AVF Venous Equity and Inclusivity Committee

In 2022, the AVF announced a new and exciting initiative centered around the importance of inclusivity, equity, and diversity entitled “Venous for All.” This effort, led by Drs. Ruth Bush, Kathleen Ozsvath, Misaki Kiguchi, and Elna Masuda evolved into an ad hoc DEI committee. Over the last few years, this team has successfully carried out the mission-aligned goal of incorporating these themes into exciting sessions at the annual AVF meetings. The enthusiasm around these sessions and topics has reinforced the importance and relevance of a commitment to this area to enable our society to be true leaders in venous disease care.

In 2024, the ad hoc DEI committee was formalized into the AVF DEI Committee under the executive branch of the AVF Board of Directors. This committee, currently chaired by Dr. Karem Harth and co-chaired by Dr. Oszvath, proposed a name change from “DEI Committee” to “VEI Committee – Venous Equity and Inclusivity Committee,” which was later approved by leadership. This committee maintains the goals of advancing awareness, understanding, acceptance, and respect of all ideas and people, and provides guidance on needed research and data on venous care and disparities.

As the VEI Committee forges ahead with efforts and ideas, a priority will be to foster research on topics that are sensitive to health disparities among underserved and underrepresented populations with a focus on venous health. We are excited about this work and look forward to bringing these efforts to our AVF annual meetings, to our members, and, importantly, to our patients.

AVF to Drive Awareness of Important Inari Study

American Venous Forum and Inari Medical, Inc. are pleased to announce a collaborative partnership on DEFIANCE, a prospective, multinational, randomized controlled trial. The trial will evaluate and compare the clinical outcomes of symptomatic unilateral iliofemoral deep vein thrombosis patients following treatment with mechanical thrombectomy using Inari’s ClotTriever^®System versus anticoagulation alone.

“AVF members pledge to practice evidence-based medicine, participate in scientific knowledge, and provide accurate information, so we commend Inari for their commitment to contributing high-quality evidence by conducting the first RCT for the use of mechanical thrombectomy in patients with DVT, comparing treatment with the ClotTriever^® System versus anticoagulation,” said Ruth Bush, MD, JD, MPH, President of AVF. “Early intervention with current mechanical thrombectomy devices has been widely adopted by our members, and since this treatment modality was introduced after DVT guidelines were last updated in 2012, this study is of great interest to our multi-disciplinary global community of venous experts.”

In collaboration with Inari, AVF will help create awareness of DEFIANCE through a series of communications to members and stakeholders. The study will enroll up to 300 patients at up to 60 global sites for 1:1 randomization to ClotTriever^® or anticoagulation treatment arms. The primary endpoint will be summarized by a win ratio methodology using a hierarchical composite endpoint of 1) treatment failure or therapy escalation, and 2) PTS severity assessed by Villalta score at the 6-month visit. The rigorous methodology of this trial will ensure that the results are reliable and applicable to real-world practice, leading to more accurate decision-making and better-informed treatment protocols.

“Inari is wholly committed to VTE patients and producing definitive evidence to support our technologies,” said Thomas Tu, MD, Inari’s Chief Medical Officer. “We are pleased to have the support of AVF, a nationally recognized academic society focused on venous disease. Our team is grateful for the collaboration and dedication of our clinical trial investigators who continually push the field forward in the name of better patient outcomes.”

AVF support for industry-sponsored scientific research is grounded in the belief that collaboration between the private sector and the scientific community can drive innovation and discovery related to novel technologies.

“DEFIANCE is an important step forward and will answer critical questions about how we manage DVT patients,” said Dr Bush. “It is our ultimate desire that the insights gained from this trial will drive advancements in patient care for all patients, enhancing safety, effectiveness, health equity, and overall healthcare quality.”

Note: AVF support of research is independent of specific products and does not constitute an endorsement.

“The American Venous Forum recognizes the importance of high-quality research including randomized controlled trials to establish guidelines in the management of venous disease like acute DVT and PTS. Ultimately, these types of studies can help to improve outcomes for our patients.” ~Ulka Sachdev, MD; Chair, AVF Research Committee

Advocacy & Policy Snapshot: AVF achieved milestones in 2024, challenges remain, 2025 looming reimbursement cuts

As we close out the final months of 2024, I am honored to give our members a brief overview of some key issues our Healthcare Policy Committee has worked on, and how we might see things evolve into early 2025. A big thanks to our Policy Committee for their insights, efforts, and their commitment to our patients and the domain of venous medicine.

• June 2024: The American Venous Forum officially seated in the American Medical Association’s House of Delegates

What an achievement! After several years of hard work, starting as just an idea, the AVF achieved a major strategic objective. In June, at the 2024 AMA Annual Meeting, our AVF delegate to the AMA, Loay S Kabbani, MD, MHSA, FACS and the American Venous forum were officially seated in the House of Delegates. This recognition of the AVF as a specialty society not only gives the AVF a voice in the “House of Medicine,” where national issues are discussed and debated, but also conveys to the AVF rights to participate in two vital forums: the CPT coding process and the RBRVS Update Committee, or RUC. The two venues, CPT and RUC, comprise the primary means by which codes are created and values determined.

In September, our new volunteer AVF Advisor to the RUC process, Harry Ma, MD, PhD, attended his first national RUC panel meeting. These meetings occur three times per year, so the AVF deeply appreciates Dr Ma’s willingness to serve as our Advisor. 2025 and 2026 may be critical years for the core venous codes, as we continue to advocate for appropriate and fair reimbursement.

