report. This will allow providers to see if their ablation rates changed over time. I expect that our Guidelines Committee will look closely at the data, and I know payors are following the study as well. Also, we want to The full study, “Significant Physician Practice expand our analysis and will likely be looking at Variability in the Utilization of Endovenous possible underutilization in ulcer care. I’m very Thermal Ablation in the 2017 Medicare curious to see what our 2020 analysis will reveal.

Population”, will be available for free at AVLS: Thank you, Drs. Mann and Schul for all https://www.jvsvenous.org/article/S2213your hard work and dedication to not only 333X(19)30410-X/fulltext from October 15th the Improving Wisely project, but also to the through December 31st.

American Vein & Lymphatic Society.

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A New Horizon in Research MARK MEISSNER, MD CHAIR, RESEARCH STANDING COMMITTEE

W

hen we consider the three tenets of the American Vein & Lymphatic Society, we must realize that advancements in the science of venous and lymphatic disease through Research is critical if we are to achieve our other tenets of Advocacy and Education. The AVLS began the pursuit of advancing research several years ago with a multi-million dollar investment in the development and deployment of the PRO Venous Registry recognizing that it is only with “big data� that we will be able to provide the clinical and scientific evidence required to support the future of the field and improve the quality of care for our patients.

Now we are embarking on the next phase of our research investments and initiatives, which are overseen by three different Advisory Committees of the AVLS. First, we have the PRO Registry Operations Committee that is chaired by Joe Jenkins, MD, FACS, FAVLS, RPVI, RPhS, RVT, CWSP. This committee is responsible for the over-site and

management of the PRO Venous Registry to ensure the system is operational and the data integrity is protected and to facilitate the expansion of the data collected along with the addition of new providers.

In 2018, the AVLS agreed to invest in upgrading the PRO Venous Registry platform from our original 1.0 version to a more modern and user friendly 2.0 version. The Operations Committee has been hard at work at getting this new database functional. This has required an essential rebuild of the entire database. The beta testing of uploaded data was completed in May 2019. Three of our major provider groups, the Center for Vein Restoration, Vein Clinics of America and Streamline MD have been working hard to get their data into the new registry, with a commitment of completion by the end of October. Testing of the query component of the registry has been completed. The PRO 2.0 registry now provides an easy way to compare pretreatment and post treatment patient reported outcome data within the registry. The minimum data set requirements for superficial 12

vein treatments that a practice needs to provide to the registry have been finalized. Registry participants will need to agree to provide, as a minimum, this data. The minimum data set for pelvic vein and deep vein treatments is in the development phase. As data analysis is initiated, AVLS will begin the process of developing specific vein therapy quality measures. This will allow submission of pertinent information to CMS in regard to MIPS and MACRA requirements. The Operations Committee knows that upgrades to PRO 2.0 will be an ongoing process and a major undertaking for 2020 will be the development of a Lymphedema Module in the registry.

Second, the AVLS has undertaken the development of three new clinical practice guidelines under the leadership of Mark Meissner, MD. In the summer of 2018, the Guidelines Advisory Committee met at the AVLS headquarters in Chicago where Dr. Gordon Guyett came to train our members on the ins and outs of developing and writing quality clinical guidelines. Coming out of that training opportunity the committee agreed to pursue the development of the following guidelines: C2 disease – Varicose Veins in cooperation with the AVF and SIR, Pelvic Vein Reflux, and Chronic Venous Obstructions. These projects are underway and are expected to be ready for publication in mid to late 2020. The AVLS will be working with the Alliance for the Implementation of Clinical Guidelines a relatively new Guideline Clearing house replacing the AHRQ National Guideline Clearing house that closed in 2018.

And most recently, the FVLD is providing a grant to the AVLS made possible by Tactile Medical to begin the development of a clearing house quality clinical guideline in Lymphedema.

This project team is currently being recruited and will begin work in early 2020.

The development of clinical guidelines is a critical responsibility of medical societies, and the AVLS as the leading society in venous and

lymphatic disease is committed to these and future projects that will support our desire to affect payment and treatment policy for our patients across the US. Our third and arguably greatest opportunity to impact the field of venous and lymphatic medicine is the investment in pursuing new research. The Research & Scientific Committee is chaired by Kathleen Gibson, MD. With the advancements in the PRO 2.0 Venous Registry, we now have sufficient data to begin conducting research across a wide magnitude of topics and areas where we will be able to truly understand the outcomes of treatments for venous and lymphatic disease on our patients.

Our goal is to produce a minimum of six to eight new and unique research projects a year. As the research is developed, our goal as a Society is to be able to provide the data that helps us impact payor policy and clinical practice.

If you never thought of the AVLS as a researchbased Society, it is time to reconsider your opinion. Not only are we investing to pursue new research out of the PRO 2.0 Venous Registry, but also, we have been selected through the Foundation to conduct two new commissioned research projects. Grants made possible by Medtronic and Merit Medical have been approved and utilize the PRO 2.0 Venous Registry to understand the long-term outcomes of their new innovative technologies for vein ablation. These projects are multi-year studies and will commence early in 2020.

As you can see there is a tremendous opportunity at AVLS to get involved in supporting our Research initiatives, and we ask you to consider getting involved and volunteering for a committee or at a minimum consider becoming a provider of data to the PRO 2.0 Venous Registry. Take a look around for one of our Committee Volunteers for Research and make sure to find out how you can become involved.

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JW Marriott Desert Ridge Resort & Spa 2019 Annual Congress Map ADDITIONAL MEETING SPACE* Desert Suite 2 Desert Suite 8

BALLROOM LAWN

TO GOLF OUTING

Presidential Boardroom

Golf Reception Welcome Drop-in

PINNACLE PEAK 3*

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Boston Scientific

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Tactile Medical

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medi USA

GRAND SONORAN G Donor Lounge

FOUNDATION

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SPECIALTY INTEREST MEETINGS GRAND SAGUARO WEST

FVLD Expedition Pick-Up Daily Breakfast Raise Your Glass New Horizon Reception FVLD Fun Run and Walk Bonnie & Clyde Pick-Up *LOCATED ON SECOND FLOOR INFORMATION SUBJECT TO CHANGE

VR Immersion – The Evolution of Medical Education MARGARET MANN, MD, FAAD, FAVLS CHAIR, AVLS EDUCATION COMMITTEE

I

deally, everyone could learn a procedure by standing right beside the performing physician and observing. Medical education has searched for ways to provide this same experiential education to everyone. Whether it is an operating theater or a live stream on a screen, the experiences are not quite the same.

But Virtual Reality or VR is changing the game.

The American Vein & Lymphatic Society is thrilled to bring Virtual Reality training to venous and lymphatic medicine through its partnership with Med360, which began with the April 2019 Sclerotherapy Course in Chicago, IL. In a live education course, VR labs will allow individuals to watch a procedure through a provided headset, putting every individual right next to the performing physician. The headset provides a full 360-degree video of the operating room creating a completely immersive experience, allowing viewers to look where they want to, when they want to, whether it is at the tools selected for the procedure or a close up of the patient. A simple click or turn of the head can change the camera angle, allowing the viewer to “stand” in a different spot in the room without affecting anyone else’s experience.

Everyone gets to learn by standing right beside the performing physician.

The next step will be having VR education in the comfort of one’s home. While nothing beats gathering together with peers to learn, it is not always feasible for every willing attendee to take time away from work to travel. Virtual reality is about removing barriers to learning.

VR training provides hundreds of remote attendees access to attend lectures with a front row seat followed by real case participation in a surgical center or clinic without leaving the comfort of their office or home. As these courses are developed, it will be possible to provide a “near-live” educational experience anytime, anywhere, without having to wait for a live course to be offered or taking time off from the office, an attendee can view lectures and live cases in an immersive experience right from their home or office.

INTERESTED IN EXPERIENCING THIS NEW LEARNING OPPORTUNITY FIRST HAND? Visit the AVLS New Horizon Plaza in the Exhibit Hall and view a preview of the Sclerotherapy Course.

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Pursuing the New Horizon NEIL KHILNANI, MD, FAVLS, FSIR CHAIRMAN, FOUNDATION FOR VENOUS & LYMPHATIC DISEASE

Since its launch at our Austin meeting exactly two years ago, a great deal has been accomplished to meet the goals of the Foundation for Venous & Lymphatic Disease’s (FVLD) New Horizon strategic and capital initiative to support the “we ARE” mission of the American Vein & Lymphatic Society (AVLS).

considerable volunteer efforts supported by a financial commitment from our membership and our colleagues in the industry to achieve them.

As the commitment phase of the project draws to a close on December 31, 2019, I would like to call your attention to what has been accomplished and focus on what we we still need.

Although we have seen such tremendous support from our members and corporate teammates, it is imperative that we achieve our goal of $6 million to reach our objectives.

By November 2018, the FVLD successfully received commitments from our member and industry partners exceeding the initial goal of $5 million set in Austin, TX. Given the ambitious goals set forth by the AVLS Board, the enthusiasm of our partners for these plans and in recognition of the accomplishments already achieved, both Board’s at the Nashville Congress voted to extend the pledge phase of the project until the end of 2019 to pursue a goal of $6 million.

Please take a moment to consider how you will support venous and lymphatic medicine.

At this time, with over 100 multi-year commitments from healthcare practitioners, corporate partners, and motivated organizations, I am pleased to report to date we have nearly $5.4 million pledged with pending decisions from commercial sources for potentially another $400,000.

As the Chairman of the FVLD, I am hoping to find an additional $300,000 in member support with one final push in Phoenix at our Annual Congress.

YOU CAN MAKE A DIFFERENCE On the 50th anniversary of the Apollo 11 achievements, it is valuable to reflect on the ability of committed individuals to achieve audacious goals. The AVLS has bold ambitions and like the moonshot, it will require the

THE NEW HORIZON CAPITAL CAMPAIGN IS CLOSING ON DECEMBER 31, 2019.

Certainly we would ask all physicians, ultrasound technologists, nurses, advanced practice providers and lymphedema therapists caring for venous and lymphatic patients to consider becoming an AVLS member to take advantage of numerous membership benefits and support our “we ARE” mission. We want to hear your voices on how we can best achieve our common and profession specific goals.

If volunteering to work to support vital committee work interests you, I invite you to speak with AVLS leadership, and in particular myself as Past-Presdient of the AVLS, Marlin Schul and Mark Meissner our current President and President-Elect, or any of the AVLS Board members. We welcome your opinions and contributions to our efforts.

However, it is important that we ask you to consider making or increasing your financial commitment to the Foundation to support the AVLS mission.

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New Horizon Campaign $6 Million $5.4 M

Member Commitment

Challenge

$1 Million

Goal

Initial Goal $700 K

AVerage 5-Year Cumulative Gift: $9,100/physician member $4,900/allied member

You can make a pledge : In-person at Foundation Row in the foyer OR Online at www.fvld.org/newhorizon

We Are Incredibly Excited for you to join us on the journey toward the New Horizon help us reach our goals!

