Vascular Specialist–June 2024

VAM 2024

Presidential welcome

It is with great excitement and anticipation that I welcome you to the Vascular Annual Meeting (VAM), taking place from June 19–22 in the city of Chicago. This year’s meeting promises to be an exceptional convergence of the brightest minds and most dedicated practitioners in vascular surgery (writes Joseph L. Mills, MD).

VAM 2024 is not just another conference—it’s a dynamic gathering where innovation meets expertise. Over four days, we will offer premier educational sessions, groundbreaking research presentations and interactive panel discussions. This year’s program is designed to ignite your curiosity and fuel your passion for excellence in vascular care.

As we look forward to the meeting, we also mark the end of an era for two of our distinguished colleagues. Andres Schanzer, MD, who has been an integral part of the Society for Vascular Surgery (SVS) Program Committee for the past decade and served as the VAM program chair, will be concluding his term. Likewise, William Robinson, MD, who has been a cornerstone of the Postgraduate Education Committee (PGEC), will be finishing his term. Their contributions have been invaluable, and we owe them a debt of gratitude for their dedication and leadership.

One of the highlights of VAM will be the inaugural SVS Keynote Speaker Series, headlined by Karith Foster, the CEO of Inversity Solutions. Her insights

2 From the editor Malachi Sheahan III ruminates on a developing “House of Cards”

10 Corner Stitch Women in leadership: It matters to trainees too, says Saranya Sundaram

12 Advocacy SVS PAC and advocating for excellency in vascular healthcare

15 Innovation ‘The forgotten stepchild of vascular surgery’: Pushing forward venous disease

www.vascularspecialistonline.com

Verified vascular!

Quality care in vascular disease will form a central backdrop to this year’s Vascular Annual Meeting (VAM).

By Kristin Spencer and Bryan Kay

The Society for Vascular Surgery (SVS) and American College of Surgeons (ACS) Vascular Verification Program (Vascular-VP) will be a central focus on VAM 2024 opening day as the topic of the E. Stanley Crawford Critical Issues Forum. The Crawford Forum, traditionally put together by the SVS president-elect, drills into the existential issues facing vascular surgery, with quality in vascular care being an ever-increasing priority for the SVS. This year’s incoming President Matthew Eagleton (pictured inset, above), MD, has assembled an experienced cast of speakers under the moniker: Quality Care

Everywhere. Following a short introduction from Eagleton, Clifford Y. Ko, MD, the director of the Division of Research and Optimal Patient Care at the ACS, will open the session with an overview of the ACS’ quality initiative, quality campaign, and its collaborations with specialty organizations. Anton N. Sidawy, MD, a former SVS president and one of the driving forces behind the VascularVP, will then outline how the vascular-specific quality program came about. Sidawy will be followed by R. Clement Darling III, MD,

See page 5

CRAWFORD FORUM

Medical Editor Malachi Sheahan III, MD

Associate Medical Editors

Bernadette Aulivola, MD | O. William Brown, MD | Elliot L. Chaikof, MD, PhD

| Carlo Dall’Olmo, MD | Alan M. Dietzek MD, RPVI, FACS | John F. Eidt, MD | Robert Fitridge, MD | Dennis R. Gable, MD | Linda Harris, MD | Krishna Jain, MD | Larry Kraiss, MD | Joann Lohr, MD

| James McKinsey, MD | Joseph Mills, MD | Erica L. Mitchell, MD, MEd, FACS

| Leila Mureebe, MD | Frank Pomposelli, MD | David Rigberg, MD | Clifford Sales, MD | Bhagwan Satiani, MD | Larry Scher, MD | Marc Schermerhorn, MD | Murray L. Shames, MD | Niten Singh, MD | Frank J. Veith, MD | Robert Eugene Zierler, MD

Resident/Fellow Editor

Christopher Audu, MD

Executive Director SVS

Kenneth M. Slaw, PhD

Senior Director for Public Affairs and Advocacy

Megan Marcinko, MPS

Manager of Marketing

Kristin Spencer

Communications Specialist

Marlén Gomez

Published by BIBA News, which is a subsidiary of BIBA Medical Ltd.

