5/30/2017 1 5/30/2017 VENOUS SYMPOSIUM: OVERVIEW Robert W. Vorhies, M.D., F.A.C.S. Vascular and Endovascular Surgery Endovenous Therapy and Vein Aesthetics Ferrell-Duncan Clinic, Cox Health Systems WHY DO WE CARE? • Epidemiology • Disability • Historical experience • Opportunity 2 5/30/2017 EPIDEMIOLOGY QUESTION #1 Which state has nearly the same population as all the people in the US with venous disease? • A. New York • B. Florida • C. California • D. Missouri EPIDEMIOLOGY QUESTION #1 Which state has nearly the population as all the people in the US with venous disease? • A. New York • B. Florida • C. California • More than 11 million men and 22 million women between the ages of 40 and 80 years in the United States have varicose veins. • Prevalence of 20% (range, 21.8%-29.4%) • D. Missouri Peter Gloviczki, Anthony J. Comerota, Michael C. Dalsing, Bo G. Eklof, David L. Gillespie, Monika L. Gloviczki, Joann M. Lohr, Robert B. McLafferty, Mark H. Meissner, M. Hassan Murad, Frank T. Padberg, Peter J. Pappas, Marc A. Passman Joseph D. Raffetto, Michael A. Vasquez, and Thomas W. Wakefield. “The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum.” J Vasc Surg . 2011;53:2S-48S. 3 5/30/2017 EPIDEMIOLOGY QUESTION #2 • Which mid western metropolitan area has about the same number of people as those with severe chronic venous insufficiency including ulcers and skin changes? • A. Minneapolis • B. Chicago • C. St. Louis • D. Kansas City. EPIDEMIOLOGY QUESTION #2 • Which mid western city has about the same number of people as those with severe chronic venous insufficiency including ulcers and skin changes? • A. Minneapolis • B. Chicago • C. St. Louis •D. Kansas City • About 2 million adults have advanced chronic venous disease (CVD) with skin changes or ulcers. • Venous edema, skin changes or venous ulcerations: about 5% (range, 3.6%-8.6%) • Active venous ulcers up to 0.5%, and 0.6% to 1.4% have healed ulcers. Peter Gloviczki, Anthony J. Comerota, Michael C. Dalsing, Bo G. Eklof, David L. Gillespie, Monika L. Gloviczki, Joann M. Lohr, Robert B. McLafferty, Mark H. Meissner, M. Hassan Murad, Frank T. Padberg, Peter J. Pappas, Marc A. Passman Joseph D. Raffetto, Michael A. Vasquez, and Thomas W. Wakefield. “The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum.” J Vasc Surg . 2011;53:2S-48S. 4 5/30/2017 EPIDEMIOLOGY QUESTION #3 • Which Ozarks area community has about the same number of people as those with newly diagnosed venous ulcers? • A. Springfield • B. Nixa • C. Harrison • D. Joplin QUESTION #3 • Which Ozarks area community has about the same number of people as those with newly diagnosed venous ulcers? • A. Springfield • B. Nixa • In the United States each year, at least 20,556 patients receive a new diagnosis of venous ulcers. • C. Harrison • D. Joplin Peter Gloviczki, Anthony J. Comerota, Michael C. Dalsing, Bo G. Eklof, David L. Gillespie, Monika L. Gloviczki, Joann M. Lohr, Robert B. McLafferty, Mark H. Meissner, M. Hassan Murad, Frank T. Padberg, Peter J. Pappas, Marc A. Passman Joseph D. Raffetto, Michael A. Vasquez, and Thomas W. Wakefield. “The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum.” J Vasc Surg . 2011;53:2S-48S. 5 5/30/2017 PREVALENCE OF CHRONIC VENOUS INSUFFICIENCY More than 30 million Americans suffer from varicose veins or a more serious form of venous disease called Chronic Venous Insufficiency (CVI). 1 Of the over 30 million Americans affected: Q Only 1.9 million seek treatment CVI Prevalence 1,2* annually. 1,2 30,000,000+ Q The vast majority remain undiagnosed and untreated. Seek Treatment *2 1,900,000 Treated 447,000 2 *Statistics based on individuals over the age of 40 1 Gloviczki P, et al. The care of patients with varicose veins and associated chronic diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. JVS; May 2011. 2 Lee, A. US markets for varicose vein treatment devices 2011. Millennium Research Group, Inc. (A Decision Resource, Inc. Company), www.mrg.net, May 2011. 1 1 DISABILITY • Loss of productivity and working days • Financial burden of venous complications to patients and society (1) • Decreased quality of life (QOL) • Early retirement. (2) 1. Bergan JJ, Schmid-Schönbein GW, Smith PD, et al. Chronic venous disease. N Engl J Med. 2006; 355: 488–498. 2) Kaplan RM, Criqui MH, Denenberg JO, Bergan J, Fronek A. “Quality of life in patients with chronic venous disease: San Diego population study.” J Vasc Surg 2003;37:1047-53. 