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Corporate Donors

Thank you

Chairman Executive Founder

Visionary Director Supporter Friend Donor

Individual Donors

donors

James Albert Dean and Debbie Bender Felicite Daftuar Terri Harper Diana Neuhardt Mel Rosenblatt Stephen Davis Scot DubĂŠ Gordon Gibbs Eric Heil James Heinz Joseph Jenkins Chris Pittman AJ Riviezzo Marlin & Susie Schul Tyler Palmer Jeffrey Schoonover Glenn Anderson Michael Di Iorio Steve Elias Lisa Eden Giammaria Brad Moseley Satish Vayuvegula Joseph Zygmunt Cynthia Asbjornsen Joseph Ty Bell Carl Black Yung-Wei Chi Alan Crowther Stephen Daugherty Mark Forrestal Kathleen Gibson Vineet Mishra Kenneth Todd III Robert Worthington-Kirsch Thomas Alosco

Chairman Chairman Chairman Chairman Chairman Chairman Diamond Diamond Diamond Diamond Diamond Diamond Diamond Diamond Diamond Ruby Ruby Emerald Emerald Emerald Emerald Emerald Emerald Emerald Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Gold Silver

John Blebea Anthony Comerota Zoe Deol Sergio Gianesini Michael Graves Evan Harris Neil Khilnani Margaret Mann Daniel Monahan Nick Morrison Saundra Sprueill Dominic Tolitano Thomas Wright Michael Aikens Lisa Amatangelo Linda Antonucci Luis Barajas Michael Cornwell Lance Dillion Aditya Gupta Todd Hansen Mohamed Hasan Fernando Illescas Laura Kelsey Seema Kumar Sanjiv Lakhanpal Duc Le John Marano William Marston Mark Meissner Khanh and Michelle Nguyen Neal Reynolds Anuj and Mehul Shah Lawrence Starin Sean Stewart Steven Zimmet

Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Silver Donor Donor Donor Donor Donor Donor Donor Donor Donor Donor Donor Donor Donor Donor Donor Donor Donor Donor Donor Donor Donor Donor Donor

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204 MD Connect 206 AMERX Health Care 207 Primus Pharmaceuticals 208 CIRK TEK 209 Terason 210 Carolon Company 212 Vein Specialists of America 216 Vein Care iGuide 218 Vein Therapy News 219 AngioDynamics 300 Medtronic 306 medi USA/CircAid 312 Center for Vein Restoration 313 SIGVARIS GROUP 319 Merit Medical 400 America Vein & Lymphatic Society 401 BTG 407 JOBST 412 Tactile Medical 413 Juzo 419 Vein Clinics of America 500 Siemens Healthineers 501 VeinDirectory.org + WebMD+VEIN Magazine 502 AI Care 503 Studycast by Core Sound Imaging 505 ESAOTE NORTH AMERICA 506 Syris Scientific 507 LP Surgical Fibers 508 ZERO GRAVITY 509 Crystal Clear Digital Marketing 511 American Physician Financial Solutions 512 Merz Aesthetics 513 United Medical Instruments 514 LymphaPress 517 NormaTec

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519 American Board of Venous & Lymphatic Medicine 600 Cardiovascular Credentialing Internationa (CCI)l 601 StreamlineMD 602 IAC 603 DIOTECH 604 Incredible Marketing 605 Venous Symposium 606 Lymphatic Education & Research Network 607 TransLite 608 Medical Positioning 609 Capital Health Solutions 610 TheraFirm, a Brand of Knit-Rite 611 Venator Performance Marketing 612 Mobile Vascular Solutions 614 HOGUE SURGICAL 615 Otto Trading 616 HOKANSON 617 Lymphology Association of North America 618 SOUND ERGONOMICS 619 Allure Medical 700 WebToMed 701 Stradis Healthcare 702 Phillips IGT 703 BiosupportMD 704 Society for Vascular Ultrasound 706 Typenex Medical 708 MDocHaus 709 GOBE Interactive 710 Venous News 713 Wagner Medical 714 International Vein Congress 718 Ames Walker 719 ACI Medical

Varithena™ (polidocanol injectable foam), for intravenous use Initial U.S. Approval: 2013 Briief Summary of Prescribing Information. For complete Prescribing Information, consult official package insert.

INDICATIONS AND USAGE VARITHENA (polidocanol injectable foam) is a sclerosing agent 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. (1).

6.1 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.

DOSAGE AND ADMINISTRATION Incompetent great saphenous or accessory saphenous veins: Use Varithena 1% (CEAP Class 2-6 Disease). (2). For intravenous use which should be performed under ultrasound guidance when treating the GSV. Use up to 5 mL per injection and 15 mL per treatment session. (2) Separate treatment sessions by a minimum of 5 days. (2).

A total of 1333 patients with GSVI 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.

DOSAGE FORMS AND STRENGTHS VARITHENA is supplied as polidocanol solution (10 mg/mL) in 18 mL or 7.75 mL; and must be activated before use. (3) Once activated, VARITHENA is a white, injectable foam delivering the polidocanol solution. (3) Each mL of VARITHENA (polidocanol injectable foam) contains 1.3 mg of polidocanol.

CONTRAINDICATIONS • Known allergy to polidocanol (4) • Acute thromboembolic disease (4) WARNINGS AND PRECAUTIONS • Be prepared to treat anaphylaxis. (5.1) • Tissue ischemia and necrosis: do not inject intra-arterially. (5.2) • Venous Thrombosis. (5.3) ADVERSE REACTIONS In clinical trials, the most common related adverse events (occurring in ≥3% of patients treated with VARITHENA) were pain/ discomfort in extremity, infusion site thrombosis (retained coagulum), injection site hematoma or pain, thrombophlebitis superficial, and extravasation. (6.1) To report SUSPECTED ADVERSE REACTIONS, contact Biocompatibles, Inc. at 1-855-971-VEIN (1-855-971-8346) or FDA at 1-800FDA-1088 or www.fda.gov/medwatch.

DRUG INTERACTIONS There are no known drug interactions with VARITHENA. (7) USE IN SPECIFIC POPULATIONS Do not use VARITHENA in pregnant women. (8.1) FULL PRESCRIBING INFORMATION

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 thrombosisa Contusion/injection site hematoma Limb discomfort Tenderness/injection site pain Venous thrombosis limbb Thrombophlebitis 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)

a Retained coagulum. b Common femoral vein thrombus extension (non-occlusive thrombi starting in the superficial vein and extending into the common femoral vein).

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

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%).

Proximal symptomatic venous thrombi occurred in <1% of patients treated with VARITHENA. Approximately half of patients with thrombi received treatment with anticoagulants.

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.

1 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.

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.

2 DOSAGE AND ADMINISTRATION For intravenous use only.

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.

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. Use up to 5 mL per injection and no more than 15 mL per session.

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

Physicians administering VARITHENA must be experienced with venous procedures and be trained in the administration of VARITHENA. Activate VARITHENA using the VARITHENA oxygen canister and polidocanol canister (see Instructions for Use). Once a VARITHENA transfer unit is in place, foam can be generated and transferred to a syringe. Discard the syringe contents if there are any visible bubbles. Administer the injectable foam within 75 seconds of extraction from the canister to maintain injectable foam properties. Use a new sterile syringe after each injection. Use a new VARITHENA transfer unit for each treatment session.

8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Pregnancy Category C. There are no adequate and well-controlled studies of VARITHENA in pregnant women. Do not use VARITHENA during pregnancy.

Animal Studies

Apply compression bandaging and stockings and have the patient walk for at least 10 minutes, while being monitored.

Maintain compression for 2 weeks after treatment.

Developmental reproductive toxicity testing was performed in rats and rabbits using intravenous administration of polidocanol solution. In rabbits, dose levels up to and including 10 mg/kg/day (approximately 12 times the proposed maximum human dose of 15 mL of 1% VARITHENA based on body surface area) did not produce any indication of adverse effects on embryo-fetal mortality, fetal weight, or the incidences of fetal abnormalities and variants. In rats administered 27 mg/kg/ day of polidocanol solution (approximately 13.5 times the human dose based on body surface area), there were no adverse effects on pregnancy performance or fetal development. In a peri-natal and post-natal study in rats, dose levels of polidocanol up to 9 mg/kg/day (approximately 4.5 times the human dose based on body surface area) were without effects on the development of the conceptus and offspring, and at a dose level of 27 mg/kg/day of polidocanol solution (approximately 13.5 times the human dose based on body surface area), effects were confined to an equivocal reduction in body weights of first-generation males, and an associated equivocal delay in the age of preputial separation.

Repeat treatment may be necessary if the size and extent of the veins to be treated require more than 15 mL of VARITHENA. Separate treatment sessions by a minimum of 5 days.

8.2 Labor and Delivery The effects of VARITHENA on labor and delivery in pregnant women are unknown.

3 DOSAGE FORMS AND STRENGTHS

8.3 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.

Local anesthetic may be administered prior to cannula insertion but neither tumescent anesthesia nor patient sedation is required. Cannulate the vein to be treated using ultrasound guidance to confirm venous access.

Inject freshly generated VARITHENA injectable foam slowly (approximately 1 mL/second in the GSV and 0.5 mL/second in accessory veins or varicosities) while monitoring using ultrasound. Confirm venospasm of the treated vein using ultrasound.

When treating the proximal GSV, stop the injection when VARITHENA is 3-5 cm distal to the saphenofemoral junction (SFJ).

VARITHENA is available in the following presentations: • 180 mg/18 mL (10 mg/mL) • 77.5 mg/7.75 mL (10 mg/mL) Once activated, VARITHENA is a white, injectable foam delivering a 1% polidocanol solution. Each mL of VARITHENA injectable foam contains 1.3 mg of polidocanol.

4 CONTRAINDICATIONS The use of VARITHENA is contraindicated in patients with: • 180 mg/18 mL (10 mg/mL) • 77.5 mg/7.75 mL (10 mg/mL) 5 WARNINGS AND PRECAUTIONS 5.1 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.

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

8.5 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.

10 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.

Varithena™ is a registered trademark of Provensis Ltd. All other trademarks are property of their respective owners.

5.2 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.

5.3 Venous Thrombosis VARITHENA can cause venous thrombosis [see Adverse Reactions (6)]. 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.

6 ADVERSE REACTIONS

Boston Scientific Five Tower Bridge, Suite 810300 Barr Harbor Drive West Conshohocken, Pennsylvania 19428 www.bostonscientific.com To order product or for more information contact customer service at 1.855.971.8346. © 2019 Boston Scientific Corporation or its affiliates. All rights reserved.

More veins3, more patients.

Varithena™ can help you treat more.3 Varithena goes where thermal can’t and enhances results where thermal can4 —all while offering a virtually pain-free experience.5 With Category 1 CPT codes and a 30-day shelf life, it doesn’t just deliver results1, it delivers value.

See us at Booth #401 Join us for a presentation at AVLS on:

Making the most of Varithena Thursday, November 7, at 12:15pm JW Marriott Phoenix Desert Ridge in Grand Saguaro East Brian Ferris, MD Vascular Surgeon Lake Washington Vascular, Bellevue, WA

For GSV and beyond, see how Varithena can help you treat more at treatmoreveins.com 1 2 3 4 5

Proven effective in CEAP clinical class C2 to C6 and GSV diameters from 1.5 to 25.4 mm. Varithena US [Prescribing Information]. London, UK: Provensis Ltd, a BTG International group company; Jan 2018.

Images are representative only and are not actual patients. Vein images are artists renderings.

Compared to FDA cleared or approved indications for other varicose vein therapies; CEAP Grade C2-6.

Vasquez M, et al. Phlebology. 2017;32:272-281.

