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Who should treat vein disease?

January 6, 2014 • the kimmel institute • Uncategorized

For years, patients suffering with varicose veins/venous insufficiency had only one treatment option – a hospital-based, painful procedure called “vein stripping,” performed only by a vascular/cardiothoracic surgeon.  This procedure was traumatic, required a long recovery period and held a high chance of recurrence. Expansion of the Venous Field In 1999, the field of vein treatment changed radically with the FDA-approval for radiofrequency ablation, and in 2002 with the FDA approval of endovenous laser ablation.  The ability for a surgeon to now “close” a diseased vein using laser or radiofrequency heat enabled the procedures to be performed in-office, under local anesthesia by physicians no longer needing hospital rights. What was once the domain of general and vascular surgeons has also fallen into the hands of anesthesiologists, dermatologists, internists, family practitioners, obstetrician/gynecologists—or “phlebologists.” Phlebology traditionally encompassed the evaluation and treatment of superficial and perforating leg veins (not deep veins) in patients with spider and varicose veins or venous ulcers, using minor surgery or sclerotherapy.  However, it is now used in much more general terms by vein specialists to refer to all venous treatment – both superficial and deep. The subspecialty of phlebology has been trying to find its proper place in our medical system for the past 25 years. Until that time, the field of phlebology was not even on the radar screen—and only a few physicians practiced it. However, soon after radiofrequency ablation obtained FDA approval in 1999, then laser ablation in 2002, the field of venous disease treatment officially embraced the minimally invasive revolution and boomed. The influx of specialists from many other fields of medicine swelled, and the landscape changed. Vein “Specialists” The question “Who should treat vein disease?” is difficult to answer, but in attempting to do so, “treat” is the key word.  Vein disease treatment is largely procedure-based. With the exception of thrombotic complications, medications are rarely effective to treat vein disease, and compression stockings are only useful to manage symptoms; they do not treat the underlying disease. To adequately treat vein disease, today’s vein specialists must be adept at all currently available minimally invasive procedures. Because venous disease may involve the superficial or deep systems, lower or upper extremities, chest, abdomen, or pelvis, comprehensive knowledge and procedural skills are required for the vein specialist to feel comfortable treating the breadth of issues with which patients may present. Comprehensive knowledge can be acquired via instructional courses, textbooks, online study, etc., by all practitioners who manage vein disease. Comprehensive knowledge must be a given. However, procedural skill sets at this comprehensive level are usually acquired via advanced fellowship training in a procedure-driven specialty such as cardiovascular/vascular surgery and may not be achievable by all. But many of today’s vein care practitioners have evolved from non-procedure oriented specialties such as family medicine, internal medicine, dermatology, etc., and are only able to treat superficial venous disease. With the overabundance of vein treatment centers, we will be driven toward a newer definition of vein specialist.  It is clear that the treatment of deep venous disease requires different skill sets than that of superficial venous disease.  Some areas of medicine, such as internal medicine and family practice, are not heavily procedure oriented. Although not impossible, it is hard to gain acceptable competency in advanced catheter/surgical techniques if one was not previously exposed to them during residency training. This differs from those who only need to “reawaken” these skills that were learned in training programs for vascular specialties. The concerted efforts and mutual cooperation of physician leaders, societies, and industry are driving us toward a clearer definition of the “vein specialist.”    As you seek your options for treatment of your vein disease in South Florida, it is important to know that this has been a highly unregulated field, and efforts are being made to identify and qualify the “true” vein specialists. Please call The Kimmel Institute, a South Florida leader in the diagnosis and treatment of vein disease, to schedule a free consult; 561-477-0210. Dr. Richard Kimmel  

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