Message from the Editor

What’s Cooking?

Julia Child knew what was cooking. She published her debut book, Mastering the Art of French Cooking, in 1961. She is credited with bringing French cooking to the United States. Many great food recipes are in her book. Recipes can be looked at in many ways: recipes for disaster, recipes for success, recipes for a successful career, etc. And the recipe for a successful AVF meeting.

This special edition of Vein Specialist highlights what the “cooks” of the AVF Program Committee have been making over the last few months. The head chef, Mikel Sadek, has empowered his sous- chefs to be creative. Now sometimes, creativity can be a recipe for disaster. Does anyone remember pet rocks or the Edsel? Or lasers being touted as the answer to every arterial problem? We think the ingredients are just right. Goldilocks and the Three Bears be damned. The theme: One World, Many Voices. Our society is similar to haute cuisine: a lot of ingredients come together to create a rich, tasty, and unusual dish.

Kitchen Confidential, the book written by Anthony Bourdain that put him on the culinary map, takes the reader inside what goes on in a restaurant’s kitchen. It ain’t pretty according to Tony. This issue puts you inside the kitchen as our contributors write about the many sessions we have put together for the repast of our annual meeting–a meal in many diverse courses. Everything is here including the dessert, our gala. As opposed to Bourdain’s take on things, this is pretty. Read this issue as it presents the prixe fixe menu. You can choose as many dishes as you want to consume. The meeting is not a Chinese restaurant. You don’t need to choose 2 from column A and 2 from column B. You can enjoy everything. Read the issue and then come to San Antonio, which has some pretty good food as well.

One World, Many Voices

Diversity. Equity. Inclusion. DEI. DEIB (The B is for belonging). Since the murder of George Floyd at the height of the pandemic, these acronyms and terms are used as central tenets of our practice and lives and have entered our collective consciousness and cultural lexicon. A dam broke, and we are all swimming either with or against the current, trying to stay afloat and evolve. The DEI session at the upcoming VENOUS2023 is the next phase of this evolution, and we are excited to offer you a ride on our raft with a spectacular session that reinforces these principles. The essence of the DEI initiative is for all of us to do better and be better clinicians and colleagues. Embracing diversity means acknowledging that our patients’ background, culture, and socioeconomic status, among other things, affect how they access medical care, accept advice, and adhere to treatment. Embracing equity means acknowledging that some patients need more resources to achieve good health outcomes. Embracing inclusion means appreciating that our research efforts and workforce should represent our population if we are all in this together.

These principles have long been part of the American Venous Forum; our recently created DEI Committee is committed to ensuring that all voices in the AVF are heard, fostering a culture of inclusion, acceptance, and appreciation of differences. The upcoming VENOUS2023 meeting will host the first “One World, Many Voices” session–a space dedicated to promoting discussion and reflection in the audience about the importance of DEI as a core component of medical practice. This session will encourage dynamic dialogue to identify disparities and create strategies to make the AVF a world leader in driving health and research equity for its members. A group of distinguished speakers from different countries has been invited to discuss their findings on multiple aspects of venous care through a DEI lens. Topics of discussion will include insurance companies’ role in dictating access to care, the importance of understanding patients’ cultural backgrounds, the influence of ethnicity and race on outcomes of venous disease, and how to promote international collaboration among practitioners.

The AVF is committed to creating a DEI-aware space for its members and collaborators to promote cultural competence and a culture of inclusion and appreciation of diversity. “One World, Many Voices” aims to be a working and learning environment where everyone in the room has equal value and voice and can share different views. Our ultimate goal at the AVF must be not only embracing tolerance but genuinely accepting and appreciating the different cultures, origins, backgrounds, and perspectives so that all members can perform at their highest potential. The significant increase in international members in the last years has contributed to the cultural enrichment of the AVF. The DEI Committee has joined efforts with the International Committee to encourage attendees from different latitudes to attend, learn and enjoy VENOUS2023. See y’all in Texas!

Many Voices of One World. International attendees at VENOUS2022.

Join us in San Antonio, TX

As you can see, there are so many wonderful things to do, see, and taste in our local Texas Hill Country as you join me for the 35^th One World, Many Voices American Venous Forum

REGISTER FOR VENOUS2023 TODAY!

