Why did you decide to specialize in vascular surgery? What interested you about vascular medicine?
I became interested in vascular surgery during my last year of medical school. I was fortunate to have my surgical rotation at the department of vascular surgery. The culture of innovation, research and comradery--combined with a heavy load of interesting cases and complex operations--left no doubt in my mind that vascular surgery should become my future specialty.
How did you become involved in the American Venous Forum?
In 1984, I started performing deep vein reconstructions. Searching for relevant information was a challenge. I wrote to Drs. Kistner and Sottiurai, and established a rapport by starting an informal exchange of experiences and case reports. Both doctors replied, but Dr. Kistner followed my initial correspondence with an invitation to present our series at the Third Annual Meeting of the American Venous Forum (1991). This was the first time I had heard of the Forum, but it was not until 2001 that I was able to participate. Working at the time with Drs. Kistner and Eklof, I learned first-hand about the Forum’s history and philosophy. I applied for membership and joined the Forum in 2002.
What AVF committees have you served on? How has your involvement with the AVF helped you professionally?
On the last day of the Third Pacific Vascular Symposium in 1999, I took part in the discussion of the possible revision of the CEAP classification. This led to my participation in the AVF international ad-hoc committee on the revision of CEAP, which was formed in 2002. I served on the Outcomes Committee, and co-chaired this committee with Dr. Moneta in 2005, Dr. Meissner in 2006-2008, and continued as the Chair until 2011. From 2008 to 2010, I served on the Strategic Planning Committee, and on the Membership Committee. From 2009 to 2011, I also served on the Board of the AVF Foundation. In 2010, I was elected to Secretary, and in 2012 I became the Vice President of the Forum. My most recent assignments were the Venous Ulcer Practical Guidelines task force, collaboration between the AVF and SVS under the leadership of Drs. O’Donnell and Passman, and the Government Relations & Reimbursement Issues task force.
Nothing can match the experience of serving on the AVF committees. The founders envisioned the Forum as a place where professionals can have a meaningful discussion of their ideas and research findings and outcomes with a constructive criticism at the highest academic level. This vision is realized not only in the annual scientific meeting, but also in the work of the committees and tasks forces.
There is no question in my mind that the progress that has been made by our specialty and our society in a large part is a result of open and respectful discussions of frequently conflicting views on issues related to the Forum and to the entire field of venous and lymphatic diseases.
The invaluable aspect of involvement with the Forum is creating personal connections with the outstanding individuals who make up the AVF membership. Many of them became my personal and family friends, as well as my mentors and advisers. My involvement with the AVF was the most effective way of learning about all aspects of the complex field of venous and lymphatic diseases.
What are the most important advances in vascular medicine that have occurred over the last decade?
The changes that took place over the last decade are so profound and broad that choosing a few most important is quite difficult. The treatment of the primary chronic venous disease (CVD) transitioned to office-based practices. The technologies that were introduced in the late 1990s are rapidly evolving. Our understanding of pathophysiology of CVD and the evidence from clinical trials laid the basis for the first set of solid evidence-based guidelines developed by the AVF and SVS.
Development of new anticoagulants opened the possibility of continuous management of patients, from prevention to treatment of venous thrombosis to extended treatment and prevention of post-thrombotic syndrome. A dedicated venous stent has been developed and is under clinical investigation. A number of minimally invasive technologies are close to clinical applications for conditions ranging from venous obstruction to venous reflux. One of the important developments is the global acceptance of standard assessment instruments, such as CEAP classification, VCSS score and disease-specific QOL instruments. Such acceptance allows generating higher levels of evidence supporting our treatment choices.
What developments of vascular medicine do you think will grow in the next 10 years?
Predicting the future is a risky business, but I will take this risk for two developments that I think should happen in the next 10 years--and hopefully even sooner. The first is not about science and innovation, but about policy and economics. At least in the United States, we are facing an increasing gap between evidence-based recommendations made by professional societies and the payers’ policies.
There is distrust on both sides of this divide, and interactions are either of lobbying or opposition. I believe we have reached the point when everyone understands that this situation needs to be changed. The AVF took the first steps by starting open dialog with the payers, and will continue this effort through the work of the Government Relations & Reimbursement Issues task force, which collaborates with other societies and our industry partners when needed. We have encouraging examples of our members working with the insurance industry to improve reimbursement policies and definitions of medical necessity. I hope that within the next 10 years we will resolve this issue, and ultimately improve the venous and lymphatic health of our population.
Another development was proposed by the 6th Pacific Vascular Symposium. This is a set of prioritized activities aimed to decrease the prevalence of venous ulcers in the United States by half in a decade from its implementation. Today, we have reached the point when this program may start.
The epidemiological study by Dr. Monika Gloviczki gave us the best possible estimate of current venous ulcer prevalence in the United States, and the evidencebased guidelines for management of venous ulcers are under review. Two components that are urgently needed are coordinated professional education and a structured patient awareness program. The key to success is to increase collaboration between all professional societies with interest in venous disease. It is challenging, but my prediction is that it will happen in the next decade.
What are you looking forward to at the 26th Annual Meeting?
I have not missed a single meeting since I joined the Forum, and every year I look forward to the next one. The scientific program improves constantly, and I am certain that under the leadership of Dr. Gasparis as the Program Committee Chair and the President Dr. Henke, this year will be even better. I am also looking forward to the Specialty Symposia. The Vascular Medicine and Thromobosis, the Wound Care and the Biomechanics and Bioengineering specialty sessions have been increasingly active and successful during the last three years. This year, a new Specialty Symposium on animal models in venous research will debut under the leadership of Dr. Diaz. I have great expectations for the success of this session. There is a need for development and coordination of efforts in this important area of research, and the Forum is ready to embrace and support this initiative.
What are you looking forward to most about serving as president?
Serving as the AVF President is a great honor. It is also a great responsibility and a unique opportunity to contribute to the presence and the future of the society. I am looking forward to working with the Executive Committee and the Board to examine and refine the priorities for future activities and initiatives. Our success depends on AVF member involvement, and so I am excited to work with all interested members to make the Forum a society that better serves their clinical, professional and academic needs.
What advice would you give to vascular physicians who want to become more involved with the AVF?
My advice is simple: get involved. Contributing your time, energy, expertise and intellectual efforts is a big investment, but the return on this investment is great. There are opportunities for a broad spectrum of interests, from research and education to issues related to practice and reimbursement, to development of the Forum itself. You may join a committee, or you may desire to start a new initiative. Talk with committee chairs and the Board of Directors, learn about existing projects, and tell us what you would like to do. We are an inclusive group, and are always looking for new active members.