In clinical trials, pain in the extremity was the most common event at 16.8%. Varithena US [Prescribing Information]. London, UK: Provensis Ltd, a BTG International group company; Jan 2018

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

IMPORTANT SAFETY INFORMATION The use of Varithena is contraindicated in patients with known allergy to polidocanol and those with acute thromboembolic disease.

Severe allergic reactions have been reported following administration of liquid polidocanol, including anaphylactic reactions, some of them fatal. Observe patients for at least 10 minutes following injection and be prepared to treat anaphylaxis appropriately. Intra-arterial injection or extravasation of polidocanol can cause severe necrosis, ischemia or gangrene. Patients with underlying arterial disease may be at increased risk for tissue ischemia. If intra-arterial injection of polidocanol occurs, consult a vascular surgeon immediately.

Varithena can cause venous thrombosis. Follow administration instructions closely and monitor for signs of venous thrombosis after treatment. Patients with reduced mobility, history of deep vein thrombosis or pulmonary embolism, or recent (within 3 months) major surgery, prolonged hospitalization, or pregnancy are at increased risk for developing thrombosis. The most common adverse events observed were pain/ discomfort in extremity, retained coagulum, injection site hematoma or pain, common femoral vein thrombus extension, superficial thrombophlebitis, and deep vein thrombosis.

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

For Full Prescribing Information visit Varithena.com Varithena is a registered trademark of Boston Scientific Corporation or its affiliates. Varithena is a registered trademark of Provensis Ltd. All other trademarks are property of their respective owners. © 2019 Boston Scientific Corporation or its affiliates. All rights reserved. US-VAR-1900246

American College of Phlebology Expands Identity with New Name, American Vein & Lymphatic Society AMANDA GODWIN DIRECTOR OF MARKETING & COMMUNICATIONS

T

he members of the American College of Phlebology (ACP) have voted to change their name to the American Vein & Lymphatic Society (AVLS). The name change is a part of the Society’s mission and vision to provide advocacy efforts, research opportunities and superior education to members and the field of venous and lymphatic medicine.

It is important for the identity of the society and its members to address and provide appropriate treatment to lymphatic patients, as well as venous patients. Thus, the leadership of the organization determined a name change was essential for the AVLS’s continued growth as a medical society. In addition, the American College of Phlebology Foundation will become the Foundation for Venous & Lymphatic Disease.

“Our goal with this name change is for our members and the medical world at large to better understand who we serve and how we will serve them,” said Dr. Marlin Schul, President of the AVLS. “We are a society, a place for venous and lymphatic healthcare professionals to gather, exchange ideas, research and learn from each other.”

While the ACP had strong recognition within the field of vein disease, outside of the field the term “phlebology” was less known. As the society worked to increase recognition within the AMA and with public and private payors, the leadership realized a switch in terminology would help our society continue to grow in these arenas.

The board of directors and other leaders spent several months discussing in depth what our name means and what elements in a name are essential. After hours of discussions, member surveys and conversations with our membership, the board of directors unanimously voted to change the name to American Vein & Lymphatic Society. The membership was informed at the 2018 AVLS Annual Congress in Nashville, Tennessee and received the news with a standing ovation. The announcement was followed by a member vote that passed by an overwhelming majority.

“This is a pivotal moment in the identity of our Society,” said Dean J Bender, Executive Director of the AVLS. “We are embracing both venous and lymphatic medicine as well as expanding our influence to include not only education, but also advocacy and research in our field.”

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Do the Right Thing: A Notable Case STEVEN E. ZIMMET, MD PRESIDENT, AMERICAN BOARD OF VENOUS & LYMPHATIC MEDICINE

I

n this, my last public commentary about our field, let me tell you about a case, a legal case. Three and a half years ago, I was contacted by the Department of Justice. A physician was performing a large amount of vein ablations on Medicare patients, and they were concerned about Medicare fraud. I agreed to review a few charts. After finding serious cause for concern, I agreed to review 42 patient files with about 8,000 pages of records and images. Sadly, it was obvious to me that these elderly patients, many of whom had significant medical problems and contraindications, didn’t need these ablations. The physician had billed Medicare about 12 million dollars over a 3-year period. One wonders how much he billed patients with other insurance coverage.

Not only did he perform unnecessary procedures, but he also up-coded using 37241, often charged for doing two procedures on the same vein (GSV) at the same time, and was storing used endovenous ablation devices for re-use.

After an exhaustive review of the records, it was clear the standard of care was horrendous with examples throughout the records including:

• Completely inadequate venous H&P’s • Missing duplex ultrasound physician interpretation reports, or reports by the radiologist dictated as long as five months after treatments had been done • Missing duplex ultrasound images or images that did not show reflux • Consent forms that were signed after the first treatment and/or were for a procedure different than what was actually done • Operative notes that did not match what vein was said to be treated • Treatment done in the face of clear contraindications The number of ablations was astounding with the physician performing an AVERAGE of more than four ablations per patient and recommending almost six ablations per patient. One 80-year-old patient had 10 veins ablated (with complications), and yet a follow-up ultrasound after all that was said on the technologist’s worksheet to demonstrate reflux in another 7 veins! Review of the actual images revealed otherwise.

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It was helpful at trial to be able to point to the recent article in Journal of Vascular Surgery: Venous and Lymphatic Disorders about utilization of venous ablation in the Medicare population, across 10,000 providers and more than 340,000 patients from 2012-2015 revealed the average patient needing ablation required 1.8 ablations1, along with registry and other data.

Given all this, one would expect it to be hard for the defense to find an expert to testify on his behalf. For a long time, they did not have an expert. I was shocked and angry that a few months before going to trial a board-certified vascular surgeon agreed to serve as their expert.

He said he was also an RVT, but a check of his certification status online and by phone call reveals his certification was revoked in 2014, presumably because he did not meet their MOC requirements. He also advertises as an expert witness with his ad listing saying he has given more than 10 depositions or testimonies over the last 4 years. By the way, I’m pretty sure that none of us know this person. He doesn’t attend any of our meetings (AVLS, AVF), though he was briefly a member of the ACP. His first two-and-ahalf-page report was so bad, he was not accepted as an expert

Photo by Wesley Tingey on Unsplash

by the judge. A more extended report followed, which was accepted, and attempted to answer the criticisms I detailed in my report.

My review, report writing, discussions with the DOJ attorneys and FBI, and trial preparation took nearly 300 hours. It was a huge effort. It was a privilege to testify at the trial. I testified for about 10 hours, 4 on direct, 6 on cross. It was meaningful to me that I was able to say I had seen true 37241 for venous malformations performed by Dr. Mel Rosenblatt during my testimony. The defendant was convicted on all counts, has surrendered his license and will be going to jail.

Hereâ&#x20AC;&#x2122;s a link about the casehttps://www.justice.gov/ opa/pr/southern-californiadoctor-found-guilty-12-million-

medicare-fraud-and-deviceadulteration Why am I telling you all this?

First, it was a big experience that I found interesting and wanted to share. Secondly, this was an ABVLM diplomate, which is where I have been living. (Of course, his certification has been revoked.) Much more importantly, while we all know that many in our field are dedicated, caring physicians committed to providing the best care we can, we also know there is significant fraud and abuse going on, and I believe it is going on across primary specialty lines, partly based on review of records in other specialties for matters for the Texas Medical board and for the FBI. In my opinion, any honest physician who had reviewed these records would not have agreed to testify as an expert.

A few thoughts in wrapping up.

Keep in mind that fraud and abuse exist across specialty lines. Do not serve as an expert unless you believe in the case.

As Peter Gloviczki told me, it is always helpful when the facts and truth are on your side. If you see fraud, report it, whether you are a physician, ultrasound technician, nurse, or member of industry. It does not serve us, our field, or society well, and does great harm to patients.

It has been an honor and privilege to be involved in this field we all care so much about. It is incredible how much progress has been made. Now, use these developments and increased interest in venous disease to promote better and standardized training programs for the venous specialist of the future and to provide the best care we can to the patients we serve.

1. A REVIEW OF UNITED STATES ENDOVENOUS ABLATION PRACTICE TRENDS FROM THE MEDICARE DATA UTILIZATION AND PAYMENT DATABASE. CRAWFORD, JM, GASPARIS, A, ET. AL. J VASC SURG VENOUS LYMPHATIC DISORD 2019 JUL;7(4):471-479.

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AMERICAN VEIN & LYMPHATIC SOCIETY

NEW NAME, NEW LOOK.

SAME COMMUNITY.

AVLS

PMS 541 C RGB 0 60 113 CMYK 100 58 9 46 #003C71

PMS 376 C RGB 132 189 0 CMYK 54 0 100 0 #84bd00

PMS 200 C RGB 186 12 47 CMYK 3 100 70 12 #ba0c2f

Join the Future of Venous and Lymphatic Medicine As a member of our organization, you are a part of: ADVOCACY • Committees dedicated to representing venous and lymphatic care to CMS, private carriers and the AMA. • Improving Wisely reports to improve health care quality.

RESEARCH • The largest registry dedicated to vein disease focusing on patient reported outcomes.

• Initiating and funding research proposals to advance venous and lymphatic care.

EDUCATION • An extensive Online Education Center accessible when you need it.

• Multiple live and virtual courses throughout the year in addition to the Annual Congress.

AMERICAN VEIN & LYMPHATIC SOCIETY

AVLS PMS 541 C RGB 0 60 113 CMYK 100 58 9 46 #003C71

PMS 376 C RGB 132 189 0 CMYK 54 0 100 0 #84bd00

Join at www.myavls.org/join

2020 EDUCATIONAL COURSE SCHEDULE PMS 200 C RGB 186 12 47 CMYK 3 100 70 12 #ba0c2f

PHLEBOLOGY REVIEW COURSE February 7-8

Courtyard by Marriott Dallas DFW Airport North/Grapevine

SCLEROTHERAPY COURSE February 8

Sheraton Suites Chicago O’Hare Airport Hotel

ULTRASOUND HANDS-ON COURSE August 14 Crowne Plaza Hotel Providence - Warwick

Courtyard by Marriott Dallas DFW Airport North/Grapevine

RPHS REVIEW COURSE April 17

SCLEROTHERAPY COURSE August 15

Crowne Plaza Hotel Providence - Warwick

Sheraton Suites Chicago O’Hare Airport Hotel

NTNT SYMPOSIUM April 18

LYMPHEDEMA COURSE April 18

PELVIC & DEEP VENOUS DISEASE SYMPOSIUM August 15 Crowne Plaza Hotel Providence - Warwick

Sheraton Suites Chicago O’Hare Airport Hotel

2020 AVLS ANNUAL CONGRESS October 15-18 Washington Hilton

Register at www.myavls.org/2020 Online education is available anywhere, anytime at www.education.phlebology.org

Photo by freddie marriage on Unsplash

Connect with AVLS Online Communities, Coming Soon JENNY TRAN MARKETING COORDINATOR, AVLS

T

he American Vein & Lymphatic Society is proud to introduce our new online communities. To further benefit our members, we have created digital spaces for members to connect, engage, and share knowledge with one another.

Online communities will bring AVLS members together and drive awareness, engagement, and growth in efforts to advance vein and lymphatic care. In collaboration with Higher Logic, members will have the ability to ask questions, participate in discussions, and share resources like never before through our new app. Members will be able to join a wide variety of committees catering to their specific interest and need.

