Promoting venous and lymphatic health
Spring Fellows, Resident, and Early Career Course was a huge success! The key to the success of the course is having the right mix of faculty. This spring there was a great group: Makis Avgerinos (Pittsburgh), John Carson (Maine), Shelia Coogan (San Antonio), Nick Sikalas (Stony Brook) and Kathleen Ozsvath (Albany) and Steve Elias as the course Director (Englewood). Thanks to all the faculty!
Did you miss it? Register for the Fall Course in Sacramento, CA, December 6-7th now!
Thank you to all our Council and Committee Chairs at the AVF for their leadership, commitment and dedication to the mission of the AVF.
ADMINISTRATIVE COUNCIL – William Marston, MD
Annual Program Committee – Patrick Muck, MD
Health Policy Committee – Daniel Monahan, MD
Membership Committee – Cassius Chaar, MD
Newsletter Committee – Steven Elias, MD
Distinguished Fellows Committee – Peter Gloviczki, MD
Early Career Venous Committee – Kathleen Ozsvath, MD
EDUCATION COUNCIL – Ruth Bush, MD
EDUCATION COUNCIL – Ellen Dillavou, MD
Ethics Committee – Joann Lohr, MD
Fellows Course Committee – Nasim Hedayati, MD
Finance Committee – Glenn Jacobowitz, MD, FACS, RVT
Patient Education Committee – John Blebea, MD
Website and Social Media Committee – Anil Hingorani, MD
West Coast Vein Forum Committee – Daniel Monahan, MD
West Coast Vein Forum Committee – Ellen Dillavou, MD
International Committee – Jorge Ulloa, MD
RESEARCH COUNCIL – Jose Diaz, MD
RESEARCH COUNCIL – Faisal Aziz, MD
Registry Committee – Jose Almeida, MD
Research Committee – Mikel Sadek, MD
Research Committee – Faisal Aziz, MD
Guidelines Committee – Cynthia Shortel, MD
Guidelines Committee – Faisal Aziz, MD
Have questions or thoughts for the council or committee chairs?
Dr. Elna Masuda
AVFF President
Chief of Department of Vascular Surgery
Straub Medical Center, Honolulu, HI
Thank you Dr. Elna Masuda for your term as President of the AVF and welcome to Dr. Masuda to your Presidency of the American Venous Forum Foundation (AVFF). Dr. Masuda, located in the beautiful islands of Hawaii, has a passion for the treatment of both arterial and venous disease. She has provided care at Straub for more than 20 years, during which time she helped to facilitate the development of a vascular department that provides care in both arterial and venous diagnosis and intervention while focused on minimally invasive procedures to amerliorate these medical problems.
AVF and the chief editor Dr. Steve Elias are proud to announce the launch of Vein Specialist, a monthly newsletter to share the latest news, technology, clinical studies, and society news.
Dr. Steve Elias
Chief Editor Vein Specialist, AVF
Director of the Center for Vein Disease
at Englewood Hospital, Englewood, NJ
Dr. Mark Iafrati is a vascular surgeon in Boston, Massachusetts and is affiliated with multiple hospitals in the area, including MelroseWakefield Hospital and Tufts Medical Center. He received his medical degree from Tufts University School of Medicine and has been in practice for more than 20 years.
Chief, Vascular Surgery; Director, Vascular Center; Director, Center for Vascular, Wound Healing and Hyperbaric Medicine; Vascular Surgeon; Associate Professor, Tufts University School of Medicine
Clinical Focus Areas: Complex vascular surgery, vascular biology, endovascular surgery, venous surgery, complex wound care
The AVF-JOBST Research Grant will be funded and administered by the AVF Foundation. The Grant will provide $90,000 over two years chosen through a competitive and confidential peer-reviewed selection process.