6 5/30/2017 DISABILITY • Chronic venous ulcerations result in the loss of 2 million workdays and cost the US healthcare system an estimated $3 billion for managing this chronic condition. (1,2) • The physical impairment observed with venous ulceration (C5 and C6) has been shown to be similar to that observed with congestive heart failure and chronic lung disease. (3) 1. Gloviczki P, Comerota AJ, Dalsing MC, et al; for the Society for Vascular Surgery; American Venous Forum. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011; 53 (5 suppl): 2S–48S 2. McGuckin M, Waterman R, Brooks J, et al. Validation of venous leg ulcer guidelines in the United States and United Kingdom. Am J Surg. 2002; 183: 132– 1373. 3. Carradice D, Mazari FA, Samuel N, et al. Modelling the effect of venous disease on quality of life. Br J Surg. 2011; 98: 1089–1098. IMPORTANT STATISTICS ABOUT CHRONIC VENOUS INSUFFICIENCY Q Affects all age groups and is ten times more prevalent then PAD (1) Q Between 20-30% (30 million) people in the US have chronic venous disease (4), Q Only 1.9 million seek treatment (4) Q At least 20,556 patients receive a new diagnosis of venous ulcers each year 4 Q Direct cost of CVI in the US is estimated to be between $150 million and $3 billion per year (2) Q Indirect costs include 2 million lost workdays, decreased Quality of Life and early retirement ( 5) 1 Gordon P, Treat-Jacobson D, Sossoman L.B. Society for Vascular Nursing Position Statement on Inclusion of Vascular Disease into Nursing Education. Soc for Vascular Nursing. 2012;Sept:10. 2 Heller J. Treatment of chronic venous insufficiency. Supplement to Endovascular Today. 2011;Oct:12-15. 3 Weiss R, Venous Insufficiency. Medscape. November 21, 2012. 4 Gloviczki P, Comerota A.J, Dalsing M.C et al. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(suppl):2S-48S. 5. Carradice D, Mazari FA, Samuel N, et al. Modelling the effect of venous disease on quality of life. Br J Surg. 2011; 98: 1089–1098. 1 4 7 5/30/2017 HISTORICAL EXPERIENCE ANCIENT GREECE Lysimachides , son of Lysimachos, from Acharnai. 4th century B.C. National Archeological Museum, Athens Greece 8 5/30/2017 EARLY AMERICAN MEDICINE www.givingblood.org MODERN ERA MEDICINE www.venacure-evlt.com 9 5/30/2017 CONTEMPORY TREATMENTS www.fallgeneralsurgery.com OPPORTUNITY 10 5/30/2017 THE VENOUS SPECTRUM • Lower extremity • Upper extremity • Abdominal • Thoracic THE VENOUS SPECTRUM • Spider veins • Reticular veins • Varicose Veins • Perforating veins • Deep veins • Central veins 11 5/30/2017 SUPERFICIAL VARICOSE VEINS • They’re ALL varicose veins • Legs • Subcutaneous varicose veins • Reticular varicose veins • Spider varicose vein • Arms • Rare • See deep venous disease EXTREMITY DEEP VENOUS DISEASE • Lower • Upper • Obstruction / Phlebitis • Obstruction / Phlebitis • Deep Venous Thrombosis (DVT) • Deep Venous Thrombosis (DVT) • Insufficiency / “Reflux” • Insufficiency (rare) • Perforating veins • Tibial veins • Popliteal vein • “Femoral vein” (previously “Superficial femoral vein”) • Common femoral vein 12 5/30/2017 EXTREMITY SUPERFICIAL VENOUS DISEASE • Lower • Upper • Obstruction / Phlebitis • Obstruction / Phlebitis • Superficial thrombophlebitis (SVT) • Insufficiency (rare) • Insufficiency / “Reflux” • Great Saphenous Vein (GSV) • Lesser Saphenous Vein (LSV) • Intersaphenous Vein of Giacomini • Superficial varicosities 13 5/30/2017 ORDER OF EVENTS: FRIDAY, 12:00 – 5:30PM • Overview • Robert Vorhies, MD • Anatomy and Physiology • John Waites, MD • Ultrasound Evaluations • Brent Wilkinson, RDMS • Conservative therapies • Julie Highfill, PA-C • Laura Ross, PA-C • Lymphedema • Jan Weiss, PT, DHS, CLT-LANA 14 5/30/2017 ORDER OF EVENTS: SATURDAY, 7:30AM – 1:00PM • Deep vein interventions • Randy Mullins, MD • Venous stasis and ulcers • John Waites, MD • Pelvic congestion • Randy Mullins, MD • Varicose vein procedures • Zak Schmittling, MD • Mechanico-Chemical Ablation • Robert Vorhies, MD REFERENCES • Peter Gloviczki, Anthony J. Comerota, Michael C. Dalsing, Bo G. Eklof, David L. Gillespie, Monika L. Gloviczki, Joann M. Lohr, Robert B. McLafferty, Mark H. Meissner, M. Hassan Murad, Frank T. Padberg, Peter J. Pappas, Marc A. Passman Joseph D. Raffetto, Michael A. Vasquez, and Thomas W. Wakefield. “The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum.” J Vasc Surg . 2011;53:2S-48S. • Lee, A. US markets for varicose vein treatment devices 2011. Millennium Research Group, Inc. (A Decision Resource, Inc. Company), www.mrg.net, May 2011. • Wikipedia Population lists of the United States • .venacure-evlt.com • .givingblood.org • fallgeneralsurgery.com • Kaplan RM, Criqui MH, Denenberg JO, Bergan J, Fronek A. “Quality of life in patients with chronic venous disease: San Diego population study.” J Vasc Surg 2003;37:1047-53 • Mallick R, Raju A, Campbell C, et al.