Online communities include: advocacy, research, education, membership, ultrasound, sclerotherapy, and more. These online communities will be moderated by experienced

professionals who will facilitate discussions and provide resources. Connecting with the AVLS online communities is easy and can be done in multiple ways such as through the app, email, and online. This is a great opportunity for members to be involved all while learning and participating from the comfort of their device.

With a growing network of members, online communities will help connect each member across the globe, allowing everyone to grow together. The introduction of our online AVLS communities will further our three-pronged strategy: We ARE â&#x20AC;Ś Advocacy, Research, and Education.

Stay tuned for more information about the AVLS online communities and check for updates at www.myavls.org.

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AVLS: New Name, New Look…

Same Community DEAN J BENDER EXECUTIVE DIRECTOR, AVLS

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ell here we are twelve months down the road from a most successful Annual Congress in Nashville, TN, where we announced the next phase of our strategic vision entitled “New Horizon” by changing our identity from the American College of Phlebology to the American Vein & Lymphatic Society (AVLS).

You might ask why was the change in identity is such an important part of our strategy for the future? What is in a name?

By becoming the AVLS we have accomplished two critical objectives: 1) We have clearly communicated to the world what we are really about. We are a society of like-minded individuals centered around the medical specialty associated with the treatment of venous and lymphatic disease and 2) We have planted a flag in the ground as the only professional medical society for physicians that specialize in the field of Lymphedema, bringing together therapists and doctors under the same umbrella and providing an environment to advance the field for the benefit of our patients.

Furthermore, the change in identity is a clear indication that our purpose as a society has also changed. As you recall in 2017 in Austin, TX, the new strategic vision and purpose for our existence was presented under the banner of the “New Horizon” where we established the three tenets of the Society - Advocacy, Research and Education. You are going to read more about what has been accomplished and what we look to pursue in the future in each of these areas, so I won’t be redundant here. Better to hear what’s what from your fellow members who have

committed their time and talent to advance the mission of the AVLS. In parallel to changing the name of the AVLS, the American College of Phlebology Foundation followed suit and announced in January its new name – the Foundation for Venous & Lymphatic Disease (FVLD). The FVLD is closing out the New Horizon capital campaign on December 31, and with your support is looking to exceed our goals which will enable us to further invest in key initiatives in venous & lymphatic disease.

And so, to keep you up to speed with other changes that have occurred over the past year, please let me share with you a few of the key changes administratively to better serve you as a member or soon to be member of the AVLS As you should all know by now, we are settled into our new offices in the River North community of Chicago. The move to Chicago has allowed us to be more central to our membership and actually enabled us to directly interact with members and potential members quite frequently. This past year we hosted the Executive Leadership Summit held by the Foundation for Venous & Lymphatic Disease, the Clinical Guidelines training session, an Open House for the attendees of the Society for Vascular Ultrasound meeting, the American Board of Venous and Lymphatic Medicine writers meeting along with a variety of other physician groups that utilized our conference facilities.

Please remember to look us up anytime you are in Chicago as we would love to host you for a great cup of coffee or show you around the city of Chicago.

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Using the AVLS App Make the Most of Your On-Site Experience!* Notetaking & Bookmarking Annotate directly on presentation slides and bookmark specific slides to view at a later time.

Personal Summary Notes and bookmarked slides can be viewed, exported as PDFs, or printed at any time.

Create & Share Schedules Attendees can schedule sessions and personal items, then sync with their own calendars!

Social Features Attendees can view and communicate with other app users, speakers, and exhibitors.

*Download before you go! On-Site WiFi service can affect the functionality of the app.

1. Download the AVLS App Search for “AVLS” in the Apple App Store or Google Play Store.

Event Name: AVLS 2019

INSTALL and OPEN the app then SELECT the event: “AVLS 2019” CLICK the icon to launch your app.

2. Login to your event App Select “Create Account” and type the event code below to unlock the app. You will then be prompted for your name and email address.

Event Code: AVLS2019

3. Take notes during a presentation Browse the event information and create a personal schedule by selecting the star next to presentation titles. These favorited presentations can now be found under “My Schedule.” Click the “Take Notes” button in the bottom nav and begin typing.

Access your notes and print them out by clicking the “My Notes” on the home screen or “Online Personal Summary” in the hamburger menu.

No mobile device? No Problem.

As long as you have an internet connection, you can take notes on presentations through your laptop via this link:

https://tinyurl.com/AVLS2019

support@eventscribe.com | 410.638.9239

Need the Schedule?

Need the Schedule?

Get the app!

Download the "AVLS" app from the Apple App Store or Google Play Store.

Get the app!

Download the "AVLS" app from the Appleevent App Store Play Find your app or byGoogle searching Store.

for “AVLS Events” or find the event icon and click to open the app.

Follow the login instructions Find your event app by searching provided by your event registration for “AVLS Events” or find the event to begin using the app.

icon and click to open the app.

Follow the login instructions provided by your event registration As long as you have antointernet connection, begin using the app.you can

access the app through your laptop via this link:

https://tinyurl.com/AVLS2019 As long as you have an internet connection, you can access the app through your laptop via this link:

https://tinyurl.com/AVLS2019

*Download before you go! On-Site WiFi service can affect the functionality of the app.

*Download before you go! On-Site WiFi service can affect the functionality of the app.

support@eventscribe.com | 410.638.9239 support@eventscribe.com | 410.638.9239

International Teamwork at the International Union of Phlebology SERGIO GIANESINI, MD, PHD, FAVLS BOARD OF DIRECTORS, AVLS

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ugust 30th, 2019 at the UIP Meeting in Krakow, Poland, the international venous community voted to support unity as representatives from the Canada, Mexico and the United States came together to make a continental bid for the International Union of Phlebology (UIP) Congress in 2023. An absolute majority of the General Council supported this vision, positively demonstrating the value of international teamwork.

The American Vein & Lymphatic Society (AVLS) reached out to the Canadian Society of Phlebology (CSP), the Academia Mexicana de Flebologia y Linfologia (AMFyL), and the American Venous Forum (AVF) this summer with the idea for the four societies to join together and make a North American, continental bid for the Congress with the goal proposed by Sergio Gianesini, MD, PhD, FACS of “Connecting the Continent, Welcoming the World.”

The meeting will be held at the Miami Beach Convention Center September 17-21, 2023 and is expected to draw over 2,000 medical practitioners that specialize in venous & lymphatic medicine from all across the world.

Miami is a city that is known for its diversity and represents a variety of cultures from around the globe. Miami is a globally connected city close to Central and Latin America and with plenty of direct flights connecting it to rest of the world.

“I must say that it is an honor for me to be a part of this historical World Congress in which geographic and societal boundaries are erased with the hope of together creating a memorable

2023 meeting, where all the world societies can equally provide their contribution,” said Dr. Marlin Schul, president of the AVLS. “When the AVLS proposed a joint bid to the Canadian Society of Phlebology, I didn’t hesitate for a second,” said Dr. Pauline RaymondMartimbeau, vice president of the CSP. “The greatest good is always found in teamwork, never in individualism. Not to mention that the first aim of the UIP constitution is to ‘Strengthen the links between the societies or associations.’”

Although the meeting is still four years away, the leadership of the AVLS has already begun the preliminary planning, securing the various hotels required to support the attendees, outlining the overall scientific and educational program and planning the social events and venues associated with the World’s largest gathering of venous and lymphatic specialists.

“We all know Miami is a wonderful location,” said Dr. Javier Serralde, vice president of the AMFyL. “Indeed, Miami is one of the closest cities to Central/Latin America with one of the most connected international airports of the world, making it an important location for a joint 34

meeting bringing the entire global venous and lymphatic community together.”

The UIP Congress convenes every two years to bring together all of the venous and lymphatic societies from around the globe to share the latest in scientific research and practical techniques for treating venous & lymphatic disease. The AVLS last hosted the UIP World meeting in 2013 in Boston, MA where over 1,580 medical practitioners represented over 70 countries.

“This continental teamwork shows that, in this globalized world, we enjoy and must support scientific, educational and social synergy,” said Dr. Tony Gasparis, vice president of the AVF. “The American Venous Forum is particularly focused on evidence-based data, and I’m delighted that the UIP Congress 2023 demonstrates that teamwork is possible.”

And so, we ask that you mark your calendars for both the next UIP 2021 meeting in Istanbul and UIP 2023 meeting in Miami Beach September 17-21, 2023 to be part of this historic meeting where we will Connect the Continent and Welcome the World! See you in Miami.

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Foundation Hosts the 3rd Executive Leadership Summit NEIL KHILNANI, MD, FAVLS, FSIR CHAIRMAN, FOUNDATION FOR VENOUS & LYMPHATIC DISEASE

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he summer of 2019 saw the convergence of the leaders of the American Vein & Lymphatic Society (AVLS) and the Executive Leadership of the Foundation for Venous & Lymphatic Disease’s (FVLD) corporate partners in Chicago, IL for the 3rd Executive Leadership Summit (ELS).

The ELS is a periodic event sponsored by the FVLD providing an opportunity for those individuals that are personally committed to advancing the field of venous and lymphatic medicine. The ELS is an invitational event limited to qualifying donors of the New Horizon capital campaign. The event this July saw just over 50 people in attendance.

The central purpose of the ELS is to provide a “think tank” type environment where membership and corporate executives can work together to explore ideas and unfiltered thoughts as to the future of the field in venous & lymphatic disease and how the Foundation and the Society might prepare itself to address the future challenges and needs. ELS III focused the attendees on a variety of topics.

Advocacy – We explored how the world of venous & lymphatic medicine is perceived from the eyes of a policy maker. We discussed the current challenges and concerns related to how care is provided today.

Research – The groups focused on developing the key priorities for our research initiatives and investments. During the FVLD Research Summit earlier this year, the participants developed a list of over 70 potential projects to be considered.

Executive Leadership Summit III

ELS attendees formed several small groups and prioritized these recommendations in writing.

Each group then presented a prioritized list to all of the ELS participants and helped provide a clear direction of the projects that should be tackled first in order to achieve the goals and objectives of our community.

Education – The final area of discussion was around the purpose of the AVLS to provide quality education for medical practitioners in venous and lymphatic medicine. We explored a new technology that is beginning to hit the scene for educational use. Virtual reality programming is now capable of providing a “near” live educational and training experience enabling a user to bring a live course into their own office or home. A lively discussion ensued with ideas on how to leverage these new technologies Aside from the formal brainstorming sessions there is always a fair amount of unfiltered discussion and interaction on a variety of issues and challenges we all face in our daily course of business.

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Of course, I do not want you to think it was all work and no play. We were able to socialize as a group and use this opportunity to build new relationships and deepen existing ones.

The ELS is not an annual event, but the FVLD has found it to be a great opportunity for those committed to the field to share their opinions. The ELS is an invitation only event limited to qualifying donors of the New Horizon capital campaign.

Executive Leadership Summit III

If you are not currently a donor to the New Horizon capital campaign of the Foundation let me encourage you to consider doing so over the next days. We are close to our goal of raising $6 million but still have a $300,000 more to raise.

Your investment is used to make a difference in the field, in our practices and most importantly in the lives of our patients.

Executive Leadership Summit III

Join the over 850 physicians who have already invested in their vein specialty certification

Why Become Certified in Venous & Lymphatic Medicine?