1061 E. Main Street
Suite 300
East Dundee, IL 60118
847-752-5355
A hemangioma, commonly known as a “strawberry birthmark”, is the most common benign tumor of infancy. These vascular tumors grow very fast during the first year of life to the fear of the parents but then stop growing and actually get smaller very slowly during childhood so that they are usually gone by school age. Only in rare cases is any treatment needed. Congenital vascular malformations are the result of blood vessels not maturing (going to full development) while the infant is still in the mother’s womb. If this happens early, the abnormal blood vessels do not have the form usually seen with blood vessels and appears more like a spongy mass which can involve neighboring body parts. If this happens later in the pregnancy, the blood vessels look more normal but are abnormally small, abnormally large or have unusually connections with other blood vessels. As a part of congenital vascular malformations, the venous malformation is the most common and possibly the easiest to manage. Congenital vascular malformations do not go away and will require a lifetime of care.
Lymphedema is swelling in the leg, arm or other parts of the body due to the body’s inability to effectively remove lymph fluid (which contains proteins, fatty acids, waste from cell feeding and bacteria that enter the body). Lymphedema can happen because the formation of the lymph vessels during maturation was less than adequate (called primary lymphedema) or damage (injury) has occurred to the normally formed lymph channels and lymph nodes during surgery, from infection, from radiation treatment or other causes. It can also occur from too much lymph fluid being made such as can happen when venous disease is present. Before treating lymphedema itself a physician has to be sure that there is no infectious or other acute medical problem that must be dealt with. The most important medical therapy used for lymphedema is external compression treatments (massage, compression pumping, compression wraps and eventually compression stockings) to decrease the swelling and to keep it down. Surgery for lymphedema is a last option for only a select group of patients.
Iliac vein or vena cava vein blockage or narrowing prevents blood flow from getting out of the leg(s) since these are the major exit sites for this blood to get back to the heart. Removing blockages from these veins is possible with techniques that allow one to place a dilating balloon and stent (metallic support device) inside the narrowed vein. In the rare case that this is not successful, there are surgical procedures which can help.
Vein valves that do not work will cause blood to flow backward in the veins into the legs. This leads to problems with swelling, skin changes and even breakdown of the skin (ulcers). There are ways to stop this abnormal backward flow of blood by fixing the vein valves. If the valve is still present but just not meeting properly, the valve can be fixed with fine sutures. If the valve is totally damaged, one must place the refluxing system below a working valve in another part of the leg veins (transposition) or must take one from the arm as a transplant. Other techniques are being investigated but so far these are the more common ways to fix the problem.
The superficial leg veins can allow the backward flow of blood down the veins and result in lower leg swelling, skin changes and even skin breakdown (ulcers). By removing these non-working veins, the symptoms are made better. One can remove these veins from the body by pulling them out (stripping) or by burning the inside so that they scar shut (laser or radiowave ablation, or sclerotherapy). The patient must know that there can be problems with each method of removal and must believe that the benefits are better than the risks involved.
The information provided here is to serve as a guideline regarding one possible treatment (sclerotherapy) and what to expect. Therapy is very individualized to a single patient and the best treatment options for your condition should be discuss with physicians skilled in the evaluation and treatment of vein problems. Most patients will require several sclerotherapy treatments to fully treat their venous disease and may have veins return over a period of time requiring further therapy.
Evaluation of venous disease whether asymptomatic or causing severe symptoms begins with a good history and a physical examination including laboratory studies if necessary. Most venous disease is not a major problem for the patient and does not require a surgery or procedure. Patients with bothersome symptoms or recurrent ulcers may benefit from a procedure or surgery.
The abnormal backward flow of blood in the leg veins or blockages to the blood getting out of the leg can lead to problem including swelling, skin changes and even ulcers. Once the diagnosis is made, placing compression from the outside of the leg can correct many of the underlying problems such that the symptoms get better. Compression therapy comes in many forms and some devices are better for healing ulcers (open skin lesions) and other for maintaining a steady state within the leg.
Spider veins are very small blemishes within the skin. The cause of the spider veins must be sought and treated prior to taking care of the skin blemish. To eliminate the spider veins, currently two treatments are commonly used; Laser treatment uses light to heat the spider vein resulting in scarring while sclerotherapy uses drugs to damage the inside of the vein resulting in scarring. Each method has risks including a worsened cosmetic appearance for the potential benefit of eliminating the blemish.