• Engaging with Payers is a core mission of the Healthcare Policy Committee, both at the national and regional Medicare level, as well as with private payers. Typically, this entails writing comment letters, but we are eager to engage directly as opportunities arise.
  • On October 8^th, the Policy Committee held a productive hour long discussion with key clinical leaders from the company EviCore. EviCore works with select private payers to create the guidelines and coverage documents that a particular private payer will utilize. We covered a wide range of superficial and deep venous topics, referenced numerous literature citations, and answered questions that the EviCore clinical team posed to our committee members. I believe this call will open up some additional doors for us to advocate and share our clinical insights into vein care. Stay tuned for some additional information as warranted
  • Working with our partner societies and industry allies, the AVF is advocating for appropriate pneumatic compression for patients who are clinical candidates for this therapy. The regional Medicare Administrative Contractor (MAC), Noridian, announced they are retiring a LCD that may have limited patient access to pneumatic compression devices. Noridian will now default to a National Coverage Determination (NCD) which clinicians should find more flexible.
• Medicare cuts and declining reimbursement for specialty care remain our most difficult challenges. On Capitol Hill, it seems politicians of both parties acknowledge that our Part B Physician Fee Schedule system is broken, but tackling long-term systemic reform requires political will, and budget resources. For 2025, in the Proposed Rule, CMS has announced cuts in the Conversion Factor that will impact all providers of Part B services. Observers hope that Congress can step in during the December session and enact a bill to help reverse the cuts for 2025. More directly, cuts to specialists are even more outsized, due to the impact due to the fact that 2025 is the final year of CMS’s Clinical Labor Update policy, which impacts interventional specialty care especially. The effect that these cuts are having on patient access and fueling consolidation are already evident.

As a new Administration will be inaugurated in January, I do think we can expect the final weeks of 2024 to be busy. We will be asking our members to reach out to their elected officials, and to make your voice heard. Thank you.

Venous Early Career Course a Success

This year’s Venous Early Career Course (VECC) was attended by 48 physicians, surgeons, APPs, and medical students who travelled from all corners of the U.S., Egypt, Japan, Korea, Poland, and Colombia. The meeting was held in Chicago on October 4 and 5 at the University of Chicago Gleacher Center on the Chicago river. The views were impressive. The weather was perfect. In the mornings Lake Michigan, visible from our hotel, would reflect the light with a glow.

Travelling AVF faculty members were joined by local experts, Drs. Kush Desai, Mona Li, and Ramona Gupta. Attendees had the opportunity to examine and evaluate ultrasound in real life patients, with audience participation. One good-humored patient roasted the attendees. Even Steve Elias was not spared.

Representatives from 10 different industry organizations provided hands-on stations. There was broad representation from makers of thrombectomy, ablation, sclerotherapy, and compression devices as well as by the American Board of Venous and Lymphatic Medicine. Attendees were able to try hands-on simulators for iliac vein stenting, IVUS, thrombectomy, and sclerotherapy.

At dinner, the Philips IVUS competition winner, Pedro Furtado Neves, presented a detailed version of his IVC recanalization case. Pedro will be remembered as an endearing and enthusiastic speaker and as the only attendee wearing a tie.

The hard work of the AVF staff, Early Career Committee Members, and faculty paid off with another great VECC.

Associate’s Corner: AVF Invests in Education for APPs

The Venous Early Career Course (VECC) took place in Chicago on October 4-5, 2024. This time-honored tradition is near and dear to many in the American Venous Forum because it provides an opportunity to meet new up-and-coming physicians, residents, and fellows interested in the venous field from all over the world. At this course, the attendees are given true hands-on training in small groups. This year marked a first of what we hope will become a tradition: Associate Member advanced practice providers (APPs) were invited to join. Also, eight APP scholarships were graciously awarded.

As a participant, I believe this was one of the most beneficial courses I have attended. The material was focused on venous disease, yes; but we also concentrated on how to complete a physical exam with a venous focus. Other attendees remarked that “having an environment conducive to interacting with the faculty” was a key aspect of the program. Indeed, the informal atmosphere and the faculty’s being so supportive and approachable did not go unnoticed. Not only did the speakers give phenomenal presentations of the workup, diagnosis, and follow-up of chronic venous insufficiency, they also touched on more proximal disease, as well as lymphedema, lipedema, and the treatments and therapies available for all. Associate Members noted, “I won’t be treating pelvic disease in my practice, but I had a pretty big knowledge gap that was filled and will help me tremendously as I assess, order studies, and refer these patients.” Another feature of this course was that the vendors took an interactive approach, providing hands-on training with some of the treatment options available. We were not rushed, as this is a small group. There was ample time to “play with the toys” and ask questions.

VECC was refreshing and fun as much as it was informative with teaching according to best practice. This will continue at the AVF APP+ sessions at VENOUS25 in February. We have planned a similar informal atmosphere along with vendor collaboration to present fully interactive sessions. The APPs will learn how to approach venous patients, perform and read ultrasounds, treat chronic wounds, and perform sclerotherapy.

Physician members are requested to encourage APPs and nurses to take advantage of our Become a Member (BAM) campaign through December 2024 to join AVF as an Associate Member and attend the APP+ sessions in Atlanta, GA. The mentorship they will receive will help provide the best venous care for all our patients.