The benefits of ABVLM certification advance your career by helping you to: ELEVATE PROMOTE DEMONSTR ATE FULFILL SUPPORT

• Elevates core knowledge in venous and lymphatic medicine (VLM) • Promotes professional standards in VLM • Demonstrates commitment to quality care of the VLM patient • Ongoing, real-time, continuing education with an online MOC module • Listed on the ABVLM “Find a Physician” website* • Highlighted on the AVLS “Find a Provider” webpage as a Diplomate of the ABVLM* • Fulfills a key AVLS requirement to obtain AVLS Fellow Status • Supports venous credentialing in hospital or practice settings • Demonstrates physician commitment to the field, which is critical to specialty recognition *A single new patient will likely cover the cost of certification

2020 ABVLM Exam Schedule Annual Application Period October 1, 2019 to January 15, 2020 Exam Administration at PearsonVUE March 28, 2020 through April 11, 2020 Eligibility criteria for U.S. and Canadian physicians, and online application info, are at www.ABVLM.org. Passing the exam earns a 10-year certification.

877-699-4114 info@ABVLM.org www.ABVLM.org

Patients trust certified education and experience

Benefits of Certification SHERRY SCOVELL, MD MY AVLS PHYSICIAN EDITOR

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he need for medical certification has been a concept that has been around since the mid-1700s when the “first Medical Society in the thirteen United States of America” was introduced and vowed to examine “every Candidate for Practice, either Apprentice or any Physician or Surgeon within this Country or Foreigner, coming into this Country.”1 The more modern advent of board certification began in Boston, Massachusetts at a meeting of the American Medical Association in 1865. Concerns were raised regarding the concept of specialism when it was noted that some physicians were advertising that they possessed special expertise in various areas of medicine without any additional formal training or scientific proof of an extended knowledge base. The topic was debated widely over the course of the next four years, until the AMA formally recognized specialties as “proper and legitimate forms of practice” in 1869. However, they also resolved that it was not acceptable for specialists to publicly advertise themselves as such without a proper title granted from an academic institution after a specified period of study.1,2 In the early 20th century, there became a call for a thirdparty verification of special clinical skills, which led to the formation of formal medical boards.1 Since 1933, the American Board of Medical Specialties developed a national system of standards for recognizing physicians for having expertise in a specific specialty and providing that information to the public for their education. This served the dual purpose of demonstrating excellence in a given specialty for the physician, but also allowed the public to become more educated about the skills of the physicians by whom they chose to provide their care. Certification allows the patients to know

that their physicians are staying current in their knowledge and skills via continuous learning and assessment throughout their careers.

The field of Venous and Lymphatic Medicine is a relatively new sub-specialty, and until recently, there was not a specific fellowship program in the United States devoted to this field. Historically, training in venous disease has been sparse and not particularly emphasized.

Even in current times and across all primary disciplines, training still remains disparate and not well standardized with respect to venous and lymphatic curriculum. The route through which physicians learn about the physiology, pathophysiology, diagnosis, and treatment of these diseases may vary widely depending upon the time and emphasis given to these topics during training.

ABVLM CERTIFICATION3 In 2007, the American Board of Venous & Lymphatic Medicine (ABVLM) was established with the goal to “improve the standards of medical practitioners and the quality of patient care related to the treatment of venous disorders.” Subsequently, the ABVLM developed and published a Core Content document as well as Program requirements, to serve as the foundation on which to build one-year VLM fellowships. The ABVLM certification was also developed to standardize the depth and breadth of knowledge that is necessary to provide high-level care to patients. This certification communicates an extended base of knowledge in venous and lymphatic disease to other physicians that are looking for a referral base.

It also communicates to patients, many of who are informed and educated consumers, that a CONTINUED ON P. 40

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BENEFITS OF CERTIFICATION CONTINUED FROM P. 39

physician has proven their commitment to and has extensive expertise in the field of venous and lymphatic medicine.

Candidates may apply online to sit for the board examination. All candidates must hold a current medical license and proof of completion of an accredited residency. The requirements vary slightly depending upon whether the physician is recently out of training or more experienced, but all require written references, a clinical case log consisting of superficial and/ or deep venous pathology, documentation of ultrasound training and experience via an ultrasound case log, and 45 CME over the past three-year period (40 related to the field of venous and lymphatic medicine). Once an application has been approved, the examination is scheduled at one of the Pearson VUE Test Centers and is a comprehensive, computerbased examination. When the examination has been passed, the candidate becomes a Diplomate of the American Board of Venous & Lymphatic Medicine, and the certification is valid for a period of ten years, assuming the Diplomate continues to meet MOC and licensing requirements.

There are multiple resources that are available to candidates prior to the examination, which are found on the ABVLM website. A general examination outline delineates the content areas and percentage of questions in each given topic. This outline can be helpful in guiding candidates during preparation. There is a complimentary practice exam online as well as recommendations for live and online review courses, including the AVLS Phlebology Review Course, and a list of key references that are available to assist in preparation. Preparation for the examination will naturally lead to a review of core material and thus be educational.

The benefits of ABVLM certification are many. To other physicians and patients, certification through the American Board of Venous & Lymphatic Medicine demonstrates

a commitment to providing the highest level of quality care to patients with venous and lymphatic disorders as well as a documented level of expertise and core knowledge in this specialty. John Landi, MD, a vascular surgeon from Florida and Diplomate of the ABVLM, was among the first to take the certifying examination. He cited credibility and the desire to fully dedicate himself to the treatment of venous and lymphatic disease for his patients as two of the most important reasons for his desire to become a Diplomate. Cynthia Asbjornsen, DO, a family medicine physician from Maine and Diplomate of the ABVLM, agrees and adds that most patients appreciate knowing that their physician is totally committed to the field of venous and lymphatic medicine and that the optimal way to illustrate this is through board certification. Additionally for Diplomates, the required on going continuing educational Online Learning & Assessment platform (OLA) is a powerful, user-friendly tool to keep up to date and identify areas that deserve further study.

This program replaces the requirement for an every 10-year recertification exam.

Additionally, Diplomates of the ABVLM have the option of having their practice listed in the ABVLM “Find a Certified Phlebologist” database as well as being highlighted as a Diplomate of the ABVLM on the American Vein & Lymphatic Society “Find a Provider” website. These databases are available to the public for free and may be customized to include a listing of the contact information for each practice as well as a link to the individual physician website for ease of use. Brochures are also available for display in the physician office to educate patients and patient families about the significance of certification. A complete list of benefits of certification in venous and lymphatic medicine is documented in the adjacent flyer.

RPHS CERTIFICATION4 Similarly, there are certification options available for the other essential members of the venous and lymphatic team. For physicians, physicians 40

Photo by Ani Kolleshi on Unsplash

assistants, nurse practitioners, and venous vascular ultrasound technologists, there is the Registered Phlebology Sonographer (RPhS) certification by Cardiovascular Credentialing International (CCI), which was developed in 2009. This is a unique credential developed specifically for medical professionals who provide care to patients with venous disease.

The RPhS exam, which is entirely focused on venous disease, is distinctly different from the RVT and RVS certification examinations, in which venous disease consists of less than 25% of the exam content. It is a computerbased examination that tests knowledge in clinical venous disease as well as knowledge of ultrasound. The majority of the examination includes questions that focus on patient diagnosis, performance of diagnostic testing, and minimally invasive and invasive treatment of patients with a smaller percentage of the examination focusing on maintaining information, facility, safety, and conservative treatment/therapy of patients. Diana Neuhardt, RPhS, RVT, FSVU, who serves as the Phlebology Registry Examination Chair for CCI, suggests that Fundamentals of Phlebology: Venous Disease for Physicians is a wonderful resource for exam preparation. She also recommends the RPhS review course offered through the AVLS for a more intensive review.

The RPhS credential is active for 9-12 months after passing the examination. After the first renewal, maintenance of active status requires submission of triennial renewal fees, signature of the Code of Ethics, and completion of 35 Continuing Education Units (CEU, with at least 30 cardiovascular CEUs) every three years.

The RPhS credential signifies dedication and expertise in the field of venous disease. Linda Antonucci, RPhS, RVT, RDCS, highlights the fact that sharing a venous-related credential between sonographers, physicians, physician assistants, and nurse practitioners translates to a higher level of dialogue regarding patient care and a unified sense of accomplishment which makes the team function in a more collaborative manner. She suggests that many venous-based practices often prefer to hire an ultrasonographer who is RPhS credentialed.

Paula Heggerick, RPhS, RVT, FSVU also adds that having the RPhS credential demonstrates a dedication to the field of Phlebology and serves to identify medical professionals that are dedicated to the diagnosis and treatment of venous disease. The RPhS credential is also being increasingly recognized by Medicare and third-party payors in some parts of the country and may play in role in reimbursement in the future, predicts Ms. Neuhardt.

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CLT-LANA CERTIFICATION5 CLT-LANA certification originally came out of a desire to create national standards for lymph therapists. The Lymphatic Association of North America (LANA) was founded in 1999.

It was created as a result of the 1998 American Cancer Society Lymphedema Workshop recommendation for certification guidelines to assure standardization in lymphedema treatments. As a result, the multidisciplinary Board of Directors identified a need for and created a national certification examination for lymphedema therapists. This certification examination focuses on fundamental knowledge that is required in the management of lymphedema. LANA is currently celebrating its 20th anniversary.

To be eligible to sit for the LANA examination, proof of the successful completion of a qualified instructional course in Complete Decongestive Therapy (CDT) is required. This requirement includes a minimum of 135 classroom hours, one third of which is from theoretic instruction (including anatomy and physiology), and twothirds from laboratory, hands-on-training (such as bandaging, skin care, etc.). There are multiple specialists that may apply for CLT-LANA certification, including occupational therapists, physical therapists, physicians, registered nurses, and certified athletic trainers. In addition, massage therapists who have additional training in soft tissue massage are also eligible.

Recertification occurs every 6 years.

Katina Kirby, MS/OTRL, CLT-LANA, Executive Director of LANA, notes that there are numerous benefits to becoming certified, and applicants

have doubled this year. She also cites the ability to promote oneself, as an expert in the field of lymphedema is one of the most prominent benefits to CLT-LANA certification. Robyn Bjork, MPT, CWS. CLWT, CLT-LANA, who is the Founder and President of the International Lymphedema & Wound Training Institute, adds that those with the credential have a consistent level of training and knowledge and demonstrate commitment to delivering the best level of care possible for all individuals with lymphedema.

Additional benefits include networking with others who have the certification and regional liaisons, which serve as a guide to resources.

There is a downloadable brochure on the LANA website to display in your office and to educate patients about CLT-LANA certification and what it exactly means. The therapists may also be listed on the LANA website. Therapists are able to upload their biography and a link to their website, which is a wonderful marketing tool.

Additionally, in at least one state, there has been a mandate that lymphedema therapists must be CLT-LANA certified (or CLT-LANA eligible for a period of 3 years) for reimbursement through Medicaid/Medicare. As a bonus, if you are thinking about taking the examination to become CLT-LANA certified, there is special pricing through December 31, 2019 to celebrate the 20th anniversary of LANA! A special thank you to those who contributed to this article via discussion regarding the significance of certification, including John Landi, MD, Cindy Asbjornsen, DO, Diana Neuhardt, RPhS, RVT, FSVU, Linda Antonucci, RPhS, RVT, RDCS, Paula Heggerick, RPhS, RVT, FSVU, Katina Kirby, MS/OTRL, CLT-LANA, and Robyn Bjork, MPT, CWS, CLWT, CLT-LANA.

REFERENCES 1.

