The Clinic is Closed

American Venous Forum 2012

I have spent the last week at the American Venous Forum in Orlando. The AVF is one of the largest international meetings of vein specialists and I believe that it is important for me to attend such meetings so that I remain up to date and to ensure that I continue to offer the most modern, safe and effective treatment options for vein conditions.

As well as providing technical information about venous disease, complications of veins and how vein problems should be treated, the AVF also sheds light on what is happening around the world and offers glimpses into the future of vein treatments.

Here are my top 5 AVF learning points:

1) The Sapheon Closure System
The results of using Sapheon super-glue were presented. A medical formulation of cyanoacrylate has been invented to seal faulty veins and the early results of the technique were presented to the AVF. The number of people treated is small, but the technique may soon be in use in Europe and the UK. The glue is injected directly into the unhealthy veins under ultrasound guidance and then eventually the veins disperse and disappear naturally. Blood is then re-routed to healthy veins. Unlike laser, VNUS or Foam Sclerotherapy, compression with medical stockings is not needed. The glue has a CE mark and is available already in Europe and is called VenaSeal. I am following this innovation with interest and as soon as it is proven to be effective and safe, I will be offering this new technique.

2) Poor Provision in UK
In the last 10 years, a huge gap in the number of people treated with varicose veins has developed between the USA and the UK. The provision of varicose vein treatments can be measured by the number of varicose vein treatments per million people of the population. In 2002, 696 vein procedures per million people were performed in the UK. The corresponding number in the USA was 533. By 2010, the number was 531 in the UK and 2,313 in the USA. So there has been a reduction in vein treatments in the UK of nearly 24% and an increase of vein procedures in the USA of over 435%! To me this indicates that there is a gross under provision in the UK and many people with vein problems are simply not receiving treatment.

3) Ultrasound is Essential
All at the AVF agree that good quality ultrasound is essential for diagnosing veins problems, monitoring treatment and assessing the results afterwards. Good equipment is needed but also the person performing the ultrasound needs to understand the vein anatomy and be knowledgable about vein disorders. My own preference at present is to perform my own ultrasound scans before, during and after treatment. I use my scanner in the way other doctors use a stethoscope – it’s always by my side in my clinic. I wouldn’t dream of sending my patients away to have someone else listen to their heart and lungs with a stethoscope and I wouldn’t dream of asking someone else to perform vein scans for me.

4) Vein Screening is Valuable
The AVF has a screening programme which allows people with leg symptoms of ache, swelling and itch to have a screening assessment to determine if they have vein problems or to check if they may be at risk of DVT. A similar programme in the UK might reduce DVT and leg ulcers.

5) Venous Disease is Important
Varicose veins are not simply cosmetic. They negatively affect people’s quality of life and are even associated with depression. In the USA, blood clots from leg veins have been identified as the 3rd leading cause of death. My impression is that many doctors in the UK do not take veins seriously.

Next month I will be speaking at a vein conference in Florence and this will be the subject of a future blog.