Publisher Stephen Greenhalgh

Content Director Urmila Kerslake

Global Commercial Director Sean Langer

Managing Editor Bryan Kay bryan@bibamedical.com

Editorial contribution Jocelyn Hudson, Will Date, Jamie Bell, Brian McHugh, Éva Malpass and George Barker

Design Terry Hawes

Advertising Nicole Schmitz nicole@bibamedical.com

Letters to the editor vascularspecialist@vascularsociety.org

BIBA Medical, Europe 526 Fulham Road, London SW6 5NR, United Kingdom

BIBA Medical, North America 155 North Wacker Drive – Suite 4250, Chicago, IL 60606, USA

Vascular Specialist is the official newspaper of the Society for Vascular Surgery and provides the vascular specialist with timely and relevant news and commentary about clinical developments and about the impact of healthcare policy. Content for Vascular Specialist is provided by BIBA News. Content for the news from SVS is provided by the Society for Vascular Surgery. The ideas and opinions expressed in Vascular Specialist do not necessarily reflect those of the Society or the Publisher. The Society for Vascular Surgery and BIBA News will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services, or the quality or endorsement of advertised products or services, mentioned herein. | The Society for Vascular Surgery headquarters is located at 9400 W. Higgins Road, Suite 315, Rosemont, IL 60018. | POSTMASTER: Send changes of address (with old mailing label) to Vascular Specialist, Subscription Services, 9400 W. Higgins Road, Suite 315, Rosemont, IL 60018. |

RECIPIENT: To change your address, e-mail subscriptions@bibamedical.com | For missing issue claims, e-mail subscriptions@bibamedical. com. | Vascular Specialist (ISSN 1558-0148) is published monthly for the Society for Vascular Surgery by BIBA News. | Printed by Ironmark |

©Copyright 2024 by the Society for Vascular Surgery

FROM THE EDITOR

House of Cards

By Malachi Sheahan III, MD

On Jan. 22, 2024, the American Heart Association (AHA) and the American College of Cardiology (ACC), together with three other major cardiology societies, submitted a proposal for the formation of the American Board of Cardiovascular Medicine. Essentially the 157-page document requests the transition of cardiology and its subspecialties from oversight within the American Board of Internal Medicine (ABIM) to an independent entity within the American Board of Medical Specialties (ABMS). The success or failure of the proposal will likely have little effect on the day-to-day practice of cardiology in our country. It does, however, give an excellent insight into the current thinking of the leadership of their major societies and their vision for the future. Unsurprisingly, I do not agree with some aspects of the document, particularly as it relates to cardiologists practicing in the peripheral vascular space.

The Accreditation Council for Graduate Medical Education (ACGME) oversees the accreditation of residency and fellowship programs in the U.S. Their Program Requirements for Graduate Medical Education (7/1/24) define interventional cardiology as “the practice of procedural techniques that improve coronary circulation, alleviate valvular stenosis and regurgitation, and treat other structural heart disease.” No mention of peripheral vascular disease, carotid stenosis or aortic aneurysms. The ACGME understood the assignment. Fittingly, the requirements for interventional cardiology fellowships include detailed descriptions of a variety of ischemic, structural and valvular disorders in which fellows must acquire competence. A minimum of 250 coronary interventions are also mandatory. Faculty members must be available with expertise in hematology, pharmacology, radiation safety and congenital heart disease in adults. There are no guidelines or requirements for training and competence in peripheral vascular disease.

The ABMS, through its 24 member boards, provides certification for a wide variety of medical specialties. The mission of ABMS is to “serve the public and the medical profession by improving the quality of healthcare through setting professional standards for lifelong certification.” The ABMS defines interventional cardiology as “an area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart, and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system.” So maybe there is the loophole. The “vascular” in “cardiovascular.” Thankfully though, the board provides blueprints of its exams so we can see the disease states which a certified interventional cardiologist is expected to treat.

is specifically tagged with a “low-frequency” designation. Look, I have no interest in being the main character on #cardiotwitter again. (By the way, why is everyone there named something like @CLTImuscularwarrior? Where are my @DVTdoughboys and @claudicationcouchpotatoes?)