BARON RJ. PROFESSIONAL SELF-REGULATION IN A CHANGING WORLD: OLD PROBLEMS NEED NEW APPROACHES. JAMA 2015;313(18):1807-1808.

2. FITZ R. THE RISE OF THE PRACTICE OF INTERNAL MEDICINE AS A SPECIALTY. N ENGL J MED 1950;242(15):569-574.

3. HTTPS://WWW.ABVLM.ORG 4. HTTP://WWW.CCI-ONLINE.ORG/CCI/CERTIFICATIONS/RPHS.ASPX 5. HTTPS://WWW.CLT-LANA.ORG/LANA-CERTIFICATION-EXAMINATION.HTML

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Remembering Mel Rosenblatt, MD MARLIN SCHUL, MD, MBA, RVT, FAVLS PRESIDENT, AVLS

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t is with heavy hearts that we gather this year, missing our dear friend Mel Rosenblatt MD, FAVLS who passed away at the age of 60 following an 18-month battle with hepatic cancer. Mel was a giant in the field of venous and lymphatic disorders. He was humble, dedicated to faith and family, and an important visionary in the AVLS. Mel understood the importance of data collection in shaping care and establishing benchmarks. He created what has become the largest dialysis access registry and followed through on his knowledge in this space to support the ACP PRO 1.0 Venous Registry transition to AVLS PRO 2.0.

Dr. Rosenblatt was boarded in Interventional Radiology and dedicated much of his career to the practice of venous and lymphatic medicine. Mel has been an active and integral part of the American Vein & Lymphatic Society for the past two decades. Mel joined the Society in August of 2002, served on numerous committees and eventually rose to the Board of Directors in 2008. In 2009, Mel was accepted as a Fellow Member of the AVLS. Mel’s service and dedication to the Society led to his election as President in 2013-2014. Following his Presidency, Mel became the Chairman of the Foundation for Venous & Lymphatic Disease in 2015-2016 and has since served on the Board of Directors of the Foundation. In 2017, Mel represented our society in Wave 2 of MACRA cost measure development, helping to build further societal awareness. In 2018, Mel was granted the position of Honorary Member of the American Vein & Lymphatic Society.

Earlier this summer he took a role in reviewing the query engine platform of the AVLS PRO 2.0 registry and affirmed it has the tools to effectively address our needs. Most recently, Mel served as the Honorary Chairman of the New Horizon Capital Initiative leading the charge to develop funding to support the growing and expanding mission and vision of the AVLS. Mel lead our Society by example through giving his time to serve, selflessly volunteering his expertise and talents, and financially committing to the mission. He continually strove to see more members involved in the society and nurtured them to collectively achieve the goals and objectives that would advance the field for the benefit of our patients.

The AVLS and FVLD will be planting a tree in memory of Mel in Israel. The family has asked that any contributions in his memory be made to the Foundation for Venous & Lymphatic Disease.

As we all mourn the passing of a great human being, colleague, husband, and father, we should do so knowing we are all better off for having known and worked alongside Mel for these many years.

Consider how you may best honor Mel’s memory by making a difference and simply “doing one more thing” for the Society and the Foundation.

In these next pages, remember Mel as you read stories shared by colleagues and friends that reflect on all he accomplished and the great man that he was.

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CATHERINE BURDGE, APRN: I am the luckiest person.

I had the honor and privilege of working with Mel Rosenblatt as his nurse practitioner for 26 years. When I look for a physician to work with, I look for three qualities: • A physician who is an expert at what he or she does • A physician who loves his or her patients • And a physician who is just a nice person Mel possessed all three qualities.

Mel was a great physician. It was his very being. I first met Mel in 1993 when I was hired as the nurse practitioner for the section of Interventional Radiology at Yale - Mel’s practice group. I got to see firsthand his passion for patient care. He and his partners revolutionized the specialty of Interventional Radiology at Yale.

They took procedures performed by surgeons out of the operating room and moved them to the interventional radiology suite where Mel and his partners would perform these procedures with more minimally invasive techniques.

This reduced risk to the patient and allowed treatment in a more-timely fashion, many times the same day as the request for care.

This was a whole new concept in medicine. They changed the paradigm of care for the dialysis patient, the oncology patient, patients with vascular issues, and other patient populations.

Mel and his partners were always available to care for their patients. They never said “no”.

Weekends, nights - always available for their patients in need.

Let me tell you just a few of the other ways Mel influenced modern day medicine:

One procedure Mel performed was chest catheter placement. Patients receive treatments, such as chemotherapy, dialysis, and antibiotics, through implanted catheters. Mel changed the approach of catheter placement - through the internal jugular vein instead of the subclavian vein - a safer and more effective approach for the patient. Mel published this new approach in the medical literature and changed medical practice. The internal jugular vein approach for chest catheter placement is the medical model for this procedure.

Mel was an inventor, always thinking about how he could make treatment better for the patient.

He invented a type of chest port, the Rosenblatt SlimPort. He named the port in honor of his father. This port, which received a patent in 1998, was created out of a need that he saw for his patients at Yale. Its small size, slim shape, and its dual lumen allows oncology patients to receive their care in a more comfortable and efficient way. It continues to be used around the world.

In 2003, Mel decided that he wanted to open his own practice to care for his patients. At that time, it was unheard of for an interventional radiologist to have a stand-alone practice - we were 1 of only 3 other interventional radiologists in the country who did this. While it was very difficult to succeed at this, Mel made it work. In fact, he made it work so well that his practice continues today at an extraordinary level of success, thanks to his dedication, expertise, the loyalty of referring clinicians and patients and the expert physician partners and devoted staff who he worked with every day.

Mel lectured on all of his accomplishments at our national specialty meetings. He headed up national workshops and committees. He was not only inspired to care for his patients, but to teach others how to care for patients in new and innovative ways. He did this every day in the 44

clinical setting, as well. He was an outstanding teacher to his medical students, residents, fellows, and other clinicians. He had a love of learning and a love of teaching. Residents would apply to the Yale fellowship program specifically because they wanted to learn from Mel. To the very end, Mel was teaching his staff every day how to give the best care to our patients. His legacy will live on for our patients every day in our center.

the best care possible. So often they would call him Mel or Dr. Mel. He was so down to earth with them and they always felt so comfortable with him. They also called him “superstar,” “my hero,” “the best doctor ever.” “He cares about me,” “I won’t go anywhere else.” “I will travel far just have Dr. Mel take care of me.” Patients actually looked forward to coming to our center to see Dr. Mel and to receive his care. He was always there for them.

Mel was a pioneer in the specialty of venous disease and was internationally known for his innovative techniques and unique approaches to a variety of venous syndromes. In 1999, he was the first in CT to perform a new minimally invasive procedure that changed the course of varicose vein treatment, and he was one of the researchers who got the device for the procedure FDA approved. This “first” is acknowledged on the timeline of “firsts” displayed at the entrance to Yale New Haven Hospital.

Mel combined his outstanding medical knowledge and creative instinct to give the most beautiful care to his patients. He would dare to perform procedures that other physicians wouldn’t even imagine, always taking into account patient and staff safety. He had a unique perspective on how the human body works, and his patients always benefited from this.

Mel continued to advance the art and science of venous disease treatment. He was President of the American College of Phlebology (now the AVLS), Chairman of its Foundation, and served repeatedly on the board of directors for both, as well as its numerous committees.

His colleagues were always seeking his advice.

“What would Mel do?” was the mantra. He was working on a new classification system of pelvic venous disease at the time of his passing. He is internationally known and was in demand to lecture at many medical conferences around the world.

The second quality - Love for his patients Mel loved his patients and they loved him. They came from near and far and from around the world for his care, returning regularly if needed, for they knew that they would always receive

Mel would do anything to help his patients - he was on call 24/7. He would make house calls. He worked weekends. He would work each day until every patient who needed his help was cared for.

That many times meant working late hours. But he got it all done with devotion to his patients.

He always said, “Do what is right for the patient, no matter what it takes.” Mel said only 2 weeks ago, “I have tried to create a practice based on one primary goal, that was quality. I only wanted to deliver the best possible care to my patients and I only endeavored to do that.”

Mel raised the bar for his staff when it came to patient care, and we always strove to meet it. He demanded a lot from us when providing patient care and he made us all better clinicians. He never asked more from us than he demanded from himself. It was expected that the patients would receive the best care possible. Mel cared for his patients until just 3 weeks before he passed away. He was amazing - dedicating CONTINUED ON P. 46

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What more could you ask for in a leader, boss, colleague and friend?

CATHERINE BURDGE CONTINUED FROM P. 45

himself so beautifully to his patients while fighting his own battle.

The third quality to look for in a great doctor is for that person to be just plain nice. And Mel sure was that. He cared about all of his staff.

When we had a problem, he wanted to help. If we had a medical issue or if a family member or a friend had a medical issue, he was always there to offer advice, review radiology films, and speak with clinicians for us.

Mel had a lot of fun in him, too. His sense of humor would get us through busy days at work.

And he was always the life of the party outside of work, whether it was a staff get together or a get together with his international friends while at a medical society gathering.

On a personal note, Mel was my dearest friend.

He was always there for my family and for me.

His children and my children grew up together, and we will always be family to each other.

Mel was kind, considerate, generous, and always thoughtful. And he was a man of his word.

STEPHEN DAUGHERTY, MD, FACS, FAVLS, RVT, RPHS: I first became aware of Mel Rosenblatt as a talented teacher and lecturer about pelvic venous insufficiency. Much of what I learned about pelvic venous insufficiency outside the interventional suite I learned from Mel’s talks and from his thoughtful answers to questions.

Although Mel’s most visible role to most attendees at the Annual Congresses of the American Vein & Lymphatic Society was his teaching, Mel distinguished himself as a leader

As much as medicine and his career meant to him, there were other things in Mel’s life that he coveted. He was devoted to his religion and to his community. He always wanted to be there for his friends. And his family meant everything to him – his dear mother and father, his sisters, nephews, Sarah’s family, his cousin, and all of his in-laws – and Danielle, Jon, Matthew, Ahuva, and Daniel, and as Mel called her, “adorable Kira.” And most of all, Sarah, his soul mate and true love. She was by his side throughout his life, supporting him, and never left his side during his illness.

I could go on about Mel’s accomplishments, but please know that he touched ever so many people around the world, both personally and professionally and will continue to do so.

And so, as much as I call myself lucky, we all are lucky to have known Mel as colleague, mentor, friend, and family. May we all carry on his legacy - his love for humanity and his devotion to caring for each other in the best way possible.

among leaders. Leadership in any organization is all about analyzing present and future needs and challenges. It requires vision to anticipate the challenges and opportunities and to formulate solutions. Leading is hard work requiring human skills, financial skills, and business acumen. Mel was an accomplished leader of the American Vein & Lymphatic Society and our Foundation with uncommon skills supported by hard work and dedication to purpose. He will be sorely missed. We can look to Mel for his example in leadership as we continue his work.

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STEVEN ELIAS, MD, FACS, FAVLS: Three Letters, One Word It couldn’t be more simple; 3 letters, 1 word: Mel. And that is Mel. Simple, Uncomplicated, Straightforward. It is fitting for a person such as Mel to have been given a short, unambiguous name. In the vein world there a few people who exist by a single moniker. Mel is one of those people. I am sure there are other “Mels” in the vein world but when Mel is mentioned, it only conjures up the visual of Mel Rosenblatt.