Two other major contributors to venous insufficiency are venous reflux and venous obstruction. Regardless of the cause, chronic venous insufficiency and chronic venous hypertension may result in leg swelling, skin darkening or hyperpigmentation, skin thickening or lipodermatosclerosis (fat and skin scar development), and even sores or ulcers. Your doctor can do laboratory testing and vascular testing to determine what conditions you may have.
Axillo-subclavian vein thrombosis occurs as a result of abnormal muscle and/or rib anomalies of the thoracic outlet at the base of the neck and ribcage. Treatment should be done rapidly and involves three steps which includes dissolving the clot, maintaining anticoagulation (stopping any new clots from forming) with a blood thinner and surgical treatment to eliminate the external compression on the subclavian vein.
Blood clots from the large veins of the legs and pelvis can produce life threatening Pulmonary Embolism (PE) if left untreated such as when standard therapy cannot be used. PE management might include placement of an inferior vena cava filter effective in preventing PE. However filter does not reduce the risk to zero nor does it treat the underlying venous clotting problem. Therefore continued anticoagulant therapy (blood thinners) should be used when possible.
The most common symptoms of DVT are pain and swelling, but many DVTs have no symptoms. The most common symptoms of PE are sudden onset of chest pain and shortness of breath. A low threshold to get further tests is needed in order to diagnose most DVTs because the symptoms are vague. DVT is usually diagnosed with ultrasound, and PE is usually diagnosed with CT scan, but other tests may be needed to make the diagnosis.
DVT and PE are treated essentially the same. In this chapter you will discover what is the treatment’s strategy using heparin (often LMWH) and warfarin. In the case of a recurrent event, warfarin may be continued for life. If blood thinners aren’t able to be used, a filter can be placed to prevent the clot from traveling to the lungs. If symptoms are very severe, removal of the clot from the vein, usually by thrombolysis, can be undertaken.
There are several interventional treatment options for acute deep venous thrombosis (DVT): catheter-directed thrombolysis with or without mechanical device use is the preferred treatment option for patients with iliofemoral deep venous thrombosis who are otherwise healthy and have no contraindication to receiving a thrombolytic drug. If thrombolysis is too high a risk, venous thrombectomy is recommended. For patients who are bedridden and those who are in very poor health, treatment with anticoagulation agents (blood-thinning agents) alone may be advisable. Successful and timely clot removal in patients with iliofemoral DVT results is less post-thrombotic symptoms and an improved health-related quality of life.
The normal balance between clot formation and breakdown can be changed by the presence of certain genetic or acquired defects leading to abnormal clot formation. In this chapter you will learn about different factors that can increase the risk of VTE. These conditions should be looked for in any person who has a VTE, unless the cause is already known.
Summary: This chapter will tell you how blood flow circulates in the blood vessels called arteries from heart to the legs and back to the heart through the veins, blood vessels that return the nutritionally depleted blood. You will learn about normal venous return and abnormal venous function, which may result in swelling or edema and skin damage such a discoloration, darkening, thickening and ulceration.
Venous thromboembolism (VTE), which is either deep vein thrombosis (DVT) or pulmonary embolus (PE), is the 4th leading cause of death in Western society. Thus, preventing VTE is very important. This chapter will discuss the main ways to prevent a DVT or PE.
Most cases of Superficial Venous Thrombosis are not noticed or taken seriously by the patient and often get better without treatment. It is important however to make sure that the patient does not have a condition which is causing more than normal blood clotting (hypercoagulable states) or has an unknown cancer. In this chapter you will learn about the diagnostic tests and treatment’s options for the Superficial Venous Thrombosis.
This chapter will discuss the common risk factors for Deep Vein Thrombosis (DVT: blood clots forming in the deep veins often of the leg, pelvic or abdomen but can also occur in the arm veins), the changes that occur in a vein after a clot has formed, and what happens to the clot over time. Among patients with DVT, one third of them are diagnosed due to a pulmonary embolus (PE), a blood clot traveling in the blood vessels to the lung, causing shortness of breath and chest pain. The long-term effects of DVT, called post-thrombotic syndrome (PTS), can be associated with skin discoloration, ulceration and other skin changes in the legs.