Venous Disease and the Vascular Medicine Specialist
Geoffrey Barnes, MD - University of Michigan Cardiovascular Center
While the field of vascular medicine is not new (it began in the 1950’s), it is also not widely recognized. In fact, formal training programs in vascular medicine exist at only a small number of academic training hospitals while the number of patients served by a vascular medicine specialist continues to grow. The unique vascular medicine skill set can be of great value to patients and providers, alike. Like training in both vascular surgery and interventional radiology, vascular medicine specialists receive training for a variety of clinical scenarios. Most vascular medicine specialists spend time with patients who have peripheral artery disease, aneurysmal arterial disease, carotid artery disease and the interpretation of vascular imaging studies. We also receive training in management of advanced lipid disorders, hypertension and anticoagulation therapy. Some even spend time training on endovascular procedures, though this is not uniform and many vascular medicine specialists do not perform invasive procedures.
Venous disease is a unique area where vascular medicine specialists can provide significant benefit to both patients and providers. Most vascular medicine specialists have undergone training in the management of acute and chronic deep venous thrombosis, acute pulmonary embolism and the complications arising from chronic venous insufficiency/post thrombotic syndrome. We have also spent time working closely with hematologists and rheumatologists to understand the nuances of hypercoagulable and inflammatory states. Given our training in internal medicine (many of us also in cardiology), we can help to assess for other systemic causes that may contribute to the venous disorder from which a patient is suffering.
Many health care systems, like ours at the University of Michigan, value a multi-disciplinary approach to the care of patients with venous disease. We frequently share patients between the vascular surgeons, vascular medicine specialists and interventional radiologists. We also have regular multidisciplinary conferences to discuss challenging patients and to develop treatment plans based on the input from members of each of these specialties.
To that end, effective training for vascular medicine specialists must include exposure to the interventional and surgical techniques used by vascular surgeons and interventional radiologists. While most training programs offer a “hands on” experience at their institution, the Fellows Training Course offered by the American Venous Forum is unique means to supplement our training. While attending the course this spring, I found that I was able to interact with trainees and faculty from all specialties who were performing routine and advanced procedures not practiced at all institutions. I was also able to discuss complex and challenging cases with the group and learn how cases are managed differently at each center. I was then able to bring that experience back to my institution and share what I learned with our multidisciplinary team. In the end, I believe that my patients will benefit from the exposure and training I received at the AVF Fellows Course.
I would strongly encourage other vascular medicine specialists and trainees to consider attending this course and the AVF should be applauded for being inclusive to trainees from a variety of programs. Like our multidisciplinary patient care, the variety of trainees at this course help to make it a better learning experience for all who attend. Along with the training received at the AVF Fellows Course and through the formal training programs, vascular medicine specialists can play a crucial role to helping to care for patients which a variety of vascular disorders, including all forms of venous disease.