Many remember and will highlight Mel’s contributions to the care of patients with vein disease. And there are many contributions to list. I’ll leave that task to others. What I want

MARK FORRESTAL, MD, FAVLS & DEBBIE FOLEY, MD: Mel walked into his first AVLS meeting and brought with him the depth and breadth of his clinical background and his academic expertise.

He generously shared it with us gracefully and modestly, raising the AVLS’s reputation and credibility at every turn.

Mel embraced the investigation and treatment of uncommon but highly morbid venous malformations, giving hope and alleviating suffering for previously neglected patients.

to highlight is the process, the journey, the approach. The man thinks. He thinks in the abstract and the concrete. Over the years I have observed his thought process. One needs to pay attention to any talk Mel gives at any meeting. It starts out relatively simple and straightforward. Then it morphs into the semi-stream of consciousness realm. In the middle of the talk you are both confused and mesmerized. The conclusions sneak up on you.

But when one of his talks ends you have been enlightened. I so enjoy listening. I don’t think he has actually constructed his talk in this manner. I think it is merely Mel being Mel, the unassuming intellectual passing his thoughts on to us. It couldn’t be more simple; 3 letters, 1 word: Mel. I thank you Mel for being Mel.

To paraphrase the artist Banksy: “...they say you die twice. Once when you stop breathing and a second time when somebody says your name for the last time.”

I know that the name Mel Rosenblatt will be said at every gathering of the AVLS as long as the organization exists. The name will be quoted in the venous and lymphatic literature as long as caring physicians seek answers for challenging patients. And it will be said in our home whenever the topic is excellence.

Our sincerest condolences to Mel’s family.

Mel raised expectations for all members of the AVLS. His attention to the finest details was both inspiring and daunting, but he never asked anything of us that he did not demand of himself.

Mel’s unconditional support of me personally is a high point of my professional life; his loss is both painful and unfathomable.

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HELANE FRONEK, MD, FACP, FAVLS: In prior years, physicians were respected for their commitment to ethical behavior, integrity, collegiality, the continual pursuit of knowledge, and, above all, a dedication to doing the right thing for patients. Few people exemplified these traits more than Mel Rosenblatt. Mel accomplished many things and was respected by all of us for his intelligence, work ethic, kindness, love for his family and faith, and his desire to contribute to the people and institutions he believed in. All one had to do was ask, and Mel would find a way to say yes.

I recall when a speaker wasn’t able to attend a meeting. Mel quietly took out a keychain full of flash drives containing innumerable power points he had created and filled in for the absent speaker in his typical humble way. There was a limitless expansiveness to Mel - adding another task to his plate was something he always seemed able to do. He did this graciously, without calling attention to the extra work or

expecting additional acknowledgment. His recent note to the membership of the AVLS reflected the way Mel lived his life: if he believed in something, he worked hard to support it. Even with so little time left in his all too short life, he asked members to join with him in supporting a cause that was dear to him. His words were poignant. “Time is fleeting, your legacy is all you have – what will people say about you when you’re gone?” We will miss Mel – the person, the doctor, the colleague, the advocate – and we are sad that we didn’t have him in our lives and our profession for as long as we would have liked.

His legacy, though, is well established. He will live on in his example of an ethical, purposeful, and humble life well lived; in the many kind, humorous and insightful interactions he had with so many of us; in the patients whose lives he touched and changed in such positive ways; in the medical advances he spearheaded; and in his family who he loved so much. Our organization, profession, and all of our lives are richer because of Mel.

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NEIL KHILNANI, MD, FAVLS, FSIR: I am profoundly sad that my colleague and good friend is leaving us much too soon. I have known Mel for 18 years; it was too short, and I will miss him a great deal.

The Mel I know possessed an amalgamation of glorious traits, any one of which would have distinguished someone as unforgettable. A devoted husband, father, son and member of his personal and professional communities, Mel was loved by most everyone who knew him. He was a master clinician, with a wonderful bedside manner and the ability to see beyond the obvious, often considering nuances that others only recognized years later. He was an insightful human who, like the best strategists and statesman, recognized the personal strengths of his colleagues and the downstream implications of decisions well before the rest of us. He was extremely clear thinking, able to synthesize multiple viewpoints and facts and facilitating creative and solutions to problems that seemed

insurmountable. Mel was a leader by example, choosing to do things he believed in and hoping others would appreciate the benefits of doing similar things themselves.

To those of us who spent time with him at the AVLS, he was a caring and thoughtful friend, who was always there when you needed him, eager to help and quick to bestow praise on others even when he deserved it more. He was also adept at helping others to succeed with sage advice, candor and unquestioning support.

To Sarah, please accept my heartfelt condolences for you and your familyâ&#x20AC;&#x2122;s incredible loss. I cannot fathom the sadness you must feel.

I consider myself extremely lucky to have had you and Mel in my life.

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MARK MEISSNER, MD:

Mel respectfully acknowledges other view points before you become convinced of the value of his insight.

“Rosenblatt’s Rules” for Life I initially met Mel when we shared the podium discussing pelvic veins at the AVLS in 2008.

He subsequently became not only my friend, but also my mentor in understanding the intricacies of pelvic venous disorders. Small but important insights, such as the value of direct puncture venography in understanding pelvic escape points have led to further advances in understanding and treating these disorders.

Mel and I spent many hours together and despite learning most of what I know about pelvic veins from him, what Mel has taught me about life is perhaps more important. I have affectionately deemed Mel’s observation that you can frequently reflux contrast / sclerosant to the level of the broad ligament from a perineal puncture as “Rosenblatt’s rule.” With some editorial license, below is my personal impression of the way Mel lived and “Rosenblatt’s Rules for Life”,

3. Whatever you believe in, commit to it with all of your heart. Mel is a man of very deep faith, which, to my observation, he unwaveringly lives every minute of every day - no compromises. While we may not all share the same beliefs, we can all learn from Mel’s example. Have faith in what you believe and live every moment according.

I am truly fortunate to have known Mel and for him to have cared about me personally and we all continue to benefit from his leadership of the AVLS. I know that I am a better person for having Mel as a friend and we are a better organization. Godspeed my friend.

1. Progress is made by sharing your insights and encouraging others to build upon them.

Although the original great idea may have been yours, encourage and support others in building on it and making it better. Allow others to take the credit. Not always an easy thing to do, but clearly responsible both for a number of clinical advances as well the progress made in the AVLS under Mel’s leadership. The idea is what is important, not the fact that you thought of it. To me, this is leadership at its best.

2. Keep an open mind, be kind, respect others, and everyone wins. Mel and I have debated and disagreed on several issues over time – we frequently both move towards the middle and the outcome is far better than the views we started with. This only happens because 50

NICK MORRISON, MD, FACS, FAVLS, RPHS & TERRI MORRISON, RN, BS To Mel, Sarah, their children and families:

and one particularly memorable road trip with Mel, he taught me a great deal about Jewish history and religion. I looked forward to a trip with Mel and his family to the Middle East, but alas that will now not happen.

Although Mel is far too humble to willingly accept the description of himself as “mentor,” I believe this term derived from Greek mythology is the essence of Mel’s character – “a wise and trusted counselor or teacher.” All of us in the field of phlebology who know Mel as an esteemed colleague would agree that it has been hugely beneficial to have Mel among us.

His innovative nature is best exemplified by his description of the diagnosis and treatment of pelvic vein insufficiency - practitioners and thousands of patients have and will greatly benefit from his leadership in this area.

Some of us have been lucky enough to come to know Mel as a trusted friend. His intellectual honesty is absolute, and while his scientific rigor is high, he is always ready to question dogma as well as his own opinions, listen to alternative theories, and adopt a compromise position where it is needed.

During long conversations at medical gatherings

So, to Mel and Sarah I say thank you for being in our lives…it has been an enormous privilege.

MARLIN SCHUL, MD, MBA, RVT, FAVLS

has become the largest dialysis access registry and followed through on his knowledge in this space to support the ACP PRO 1.0 Venous Registry transition to AVLS PRO 2.0. I look back quite fondly on times with Mel and laugh at the fun stories we created just sharing time with family. Mel will be deeply missed yet left a lasting legacy we should all embrace.

Mel was a giant in the field of venous and lymphatic disorders. He was humble, dedicated to faith and family, and an important visionary in the history of AVLS. Mel understood the importance of data collection in shaping care and establishing benchmarks. He created what

Perhaps most importantly, Mel’s humanity is his biggest attribute. He has cared for patients, colleagues, and friends in a manner we all wish we could emulate. Few people have done it any better.

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DIANA NEUHARDT, RPHS, RVT, FSVU It was truly an honor to be friends with Mel Rosenblatt. I met Mel way back when, not even sure when, and we instantly connected with our numerous shared interests. Some of my beloved memories include the walks we took together with the group at meetings after sundown on Friday nights. Mel was generous, kind, and extremely creative, and one of his hobbies included working with wood. One day Mel, his wife Sarah, another friend Karen, and I were hiking while in Sedona. It was a beautiful day, sunny and the weather was priceless. As we were walking along, we all were all chatting except for Mel, who was distractedly looking at “wood pieces.” He would say, “Diana, can you mail me that wood?” (I would do it, and months later I received an incredible wood carved pen in the mail.) As we were finishing our hike, we wanted a photo of the four of us to memorialize the day, a “selfie.” Now of all the talents Mel had, selfie photography was not his strength. It was about the only thing I can think of that he wasn’t highly skilled or perfect at doing. The selfie involved more than a few minutes, many tries, extensive shaming, and much laughter. I am so grateful I kept every unfocused shot. (I’m sharing the infamous selfie that made the cut with this tribute.) Anytime I need a laugh, or to share Mel’s presence, I simply scroll to my pictures and there we are – well, most of us, anyway! My dear Mel, thank you for all the priceless memories.

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KENNETH L (TRIP) TODD III, MD, FAVLS If God ever made a true “gentleman physician,” it was Mel Rosenblatt. Mel was the guy who did the right thing regardless. No matter the sacrifice to himself or his time, Mel was going to stand for not just what was right for our society (AVLS), but society as a whole.

I first got to know Mel, and Sarah as well, when I asked him to sit on the program committee for the annual AVLS meeting in Naples.

meeting in New Orleans during Mardis Gras, I bought lunch for Mel on Saturday. Over the twohour, lunch I did my best to explain how Mardis Gras has changed from a religious to a mostly secular event. I was not very successful. As we walked back to the hotel a typical Mardis Gras Parade passed by.

Mel, with that same wry smile said, “is this the religious or the secular part?” Mel was a fantastic physician, wonderful husband, father and unparalleled friend. He leaves a void that will never truly be filled.

His ability to steer the rest of the committee in the appropriate direction with an eyeroll and a wry smile became an ongoing point of great humor for the whole committee. Later, at a

STEVEN ZIMMET, MD, RPVI, RVT, FAVLS I don’t remember the exact year I met Mel, but it was at an AVLS Annual Congress. I think it was the first time he had attended one of our meetings. I had heard Mel give a presentation, and of course it was immediately obvious how brilliant and talented he was, and he seemed to be such a great and kind person, which of course he was. I made it a point to meet him soon after and caught up with him as he was walking on a bridge. I’d hoped, as I’m sure others did after hearing his talk, that he’d get involved with AVLS. Mel was a great communicator, and it was awe inspiring to hear Mel give a talk and to hear his comments about various initiatives being considered in the board room. At the ABVLM, we’re so very grateful that Mel has been with us from the start, doing tremendous work on the

Item Writer committee and on the Board.

