Q&A Featured Doctor Incoming AVF President John Blebea, MD, MBA, FACS

How did you become interested in vascular medicine as a specialty?

Since kindergarten, when I had the role of a surgeon in a classroom play, I have wanted to become a surgeon. The decision to go specifically into vascular surgery was greatly influenced in medical school during my third year rotation on surgery when I was on the service of Dr. Robert S. Rhodes, then at Case Western Reserve University. His meticulous surgical technique and calm, yet commanding presence was an inspiring role model for me.

During my surgical residency, I took a year off for research in the laboratory of Dr. Robert W. Hobson II at the New Jersey Medical School. The vascular group there was a very stimulating community involved in arterial and venous research—both at the basic science and clinical levels. That experience confirmed my desire to pursue a career in vascular surgery.

How did you become involved in the American Venous Forum (AVF)?

Both Dr. Hobson and Dr. James DeWeese, my vascular fellowship program director at the University of Rochester, were founding members of the American Venous Forum with long-standing interests in venous disease. They encouraged and supported my participation in the AVF. The first meeting that I attended was in San Diego at the second annual meeting of the AVF, where I spoke on the surgical treatment for axillary-subclavian vein thrombosis.

What AVF committees have you served on?

I have had the pleasure of serving on multiple AVF committees and in chairmanship positions on these committees. These have included the Scholarship Committee, Sigvaris Traveling Fellowship, Research Committee, Grants and Awards Committee, Issues Committee, Finance Committee, and on the Education and Research Councils. I have previously served as a council member, treasurer, and vice-president on the AVF Board of Directors.

I am presently the AVF representative to American College of Surgeons, where I serve on the Advisory Council for Vascular Surgery. I have also been a director and treasurer of the American Venous Forum Foundation. Looking back at this list, it has been a wonderful experience working with many different people over the years.

How has your involvement with the AVF helped you professionally?

Similar to the experience of others, the AVF has provided me with the opportunity to meet and develop friendships with wonderful colleagues and the world’s leading experts in venous disease. The meetings have always been clinically enlightening and scientifically stimulating. At AVF annual meetings, one could learn of both optimal clinical management and leading edge research in a forum that encouraged open discussion and debate.

The participation of physicians from all over the world provided additional perspectives not easily found at other meetings. Finally, the opportunity to participate within the AVF and the AVF Foundation on multiple committees and organizational functions helped me to develop collaborative leadership skills that have been quite useful in my professional career.

What would be your three main goals as president of the AVF?

We have a strategic retreat in December of 2014 where the leadership of the AVF will meet to prioritize our organizational objectives for the next 3-5 years. Those organizational goals will, of course, also become my priorities as the president.

However, on a personal level, there are additional aims that I will simultaneously pursue. These will include increasing membership and participation of members within the activities of the society, augmenting inter-societal and cross-specialty collaboration, enhancing our fundraising capabilities, amplifying our support for research and clinical guidelines development, and utilizing more fully web-based technology for communication among our members and with the lay public. All of that should keep me very busy!

What are you looking forward to most about serving as president?

The opportunity to work even more closely with wonderful friends and colleagues throughout the world! There are so many exciting innovations taking place in venous disease, and it will be great to be at the center of some of those discussions. In addition, and probably more importantly, the upcoming year will provide me with the chance to give back to the AVF by continuing to build upon the foundation that has already been established by the wonderful surgeons and innovators that have preceded me.

What are the most important advances in vascular medicine that have occurred over the last decade?

Specifically in the field of venous medicine, there are several that have made a tremendous impact on both physicians and patients. Endovenous ablation, by either radiofrequency or laser techniques, has had a positive therapeutic effect on literally hundreds of thousands of patients each year across the globe.

Thrombolytic therapy for acute iliofemoral deep venous thrombosis, and associated stenting of the iliac veins for stenosis or external compression, has provided improvement for patients who otherwise would have suffered the longterm sequelae of chronic venous insufficiency. The use of objective measurements of venous disease, such as CEAP and Venous Clinical Severity Score, among others, has provided an improved methodology for measuring outcomes in both the clinical setting and in research. Finally, the recent availability of oral anti-Xa and direct thrombin inhibitors for the treatment of acute DVT and pulmonary embolization has been the most significant development since the approval of warfarin 60 years ago.

What developments of vascular medicine do you think will grow in the next five to 10 years?

Looking into the near future, I expect that the new oral anticoagulants will effectively replace warfarin in the venous arena very quickly. In addition to potential revisions of CEAP and VCSS, patient-centered outcome measures will become part of the standard tools that will be employed with each patient encounter. Non-thermal endovenous ablation techniques, without the requirement for tumescent anesthesia, will probably replace present laser and radiofrequency modalities for most patients. Foam sclerotherapy for varicose vein tributaries will become standard treatment.

The outcome of the prospective randomized Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial will define when, and for what subset of patients, iliofemoral thrombectomy and thrombolysis should be employed. The next decade will be an exciting one for the treatment of venous disease!

What advice would you give to vascular physicians who want to become more involved with the AVF?

For those who are not yet members, I would encourage them to access a membership application on our website, veinforum.org, and submit it as soon as possible. For members, they should volunteer (also online) for participation in any of our committees or initiatives. For everyone, I would invite them to come to our meetings, either the regional courses or our annual national meeting. Everyone at the annual meeting is welcome to discuss the presentations or ask questions of the speakers. In addition, those interested should not hesitate to contact me or any of the other officers of the AVF if they wish to volunteer for any committee or other programs within the society.

What are you looking forward to at the 27th annual meeting in Palm Springs?

Everything! It will be a great meeting in a wonderful location. The program that has been put together is excellent. It has a terrific combination of scientific presentations and clinically-relevant sessions. The David S. Sumner Venous Summit this year will focus on “Office- Based Vein Centers: The Next Generation,” and there will be specialty symposia on biomechanics and bioengineering, wound care, lymphedema and compression, deep venous disease, vascular medicine and thrombosis, superficial venous disease, allied health and animal models in venous research. There will be something for everyone.