Aesthetic and Allied Health @ VENOUS2023

Building on the success of the Aesthetic Session at VENOUS2022, it was decided to expand the focus of the session to include topics of interest to our Allied Health membership. For VENOUS2023, the endeavor is to give the audience a 120-minute overview of an aesthetic venous practice and to also provide guidance to early-career allied health practitioners. We have a lineup of talks to be given by physicians and allied health experts in the field with ample time for audience discussion and questions. At the end of the session, the attendees will be familiar with the entire spectrum of aesthetic practice (face, hands, legs, and feet) from the basics to the advanced. Additionally, the early-career allied health practitioner will benefit from having a road map to navigate a career in aesthetic and medical venous disease. The tentative list of talks is noted below. Please join us for the Aesthetic & Allied Health Session on Saturday, February 25, 2023, at the La Cantera Resort in San Antonio, TX. And don’t forget that this session is free for all–so bring along your colleagues as well and attend either in person or virtually.

Julianne Stoughton and her cat presenting virtually at VENOUS2022 after being snowed in.

Join us for the VENOUS2023 Gala!

VENOUS 2023 promises to bring the venous world together in San Antonio Texas. The theme for the meeting is:

One World, Many Voices: Our Future is Together

This year, we will bring together Clinical and Scientific Voices, International Voices, and All Voices. We will also focus on Diversity, Equity, and Inclusion, and expand sessions for allied health specialists. We look forward to hearing from our experts in sessions such as “How I do It” and “What Would You Do?”

The Program Committee hopes to make this the most comprehensive, engaging, and enjoyable meeting to date. Please peruse the highlights for each of the upcoming sessions to get a flavor of how the program has shaped up–you won’t be disappointed.

The celebration of the venous world’s efforts will culminate in the Gala, a grand affair with a touch of Texas spice. It will be a place to mix and mingle with old and with new friends. It always serves as a tremendous opportunity to cross-pollinate ideas, spark collaborations, and simply to meet someone new who shares your professional interests and passions. You certainly will be fed well, and if history is any indicator, you might let loose a little bit also.

As part of the inclusive theme of the program, every single one of you and your guests are invited and encouraged to attend the festivities Friday evening, so mark your agendas! On behalf of the Program Committee and the American Venous Forum, we are so very honored that you have chosen to come to our meeting. As your hosts, we will go BIG in TEXAS, and we intend to provide you with a BIG VENOUS2023!

Photos from the VENOUS2022 Gala in Orlando, FL.

Fellows/Early-career Attendees: Don’t Miss This Event!

At the VENOUS2023 Meeting held in San Antonio, Texas on February 22-25, join us for a dedicated Fellows/Early Career Session program. The 2 sessions will be on Thursday, February 23, at 1:45pm and Friday, February 24, at 8:30am. These 2 physician-in-training sessions will focus primarily on practical hands-on content with live patient volunteers. This will be your chance to ask questions regarding how to properly use an ultrasound to diagnosis venous reflux, use the IVUS machine through dynamic cases scenarios, and see up close and personal live sclero procedures! Don’t miss this event!

Proudly brought to you by the Early Career Committee:

What is New in Superficial Venous Disease Management? 

Many outstanding abstracts were submitted to VENOUS2023 on management of superficial venous disease. As we all are aware, treating superficial venous disease is not always straightforward. We face a diverse patient population that has varying expectations of treatment outcomes. Also, unique challenges pertain to superficial venous disease that other fields of vascular disease do not see as often. For example, insurance coverage for superficial venous disease offers its own special set of challenges. In the VENOUS2023 Superficial Venous Disease session, Dr Paula Rodriguez will delve into these specific issues like inconsistency of coverage policies. Drs Kathy Gibson and Steven Elias will kick off the session with their experience treating superficial venous disease patients. Risk factors for recanalization following ablation and patterns of reflux will be discussed by Dr Matthew Vuoncino and Dr Zoe Deol, respectively. Additionally, Dr Bai will present on a comparison between below-knee versus above-knee varicose vein treatment and their outcomes. The session will conclude with a discussion on how to predict hypersensitivity reaction after cyanoacrylate closure by Drs Nelzen and Chandrasekhar. We look forward to your joining our session!   

Veins are Skin Deep!

