Venous Ulcer Taskforce: A Multi-Society effort to serve the neediest vein patients Dr. Marlin W. Schul
Marlin W. Schul, MD, RVT, FAVLS, DABVLM
• The NEJM EVRA Trial showed how important early intervention was in healing venous ulcers.
As vein care clinicians, we know that venous ulceration presents not only a clinical challenge but also an excellent opportunity to help those patients most in need. The landmark New England Journal of Medicine study, Early Endovenous Ablation in Venous Ulceration, or the EVRA trial, gave real-world evidence on early intervention and time to healing.
• New LCDs for Novitas and First Coast allow prompt treatment for venous patients who would likely NOT benefit from a period of conservative care. • Improving Wisely identified a global gap in care, suggesting that less than 1% of VLU patients acquire surgical intervention of ANY type.
Despite Level I evidence, many barriers continue to exist, delaying referral for vascular evaluation in those most in need of vein care. A group of physicians representing several disciplines came together in 2020 to launch a project to brainstorm how we might collectively change the narrative and move the needle to ensure those with a leg ulcer receive a prompt referral and diagnostic vascular assessment of the limb(s).
• We all identify that the IW findings were not in error. We see patients in wound centers for years before they get a vascular referral. • It is widely recognized that those treating venous ulcers in a wound center may not recognize venous leg ulcers, and often those that do recognize venous leg ulcers do not know to whom to refer their patients.
In sum, the task force’s charge is to support patient access to needed venous care by creating and disseminating evidence-based protocols for venous ulcers and diagnostic assessment of suspected venous ulceration. Particular emphasis is placed on reaching and educating providers who might not be vascular or venous specialists on how they need to work up suspected ulcer patients.
• The AVLS Registry and private data from the wound care community could be leveraged to give insight into key clinical questions. • Current Multi-Society Composition of the Ulcer Taskforce. » Marlin Schul- AVLS co-chair » Harold Welch- AVF co-chair
WHY NOW? HOW DID WE ARRIVE AT THE POINT?
» Joe Raffetto-AVLS » Eri Fukaya- SVM
Several factors served as motivation for the task force. Namely,
» Leigh Ann O’Banion- AVF, SVS
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