25 Most Influential: Ronald G. Bush, MD, FACS

Ronald G. Bush, MD, FACS

A colleague had this to say: “Dr. Bush’s credentials are exceptional. He is Board certified in four surgical specialties: surgery, thoracic surgery, general vascular surgery and laser surgery, which gives him a high level of expertise not often found in a community setting.”

Where do you see the specialty of phlebology in 5 years? 10 years?

As this specialty progresses, I think two issues will come to the forefront. A) As our knowledge increases, especially with good histological analysis, I see more of a shift from thermal ablation to foam techniques for saphenous disease. If foam can be delivered safely with minimal complications and the long term results are comparable, then both insurance and patient awareness will shift to a new paradigm. B) Sound knowledge of pathophysiology of venous disease is essential and must be improved upon. Most importantly in 10 years, hopefully, new techniques will be developed for the treatment of deep venous insufficiency that can be performed in the ambulatory setting.

Is there a particular case that stands out in your mind?

Many cases stand out but one of the most rewarding was a 40 year old female post high ligation with subsequent pregnancies. She presented with a large venous aneurysm (35mm) at the previous surgical site. By treating first the inflow and then the aneurysm itself 3 separate times with 3% sotradecol foam (CO2), the vein measured 7mm and there was no longer any reflux. As a surgeon, I know this would have been a very difficult case. Dissection would have been difficult and the chance for complications and recurrence are always present.

Tell us about any publications or research you are currently working on or recently finished.

I have just finished a manuscript that was accepted for publication on the long term histological effects of thermal ablation. This study shows the cellular response to heat injury and the progression from time of injury to 4 months. The most significant finding is that fibroblasts are responsible for the long term success of thermal ablation. I am currently looking at the cellular response to foam sclerotherapy to determine if histological findings will be similar. Another study I am completing is the mathematical model of laser injury to the saphenous vein as well as in vivo temperature determinations.

You are well-known in your field of work. What is something about you that would surprise your colleagues?

I still practice ju-jitsu and am working on my advanced black belts even at my age. I love the ocean and I am a skilled captain and navigator.

Who or what inspires you the most?

Any parent who will love and teach a child. Also those who dedicate their life and talent to the service or others without monetary reward.

If you could do anything else for a living, what would it be? Why?

I would work as a boat captain because there is nothing as beautiful or terrifying as the sea.

What question did we not ask that we should? Now, answer it!!

Q. What is a problem you see in the field of phlebology? A. Many practitioners that are not adequately trained or do not have a good foundation or knowledge of venous disease.

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