VENOUS2023 is shaking up the program with a dedicated Deep Venous Session on Thursday, February 23^rd, as well as hybrid sessions on Friday, which combine deep venous talks with venous thromboembolism and superficial venous disease. The quest for a bioprosthetic venous valve continues, and on Thursday Dr Sebastian Cifuentes from the Mayo Clinic will divulge their mid-term results. Dr Karem Harth from UH Cleveland Medical Center will present the trends in venous stent usage from 2014-2021, and we will learn whether age (Dr Jason Storch, Mount Sinai Hospital) or early antiplatelet therapy (Dr Nishant Agrawal, University of Pittsburgh Medical Center) affects outcomes. If you ever considered using covered stents for iliocaval occlusion, come visit the Friday session where Dr Sina Zarrintan will report UC San Diego’s experience. Lastly, if you thought you could just sit back and listen to all the presentations—think again! The “What Would You Do” talks at the end of each session promise to be interactive and engaging.

Venous stenting of post-thrombotic left iliac vein compression

European Venous Forum (EVF) and American Venous Forum (AVF) Joint Scientific Session

The session will cover existing and emerging areas in venous disease. The speakers, the topics, and the moderators will ensure that the session will be informative, clinically relevant, and interactive with discussion.

The speakers are nationally and internationally recognized and provide a breadth of expertise and knowledge. From the EVF we have Dominik Heim (Universitätsspital, Basel, Switzerland) discussing Venoactive Drugs: Evidence of Action and Clinical Indications, and Marzia Lugli (Chirurgia Vascolare di Hesperia Hospital di Modena, Italy) discussing Venous Aneurysms. From the AVF we have Andrea Obi (University of Michigan, Ann Arbor, Michigan, USA) discussing What Practical Knowledge has the VQI VVR Contributed to Superficial Venous Disease?, and Kush Desai (Northwestern University, Chicago, Illinois, USA) discussing Contemporary Use of Venous Stents for Venous Outflow Obstruction.  

The moderators for the EVF-AVF Session are Professor Andrew Nicolaides (Emeritus Professor of Vascular Surgery, Imperial College, UK), and Dr Joseph Raffetto (Harvard University, Cambridge, Massachusetts, USA), both recognized nationally and internationally in the field of chronic venous disease.

We invite everyone to this wonderful collaborative session. The EVF-AVF session will have instructional material; provide interest to all venous specialist and advanced practitioner providers, students, residents, and fellows; be thought provoking; and engage everyone for participation during and after the session. Please make time in your schedule to attend this wonderful and rewarding session.

From your session chairs we look forward to seeing you at the AVF meeting and the EVF-AVF session.

International Session Highlights

AVF is waiting for International Delegates in SAN ANTONIO AVF ANNUAL MEETING

The AVF’s 35th annual meeting, VENOUS2023, is just around the corner. American Venous Forum members and nonmembers are expected in San Antonio, Texas, in February 2023. Among them we hope to welcome many international delegates joining not only the AVF annual meeting but also joining the American Venous Forum members – the community of phlebologists widely open for international cooperation in the field of science and experience exchange.

 As the AVF International Committee we are very proud and happy that during this year’s abstract submission, almost 30% of all abstracts submitted are international; we hope to see the best of them in the oral presentations and discussions. We are also certain that the program of the Villavicencio International Session will bring to the participants several top abstracts stimulating interesting discussion and knowledge exchange. The DEI (Diversity, Equity, and Inclusion) session will be another wonderful opportunity for the exchange of experience between US and international presenters and discussants. We count on interesting, stimulating discussion also in many other abstract- as well as non-abstract sessions, where we would like to welcome our international delegates. Undoubtedly, we also count on our AVF Ambassadors’ attendance. We invite all ambassadors from the AVF Ambassador Program as well as their mentees. We hope to welcome all of them and thank them for their active work during the international portion of the Welcome Reception.  We will also look forward to discussions in San Antonio about future advances of the AVF Ambassador Program.

“One World, Many Voices” is the theme of VENOUS2023. Join us with your important international voice in San Antonio!     

Strandness Session Keynote Speaker: Dr Donna Mendes

She has served on countless committees and been honored in many ways. Dr Mendes was on the Advisory Council for Vascular Surgery within the American College of Surgery. As a member of the Society of Vascular Surgery, she served as chair of the Minority Affairs Committee and Public Affairs Committee. She is a member of the Society of Black Vascular Surgeons and focuses on mentoring young surgeons. She served on the board of trustees of Hofstra University, her alma mater. Her awards include the Harlem Fine Arts Awards, winning for Excellence for African Americans in Medicine twice. She is designated as one of the Top Doctors in Vascular Surgery for the past 8 years in a row by Castle Connolly. Dr Mendes was named one of the most Powerful Women of NAACP.

