by A.M. Sutton
In past years, IVC has concentrated on topics such as the treatment of superficial venous thrombophlebitis and preventing complications of foam sclerotherapy. At IVC 2011, Course Director Jose Almeida, MD , covered those and added talks on topics such as endovascular treatment of acute pulmonary artery embolus and chronic total occlusions of the oliofemoral outflow tract
“Certainly, we should all have some familiarity with deep venous disease, how it presents and either how to treat it or what to advise patients,” Dr. Almeida said. “There is a revolution going on. Just as advances in tumescent anesthesia and other technology made possible in-office procedures for superficial disease, so are the new devices and procedures making it easier to treat deep venous disease,” he said.“Doctors should consider maintaining hospital privileges,” he told the audience
Attendees applauded the meeting’s new emphasis on serious venous disease. “By all means, include the deep system as well as the superficial,” urged John W. Daake, MD , of Reno, NV. “Frequently, patients are seen with the sequelae of unrecognized DVT or with symptoms associated with deep system insufficiency, and have not been properly evaluated by other health providers,” notes Daake, suggesting that knowledge of deep disease is important even for those who do not treat it.
Added Mario Duran, MD, of Quito, Ecuador, “I have attended IVC four times, and I think that this last meeting was the most interesting because the subject of deep venous disease was brought in.”
Dr. Daake, reflecting upon what he learned at the meeting, addressed the ever-present financial considerations that practitioners must think about. “As was mentioned in one of the presentations, if trials validate certain interventions for DVT , then future guidelines for treatment and reimbursement will favor the use of those interventions while reimbursement for superficial vein treatments is being diminished,” he said.
A regular and much-anticipated feature of IVC is the transmission of live cases from the Miami Vein Center to the ballroom of the Fontainebleau Miami Beach. These “front row” seats, as it were, gave attendees a direct view of procedures. The step-by-step explanation provided by the operator and the accompanying commentary from a panel of experts gave attendees a chance to see how noted authorities work and hear how others might approach the case differently. “As an advanced vein specialist, I always take a pearl away from the live cases presentation,” said Gregory Azia, MD, of New London, CT.
CCVSI, NIVL & THE AVR
Other highlights of IVC 2011 includeda session on the hot topic of chronic cerebrospinal venous insufficiency (CCV - SI) and a keynote from the American Venous Forum President, Seshadri Raju, MD, on “High Prevalence of Non-thrombotic Iliac Vein Lesions (NIVL) in Chronic Venous Disease: A Permissive Role in Pathogenicity.”
Dr. Almeida also made a strong push for physicians to take advantage of the online American Venous Registry (AVR ) established by the American Venous Forum (see cover story, VEIN Winter 2011). Venous practitioners can enter data from their own work with patients and the aggregate collection of data will allow for the assessment of functional outcomes and comparative analyses of different clinical approaches to venous disease management. The AVR will identify practice patterns for venous disease diagnosis and treatment across the United States and across varied specialties.
“’Medicine as art’ is not realistic anymore,” Dr. Almeida said “The focus has shifted to evidenced-based medicine. It is clear that we need good evidence good trials and good data going forward.”