Cardiologists don’t have to take my word for what constitutes adequate training in peripheral vascular disease. Their own leading societies—the ACC, AHA and Society for Cardiovascular Angiography and Interventions (SCAI)— published an advanced training statement in 2023. They lay out the problem here: “One year of advanced fellowship training focused predominantly on coronary interventions will likely not provide adequate clinical exposure and procedural experience to achieve competency in all other areas of interventional cardiology. Additional fellowship or post-fellowship training will be needed to gain the experience necessary to become a competent, independent expert in most aspects of peripheral vascular or structural heart interventions.” The statement then describes what they refer to as Level III training in peripheral vascular interventions, most of which they admit must be acquired outside of the traditional interventional cardiology fellowship. The document lists a variety of vascular conditions, suggesting that physicians can pick and choose to learn them individually, like ordering apps in a Cheesecake Factory. Level III trainees are not expected to be expert in the management of less common vascular conditions and should utilize “information technology or other available methodologies.” Unfortunately, there is no Level IV in this training paradigm so I guess Google it?

Cardiologists don’t have to take my word for what constitutes adequate training in peripheral vascular disease. Their own leading societies published an advanced training statement in 2023

What about venous disorders? The document states “management of venous occlusive disease, compression and reflux should be part of the curriculum.” Spoiler—it is not. In listing the milestones for peripheral vascular interventions, essentially everything outside of a nonselective aortogram is considered an additional competency that extends beyond the core expectations. Taken as a whole, this consensus statement is a step-by-step outline for why it is impossible to become competent in the treatment of peripheral vascular disease within the context of interventional cardiology training. Virtually none of the requirements are covered by the existing residency requirements or testing blueprints. For endovascular aneurysm repair (EVAR), the authors simply note “additional training will likely be required through non-ACGME-accredited advanced fellowships or post-fellowship training through courses, proctoring or direct mentorship”—a statement that should stoke fear in the hearts of anyone without a significant financial stake in an endograft company. Folks, it is OK to just say, “Hey, maybe doctors should not do things they are not trained to do!”

In the content outline for the initial certification exam, the broadly defined “evaluation and case selection in noncardiac disease” constitutes just 5% of the total. While this blueprint details a wide range of cardiac pathologies common and rare (Takotsubo syndrome?), there is no mention of claudication, rest pain or aneurysms. Similarly, the open book 10-year Maintenance of Certification exam dedicates just 10% to catheter-based management of noncoronary disease, with the majority concerning structural and valvular heart disease. Cilostazol, the only drug thus far proven to demonstrate consistent benefits in clinical trials in patients with claudication,

It is not really clear to me how cardiologists began working in the peripheral space. The interventional aspect of the field is fairly young. Cardiology joined the ABIM in 1941, but the first coronary angioplasty was performed three decades later. The volume of coronary interventions declined in the U.S. over the first 10 years of the 2000s. Regrettably, this happened at a time when interventional cardiology saw an explosion in its workforce. Between 2008–2013, there was an 85% increase in active interventional cardiologists. No other medical or surgical specialty saw an increase of

continued on page 10

Malachi Sheahan III

Hydrodynamic Thrombectomy System

S M ALL ENOUGH F OR ARTERIES POWERFUL ENOUGH FOR VEINS

Intracatheter fragmentation

Continuous aspiration

High-pressure saline jet

Dual-action1 thrombectomy for efficient clot removal2

Introducing JETi™ Hydrodynamic Thrombectomy System, a unique dual-action thrombectomy system that combines aspiration with hydrodynamic fragmentation within the safety of the catheter.1

Experience the JETi™ Hydrodynamic Thrombectomy System today

1. JETi™ Thrombectomy System Instructions for Use (IFU). Refer to IFU for additional information.

See Important Safety Information on the next page. INDICATIONS The JETi™ Hydrodynamic Thrombectomy System is intended to remove/aspirate fluid and break-up soft emboli and thrombus from the peripheral vasculature and to sub selectively infuse/deliver diagnostics or therapeutics with or without vessel occlusion.

2. Schubert et al. Cardiovasc Intervent Radiol. 2022.

IMPORTANT SAFETY INFORMATION

JETi™ Hydrodynamic Thrombectomy System

INDICATIONS FOR USE

The JETi™ Hydrodynamic Thrombectomy System is intended to remove/aspirate fluid and break-up soft emboli and thrombus from the peripheral vasculature and to sub selectively infuse/deliver diagnostics or therapeutics with or without vessel occlusion.