It was always fun to sit next to Mel in meetings, as he would quietly analyze in great detail the presentation we were listening to. And it was a particular joy to be with him during the social aspect of the meetings. I always felt that Mel had a quiet but powerful joie de vivre.

We’ve been so lucky to have Mel’s leadership in the field and to know Mel personally. There are so many things to respect, appreciate and admire about Mel, including his integrity, intelligence, humility, equanimity, and service to others, to name a few. Mel’s passing is a tremendous loss for everyone, but we are so lucky to have known Mel and to have benefited from his many talents and friendship.

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Meet the 2019 Program Planning Committee CONGRESS CHAIR & AVLS: LIVE STEVEN ELIAS, MD, FACS, FAVLS Dr. Elias is director of the Center for Vein Disease at Englewood Hospital. He is board certified in venous and lymphatic medicine and in general surgery, and he completed a fellowship in vascular surgery at Englewood Hospital.

Dr. Elias’s clinical interests include all aspects of minimally invasive vein care; he is also committed to procedure development and teaching. He has lectured, written, and taught about vein disease both nationally and internationally. He has been principal investigator/investigator on numerous clinical trials and performed the first ClariVein procedure on a human. He has been director of the vascular vein programs at the Mount Sinai Vein Center and at Columbia University.

AVLS: LIVE ELLEN DILLAVOU, MD, FACS Dr. Ellen Dillavou is a vascular surgeon at Duke Regional Hospital and Duke University Hospital. She treats the full spectrum of vascular surgery disorders, and specializes in vein disease and vascular access. Drawn by the challenge of the vascular surgery, she has since dedicated herself to provide procedures best suited for patients. Dr. Dillavou has published various pieces focusing on vascular surgery dating back to 1997.

AVLS: INTERACTIVE & DEEP VEINS ANTONIO GASPARIS, MD Dr. Antonios Gasparis is a board-certified vascular surgeon and has been in practice for over 10 years. He is a leader in the field of vein disease, recognized for his work as a clinician, researcher, and educator. An active researcher, Dr. Gasparis is the author of 40 published papers and 5 book chapters on varicose veins, DVT, and pelvic vein disease. He teaches new techniques and technologies and has given over 100 presentations throughout the U.S. and internationally. Dr. Gasparis also serves as a reviewer for the Journal of Vascular Surgery and Phlebology. He has been cited as an “American Top Surgeon” for five years.

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AVLS: INTERACTIVE PETER PAPPAS, MD Dr. Peter J. Pappas is a board certified General and Vascular Surgeon who graduated from UMDNJ-Robert Wood Johnson Medical School in 1987. Dr. Pappas completed his General Surgery Residency at Cooper Hospital University Medical Center, a Robert Wood Johnson affiliate, in 1993. He is nationally recognized for his basic science and clinical research activities in venous disease. He was also the first recipient of the JOBST Research Fellowship in Venous and Lymphatic Disease of the American Venous Forum Foundation.

AVLS: EMERGING SCIENCE JOSEPH RAFFETTO, MD, FACS, FSVM Dr. Joseph Raffetto, MD, FACS, FSVM, is a vascular surgeon in West Roxbury, Massachusetts. Graduating from the Boston University School of Medicine in 1989, Dr. Raffetto has published publications focusing on chronic venous diseases, venous ulcers, vascular contraction, varicose veins, and lymphedema.

Dr. Raffetto has research interests in understanding the cellular mechanisms of vascular disease. As an expertise in the characterization of the molecular mechanisms underlying the vein wall dysfunction, Dr. Raffetto has experience performing experiments on isolated vessels from animals and humans. His current research interest is in varicose vein pathophysiology, endothelial function with dilation and relaxation pathways, interaction of MMPs with vein wall pathways, and venous leg ulcer pathophysiology.

AVLS: PRACTICAL - ALLIED HEALTH SARAH WHITEHEAD, ARNP Sarah D. Whitehead, ARNP, works with surgical and nonsurgical vascular patients at the University of Washington Medical Center since 2008. Beginning as the clinic nurse and transitioning in 2012 as the advanced registered nurse practitioner, her interests include varicose veins, venous ulcerations, central venous stenosis, lymphedema, effort thrombosis, SVC syndrome, vascular malformations, MayThurner and Nutcracker Syndrome.

She has presented annually at the Pacific Northwest Endovascular Conference Nursing Session since 2013 on topics such as new DOAC management, venous ulcer wound care, and venous insufficiency.

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MEET THE COMMITTEE CONTINUED FROM P. 55

AVLS: PRACTICAL - DEEP VEINS CARL BLACK, MD Dr. Carl M. Black is fellowship-trained and board certified in interventional radiology. His primary professional focus is in the comprehensive treatment of venous disease, including endovascular management of deep and superficial venous insufficiency, pelvic venous hypertension, vascular malformations, deep venous thrombosis and IVC filter management. His other areas of expertise include endovascular PE management, peripheral arterial disease, acute ischemic stroke treatment, chronic pain management, interventional oncology and multimodality vascular imaging. Dr. Black is an active researcher and has authored many peer-reviewed scientific publications and book chapters and has presented at numerous scientific meetings. He serves on the boards of the AVLS and the ABVLM and is an ABVLM diplomate.

AVLS: PRACTICAL - LYMPHEDEMA STEVEN DEAN, DO, FACP, RPVI Steven M. Dean, DO, FACP, RPVI, is the director of the Vascular Medicine Program, director of Cardiovascular Medicine’s Noninvasive Peripheral Vascular Laboratory, and professor of clinical medicine at the Ohio State University Wexner Medical Center.

Dr. Dean’s clinical expertise is the diagnosis and nonsurgical treatment of vascular diseases such as lymphedema, venous diseases, vasospastic diseases, unusual lower extremity ulcerations, enigmatic limb swelling and noninvasive imaging.

AVLS: PRACTICAL - LYMPHEDEMA HEATHER HETTRICK, PT, PHD, CWS, CLT, CLWT Dr. Hettrick has been a licensed physical therapist since 1995. She has dedicated her entire professional career to integumentary function and dysfunction, becoming a key opinion leader on integumentary function, repair and regeneration, as well as wound, lymphedema and burn management.

Dr. Hettrick’s diverse clinical background is complemented by experience in research, professional writing and publication, speaking on the national and international circuit, volunteering on professional board organizations, consulting, lobbying for legislative change on Capitol Hill, organizing humanitarian work in Haiti, and creating entrepreneurial endeavors focusing on experiential learning.

AVLS: PRACTICAL - PELVIC & WOMEN’S VEINS KATHLEEN GIBSON, MD Dr. Kathleen Gibson plays an active role in a range of venous and vascular societies, and is currently involved in developing standardization of definitions and tools for treating pelvic venous disease. Dr. Gibson serves on the American Vein & Lymphatic Society Board of Directors Executive Committee.

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AVLS: PRACTICAL - PELVIC & WOMEN’S VEINS MARK MEISSNER, MD Mark Meissner earned his medical degree from the University of Colorado School of Medicine in 1985. He then completed his residency, his fellowship in Vascular Surgery and his fellowship in Interventional Radiology at the University of Washington. His clinical interests are acute deep venous thrombosis, chronic venous disease and the management of pelvic venous reflux. Dr. Meissner serves on the American Vein & Lymhpatic Society Board of Directors Executive Committee.

AVLS: PRACTICAL - SUPERFICIAL VEINS NEIL KHILNANI, MD, FSIR, FAVLS Dr. Khilnani has been a member of the Division of Cardiovascular and Interventional Radiology at the New York Presbyterian Hospital-Weill Cornell Medical Center since 1992. He is an Associate Professor of Clinical Radiology at Weill Cornell Medicine.

He is the past president for the American Vein & Lymphatic Society, Chairman of the Foundation for Venous & Lymphatic Disease, Venous Service Line Co-Chair for the Society of Interventional Radiology, and President-Elect of the Intersocietal Accredidation Commission for Vein Centers. The majority of Dr. Khilnani’s clinical practice is related to the care of patients with superficial venous insufficiency.

AVLS: PRACTICAL - SUPERFICIAL VEINS NICOS LABROPOULOS, PHD Dr. Nicos Labropoulos is currently a professor of Surgery and Radiology at Stony Brook University Hsopital, Long Island, NY. He is the director of the Vascular Laboratory and has a major interest in pathophysiology, diagnosis and treatment of vascular diseases. He completed his undergraduate training at the University of London and his PhD and Vascular Fellowship at St. Mary’s Hospital, Imperial College of Science Technology and Medicine, London, UK. Professor Labropoulos is on the editorial board of 11 journals and serves as a reviewer for over 20 medical and surgical journals.

AVLS: PRACTICAL - VASCULAR MEDICINE YUNG-WEI CHI, DO, FAHA, FSVM, FAVLS Dr. Chi is a nationally recognized expert in vascular medicine with clinical expertise on venous, arterial, and lymphatic disorders. He has presented his research works and lectured at major national and international conferences. His research comprises aspects of vascular medicine, focusing on vascular ultrasound imaging, antithrombotic therapy, cellular based/angiogenesis therapy for peripheral arterial disease, and venous diseases and interventions. He serves on the American Vein & Lymphatic Society Board of Directors.

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MEET THE COMMITTEE CONTINUED FROM P. 57

AVLS: PRACTICAL - VASCULAR MEDICINE JOHN BARTHOLOMEW, MD John R. Bartholomew, MD is former Section Head of Vascular Medicine and a staff physician in the Sydell and Arnold Family Heart & Vascular Institute. He is also a member of the Taussig Hematology and Oncology Institute. He is board-certified as a Diplomate of the American Board of Internal Medicine and the American Board of Vascular Medicine. He is a Professor of Medicine at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University. Dr. Bartholomew is the Medical Director of the Cleveland Clinic Thrombosis Center and is a former member of the Steering Committee for the National Quality Forum on Deep Vein Thrombosis. He is a Master of the Society for Vascular Medicine and is Past President for the Society.

AVLS: PRACTICAL - VASCULAR ULTRASOUND SARA SKJONSBERG, RVT, RPHS Sara Skjonsberg, RPhS, RVT graduated from Seattle Universityâ&#x20AC;&#x2122;s Diagnostic Ultrasound program in 2013. Sara is currently a vascular sonographer at Oregon Vascular Specialists. Sara is especially interested in pelvic venous disorders and education of current and future sonographers. She is actively involved in the Seattle University and Bellevue College vascular ultrasound sections.

AVLS: PRACTICAL - WOUND CARE WILLIAM MARSTON, MD William Marston, MD graduated from the University of Virgina in 1988. He specializes in endovascular surgery, limb preservation, would care, vein disorders, and dialysis access. He is currently the Chief, Division of Vascular Surgery at University of North Carolina at Chapel Hill.

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my AVLS Sherry Scovell, MD Physician Editor Amanda Godwin Managing Editor Ignacio Pintos Graphic Desinger Jenny Tran Copy Editor Contributors: Dean J Bender Stephen Daugherty, MD Steve Elias, MD Sergio Gianesini, MD Amanda Godwin Neil Khilnani, MD Margaret Mann, MD Mark Meissner, MD Sherry Scovell, MD Marlin Schul, MD Jenny Tran Robert White Steven Zimmet, MD

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