Recently, Dr Mendes became the Vice Chair of Education at Lenox Hill Hospital, Department of Surgery. She will continue to teach, guide, and lead others.

One World, Many Voices. 

AVF President Dr Marston and the AVF membership are is pleased to welcome Dr Mendes as the Keynote Invited speaker of the Strandness Session at VENOUS2023.

Pioneering Frontline Care: How Penumbra engages the care team early and often to advance the latest innovations to address peripheral conditions

Changing the paradigm of patient care is not easy. Rarely is it enough to tout the latest innovations. Broad and sustained adoption requires an effective and robust physician engagement and continuing medical education program.

Penumbra, Inc., a global healthcare company, has been revolutionizing interventional care for nearly 20 years, including pioneering mechanical thrombectomy and redefining the embolization space. The company was first-to-market with aspiration technology to remove stroke-causing blood clots from the brain, as well as in the peripheral vascular system. Recently, the company introduced its latest technology that uses a unique computer-aided clot detection innovation designed to remove pulmonary emboli, and blood clots from the arteries and veins.

Rapid adoption of Penumbra’s novel mechanical thrombectomy technologies can be attributed to a confluence of user-friendly, efficient design, a track record of clinical excellence, and notably a dynamic physician outreach program. Here are a few key insights that drive Penumbra’s successful continuing education program.

Taking a Multi-Disciplinary, Peer-to-Peer Approach

Overall, Penumbra’s philosophy to medical education – from physicians-in-training to seasoned health care professionals- is to employ a multi-disciplinary approach. Our programs bring together internationally recognized leaders and educators to highlight our device functionality, performance, and latest clinical data. These programs are successful at enhancing clinical skill sets and patient management.

Among our most impactful programs are peer-to-peer and disease state specific events. Our peer-to-peer programs often include a diverse panel and come in various formats. One is a comprehensive overview of our entire product and procedural portfolio. This format allows for an interactive discussion, featuring radiologists, vascular surgeons, and interventional cardiologists, to review the latest advancements in mechanical thrombectomy and embolization, and examine procedural mechanics through best practices. Case presentations are an important part of the teaching tools used to educate physicians and medical team. The audience is typically early in their experience with Penumbra’s technology. Another program format is focused on specific disease states (ie, venous disease), bringing together specialists for a deep dive into the condition, assessing recent clinical research and applying clinical data to day-to-day practice.    

Adopting Virtual and Hybrid Programming to Extend Global Reach

The COVID-19 pandemic escalated the adoption of virtual teaching modalities to connect and communicate with medical staff and physicians. The opportunity to offer new ways to engage and educate allowed us to connect world-renowned key opinion leaders with care providers across the globe, which was particularly impactful in rural areas and other remote locations.

We partnered with many professional societies to provide unique education opportunities through virtual webinars and live-streaming content on a variety of digital platforms. This was important when we launched new technology during the pandemic across many regions around the world, and now is a significant addition to our educational program offering for years to come. For example, Penumbra’s partnership with live stream companies such as Avail Medsystems enables us to share live cases with providers virtually anywhere around the world. This is an effective presentation of our technology in-use and allows for group discussion around clinically significant aspects to the case, furthering the ability to refine technique and foster conversation around real-world use.

Educating Across Care Teams

We believe that all members of the care team are important to achieve successful patient outcomes. By engaging a broad array of clinical staff, we can improve patient care by anticipating needs pre-, during, and post procedure. In 2022 alone, we have provided education to thousands of technologists and nurses with our continuing education programming.

As the field of interventional medicine and mechanical thrombectomy innovation continue to advance, engaging providers across specialties and career-levels remains a high priority to ensure physicians and patients have access to the best treatment options. Innovative programming, strategic collaborations, and opportunities to connect both in-person or virtually all are imperative to achieve our collective goal of improving patient care with the latest technologies.

Penumbra, Inc. is a global healthcare company that designs, develops, manufactures, and markets novel products and has a broad portfolio that addresses challenging medical conditions in markets with significant unmet need. To learn more about Penumbra’s upcoming medical education programs, please email [email protected].