CONTRAINDICATIONS

The JETi™ Hydrodynamic Thrombectomy System is contraindicated for use in:

• Vessels smaller than 4 mm (0.16”)

• Coronary, pulmonary, and neurovasculature WARNINGS

• The catheter, suction tubing, and pump set contents are supplied sterile using ethylene oxidi (EO). Do not use if the expiration date has passed or the sterile barrier is damaged.

• The catheter, suction tubing and pump set contents are for single patient use only. Dispose after use. Do not reuse, reprocess, modify, or resterilize. Reuse, reprocessing, modification, or resterilization may compromise the structural integrity of the device and/or lead to device failure which, may result in patient injury, illness or death. Reuse, reprocessing, or resterilization may also create a risk of contamination of the device and/or cause patient infection or cross-infection, including, but not limited to, the transmission of infectious disease(s) from one patient to another. Contamination of the device may lead to injury, illness, or death of the patient.

• The JETi™ Hydrodynamic Thrombectomy System is not approved for use with defibrillation. In the event shock must be delivered to the patient, remove the catheter and clear all connected system components from the patient before delivering shock.

• Do not use a catheter that has been kinked or damaged.

• Do not use a pump set if it does not prime.

• Only use the JETi™ Catheter, JETi™ Pump Set, JETi™ Suction Tubing, and JETi™ Non-Sterile Canister Set with the JETi™ AIO Saline Drive Unit or the JETi™ Saline Drive Unit.

• Do not mix contrast media in the saline bag.

• When the catheter is exposed to the arterial system, it should be manipulated while under high-quality fluoroscopic observation.

• In the event that the catheter becomes blocked or clogged with thrombus, remove and replace the device with a new device.

• Do not use if package is opened or damaged.

• To avoid risk of electric shock, the SDU must only be connected to mains power with a protective earth.

• The power socket-outlet must be located near the device and must be easily accessible.

• Do not modify or alter the device.

• Do not step or stand on the base of the device.

• Do not push or lean against the IV pole.

PRECAUTIONS

• Physicians must read and understand the Instructions for Use (IFU) prior to using the device. The device must be used by physicians skilled in percutaneous, intravascular techniques in a fully equipped catheterization laboratory.

• When delivering fluid through the catheter aspiration lumen, do not exceed the maximum recommended flow rate, per Table 1 below.

Table 1. Catheter Fluid Delivery Flow Rate

Fluid Maximum Recommended Fluid Delivery Flow Rate Saline 4.0 mL/s 60% Ionic

1.8 mL/s

POTENTIAL ADVERSE EVENTS

Potential adverse events include, but are not limited to:

• Acute closure

• Aneurysm or pseudo aneurysm

• Allergic reaction to contrast

• Arrhythmia

• Death

• Embolism (air or device)

• Embolization (thrombotic)

• Emergency surgery

• Access site pain, hemorrhage, or hematoma

• Infection (systemic/sepsis)

• Local infection (puncture site)

• Minimal blood loss

• Vessel dissection, perforation, or other injury

• Vessel spasm

• Thrombosis

CAUTION: This product is intended for use by or under the direction of a physician. Prior to use, reference the Instructions for Use, inside the product carton (when available) or at vascular.eifu.abbott or at medical.abbott/manuals for more detailed information on Indications, Contraindications, Warnings, Precautions and Adverse Events. This material is intended for use with healthcare professionals only.

Illustrations are artist’s representations only and should not be considered as engineering drawings or photographs. Information contained herein for DISTRIBUTION in the U.S. ONLY.

Abbott

3200 Lakeside Dr., Santa Clara, CA 95054 USA, Tel: 1.800.227.9902

™ Indicates a trademark of the Abbott Group of Companies.

