The variation in insurance policy coverage pertaining to the treatment of venous disease in the United States continues to unevenly impact patients and providers. To better understand this insurance landscape, the Research Committee of the American Venous Forum utilized the AVF’s Venous Policy Navigator to compare more than 230 insurance policies active in 2022. Their findings, published in the November issue of the JVS-VL, demonstrate that despite thorough clinical practice guidelines endorsed by the AVF, SVS, and ALVS and many other clinical organizations, payors continue to perpetuate restrictive policies. In this paper the Research Committee examined the question as to whether policies covering multiple states differed from single-state policies. These data reflect that the multistate policies, while far from perfect, have generally moved significantly in the direction of adopting clinical practice guidelines impacting the technologies covered, vein size, reflux time, and compression trials compared to single-state policies. This likely reflects the increased level of importance assigned to writing and revising policies that have a national or regional impact.  While we applaud the progress made in updating these multistate policies this report clearly identifies the need for Advocacy groups to work with carriers with single-state vein policies to embrace evidence-based policies and to appropriately weight the recommendations in Clinical Practice Guidelines in making their policy decisions. The AVF’s Venous Policy Navigator has been shown to be a tremendously powerful tool in bringing these disparities to light and provides us a streamlined avenue to track changes moving forward.

Click here to read the article, Variations and inconsistencies in venous ablation coverage policies between single-state and multistate carriers in the United States

Hemodynamics for Surgeons, edited by Strandness and Sumner, was published in 1975 and quickly fell into the ”must have”’ category for an emerging new cadre of vascular surgeons. Today, the original edition has long been out of print, but used copies still sell for thousands of dollars, a sign of the lasting popularity of the book.  The new Sumner’s Hemodynamic Guide to Venous Diagnosis and Interventionedited by Jose Almeida, Ghassan Kassab, and Fedor Lurie is modeled to perpetuate the essence and style of the original book.

The primary audience for this book is venous clinicians. But, as we know, the venous space has become very device-centric; there are many stakeholders now, particularly engineers. There is a collaborative nature in work so that we have clinicians and engineers working together. Physicians bring in engineers and help them understand what the problems are, what things work, and more importantly, what things don’t work; for  example, what do we look for in a stent? What are the material characteristics that are more suitable for the venous system? How does it interact with the arterial system? What is the long-term follow up? What are the complications? What happens to these stents over time? What about post-thrombotic veins?

Engineers appreciate analytical and mathematical precision. The same laws of physics that apply to a shuttle or a bridge apply to our bodies too. If an engineer must design a bridge or a space shuttle or an automobile, they clearly need to understand the structure or the geometry of the system. To us on the medical side, we call that anatomy and physiology. In our case, we seek to understand the vascular system (the irrigation system, if you will) that delivers blood flow.

BB Lee, MD wrote an extensive review of the book in the Journal of Theoretical and Applied Vascular Research. He states “More precisely, they made such extensive review on every topic of venous hemodynamics, item after item, to leave no stone unturned…(1)

To order either the print or digital book (AVF members receive a 10% discount) on Shopify, go to https://cinemed.myshopify.com/.

Customer questions can be directed to Mary Panagrosso, CineMed, Inc. (800) 253-7657, ext 106.[email protected]

Reference

1. Lee BB. Review of Sumner’s Hemodynamic Guide to Venous Diagnosis and Intervention. JTAVR 2023;8:72.