Excellence & Innovation in Vascular Care SVS President on the Society's Future

by Peter Gloviczki, MD

The Society for Vascular Surgery (SVS) will celebrate its 67th anniversary later this year. To serve as the 67th president of this distinguished society in 2012-2013 has been both an exceptional honor and a great responsibility. As a result of efforts from hundreds of volunteers, today the SVS is the largest and most respected vascular surgery society of the world. Our main goals are aligned with our mission to advance excellence and innovation in vascular health. We've increased our membership, and SVS in 2013 is stronger than it has ever been before, representing more than 4000 professionals dedicated to prevention and care of patients with arterial, venous, and lymphatic diseases.

Innovation has been in the center of attention of vascular surgeons for decades. With the introduction of minimally invasive, catheter-based percutaneous treatments, vascular surgery has transformed the way we deliver the best care to our patients every day. Endovascular surgery today includes treatment of life-threatening blood clots with drugs delivered through small catheters, treatment of severe arterial or venous blockages with percutaneously placed stents, and repair of aortic aneurysms and deadly aortic dissections with stent grafts placed percutaneously or though small incisions at the groin done frequently with only overnight hospitalization of the patients. While conventional open surgical procedures are still required in some patients, many will be treated with endovascular interventions with short, minimal, no hospitalization, or as outpatient, with less pain and less disability than before and with an earlier return to work period. Treatments of varicose veins and disabling chronic venous insufficiency have also been revolutionized. Today, outpatient, office-based therapy is delivered with minimal discomfort using laser fibers, small radio-frequency catheters, or performing liquid or foam sclerotherapy. Educating the patients, the referring physicians, and the public about advances and major innovations that vascular and endovascular surgery has to offer is just one of the many goals of our society. We are also committed to educating our trainees and the vascular surgery workforce on how to learn and deliver these most innovative and effective minimally invasive endovascular therapies for the benefit of our patients and our society.

Excellence has been the cornerstone of SVS with a focus on delivering high quality, cost-effective care. A major accomplishment of our quest for excellence in the past two years has been the development of the Vascular Quality Initiative (VQI) of the SVS Public Safety organization (PSO). The SVS-VQI is a robust web-based system that collects, analyzes, and reports clinical data on different vascular interventions with one goal in mind: to improve patient care. The Patient Safety Act and the SVS-PSO permits quality improvement without identifying patients, providers, or the hospital. The goal is to provide anonymous benchmark comparisons that will stimulate improvement. The growth of this program has been tremendous. As of February 1, 2013, 44 states in the US and Ontario in Canada signed up with 217 medical centers, 15 regional quality groups, reporting on more than 3000 procedures monthly. SVS' recent collaboration with the American Venous Forum (AVF) has been fruitful: SVS with AVF is now uniquely positioned to become a leader in quality improvement for venous disease. The Inferior Vena Cava Filter module has just been rolled out and immediate plans to prepare data collections on varicose vein treatments are underway. Additional fields of data collections in the near future will include venous stenting, deep vein thrombosis and thrombolysis, as well as upper extremity venous thrombosis.

SVS maintains excellence in physician education by publishing basic and clinical research, evidence-based guidelines, and reporting standards in a high-quality, peerreviewed publication, the Journal of Vascular Surgery. This year has been an exceptional year for the Journal. It launched the first issue-of a daughter journal: Journal of Vascular Surgery: Venous and Lymphatic Disorders, published four times annually. Overseen by a distinguished international editorial board, the Journal will seek to provide novel and timely information to vascular surgeons, interventionalists, phlebologists, wound care specialists, and allied health professionals who treat patients presenting with venous and lymphatic disease. The Journal is another evidence of collaboration between SVS and AVF in venous disease. The goal is to continue to expand the scope of practice of vascular surgeons to all areas of vascular disease?arterial, venous, and lymphatic. Other areas of collaborations in venous disease include the recently published joint guidelines, one on acute and another on chronic venous disease (Early Thrombus Removal Strategies for Acute Deep Venous Thrombosis: Clinical Practice Guidelines for the Society for Vascular Surgery and the American Venous Forum, J Vasc Surg 2012; 55; 1449-1462; The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum, J Vasc Surg 2011; 53:2S-48S [May 2011 Supplement]). This year will bring another joint guideline on management of venous ulcers, this time under the leadership of Thomas O'Donnell, Jr., MD, and Marc Passman, MD.

Another important accomplishment of the SVS in 2013 was a collaborative project with the Society of Interventional Radiology (SIR). The two societies just announced that they will jointly launch the PRESERVE study?the first largescale, multispecialty prospective study to evaluate the use of inferior vena cava (IVC) filters and related follow-up treatment. The study, along with the formation of the IVC Filter Group Foundation, are direct actions taken to address the FDA?s August 2010 medical alert detailing the possibility that retrieval IVC filters could move or break, potentially causing significant health risks for patients. SVS and SIR are in the process of determining a framework for PRESERVE (PREdicting the Safety and Effectiveness of inferioR VEna Cava Filters) study, with the goal of obtaining a functional view of all filters placed in the US.

SVS has a strong representation through our office in Washington, D.C., and we are directly involved in
representing the interest of our members and our patients in the Medicare Physician Payment Reform. SVS leaders met with House Energy and Commerce and Ways and Means staff about a new Medicare physician payment system that could replace the problematic Sustainable Growth Rate (SGR) formula, which is now used to determine physician payment. Since vascular surgeons are almost completely responsible for diseases that affect Medicare beneficiaries, SVS is uniquely positioned and has moved into the forefront of this debate.

The SVS Health Policy Committee created a blueprint for the replacement of the SGR formula for surgeons. The vascular healthcare community is discussing the blueprint with members of the House Energy and Commerce and Ways and Means Committee as well as the Senate Finance Committee. These committees have jurisdiction over Medicare and have created their own overview of SGR repeal and reform, which has many elements in common with the SVS document.

On a final note, SVS is ready to become a real international organization in order to attract vascular surgeons and professionals from all corners of the world. Our call to increase our international membership and form new international chapters of the SVS was well received by our foreign colleagues. Plans this year include doubling our international membership from the current 266 members and inaugurating new Italian, German, and Polish chapters of the SVS at the upcoming Vascular Annual Meeting of the SVS on May 30 June 2, 2013, in San Francisco, CA. These will join the ranks of our five current international chapters (Columbia, India, Brazil, Hungary and Egypt).

It is clear that SVS is alive and doing well. It's a remarkable society with rich tradition, guided by thoughtful leaders who focus on excellence and innovation in practice, education and research. The future of vascular surgery is bright but it also holds many exciting and sometimes trying challenges. The Society of Vascular Surgery is ready to serve its members to lead and to adapt to the changes that lie ahead.