JETi™ is a trademark of Walk Vascular. Walk Vascular is a subsidiary of the Abbott Group of Companies. Manufactured by Walk Vascular LLC, 17171 Daimler Street, Irvine CA, 92614 US www.cardiovascular.abbott

©2023 Abbott. All rights reserved. MAT-2214149 v2.0

FROM THE COVER CRAWFORD FORUM: VERIFIED VASCULAR!

continued from page 1

another former SVS president, who is set to showcase the inpatient side of the Vascular-VP. William P. Shutze, MD, SVS secretary, will run down the workings of the outpatient version of the program.

Darling’s institution, the Albany Medical Center in Albany, New York, was among the first cohort of centers to gain both inpatient and outpatient VascularVP status. Shutze’s center, Baylor Scott & White Heart Hospital in Plano, Texas, was among the first tranche of hospitals verified on the inpatient side.

The Crawford Forum will be rounded out with a subjective analysis of how the Vascular-VP impacts practice from Dennis Gable, MD, from Texas Vascular Associates, which operates in both Dallas and Plano, a Dallas suburb. Gable will present, “Personal experience and the ‘value add’ to a vascular surgery practice and service line from the Vascular-VP,” before the session is opened up to audience participation.

The VAM 2024 program—which will see Joseph L. Mills, MD, deliver his presidential address on Friday morning—is stacked with top-tier education content that is both clinical and non-clinical across four days. The conference received record-breaking submission numbers when it came to abstracts and education sessions, causing great excitement amongst the VAM Program Committee and Postgraduate Education Committee (PGEC) as they organized this year’s agenda.

“There will be 26 education sessions across the first three days of the meeting,” said William Robinson, MD, chair of the PGEC. “We were excited to see a record-breaking 90 proposals submitted for VAM 2024 education sessions. These were submitted last

FROM THE COVER Presidential welcome

continued from page 1

will undoubtedly inspire and challenge us to think beyond the conventional boundaries of our field.

Another event not to be missed is the E. Stanley Crawford Critical Issues Forum. For those looking to immerse themselves in the local culture, we’re bringing the spirit of Chicago football to Soldier Field with our second annual SVS Connect@VAM: Building Community.

The SVS section sessions will provide a broad exposure into the latest advancements in our field, offering valuable insights and practical knowledge. These sessions are designed to foster a dynamic and well-informed community of vascular surgeons.

For those in the early stages of their working life, our career fair presents an unparalleled opportunity to explore a wide range of career options across the country. Networking with peers and potential

autumn and initiated a process of session selection and development, which continued through this spring. Our committee is very excited about the 2024 education program, which is both cutting-edge and as comprehensive as possible.”

Robinson expressed his excitement over the breadth and depth of content and the expanding faculty for the 2024 meeting. “We have 188 expert faculty in the education program; we placed an emphasis on representing the broad SVS membership when choosing faculty members,” he said.

“As for the sessions, multiple will be interactive with the audience, and some have already solicited case submissions from attendees to feature in the sessions to help drive the discussion. I think these cases and the utilization of interactive formats will bring a variety of unique perspectives to the meeting and hopefully make the audience feel more engaged.”

Robinson is wrapping up his final year as chair of the PGEC at VAM, having been on the committee since 2016. His tenure on the PGEC draws to a close alongside SVS Program Committee Chair Andres Schanzer, MD, who expressed similar enthusiasm to Robinson when it came to VAM 2024 programming.

“This was an exciting year to be a part of the

“Multiple sessions will be interactive with the audience, and some have already solicited case submissions from attendees to feature in the sessions to help drive the discussion”

WILLIAM ROBINSON

employers can significantly impact your professional journey.

Finally, don’t miss the SVS Foundation Gala. This event includes complimentary round-trip transportation from the Marriott Marquis to the Museum of Science and Industry for an opportunity to relax and celebrate our shared achievements in a grand setting.

If you forgot to cast your electronic ballot for vice president in the SVS officer election, you can do so in person at VAM 2024 until 2 p.m. Central Time on Friday, June 21. Finally, to fully benefit from VAM 2024, I encourage you to stay for all four days. The comprehensive learning opportunities, professional development sessions and networking events are designed to maximize your experience and provide you with the tools you need to excel in your practice.

Welcome to VAM 2024! Let’s make this an unforgettable meeting filled with learning, collaboration and inspiration.

Warm regards,

Joseph L. Mills, MD SVS

president

Program Committee, and not just from the scientific session standpoint,” he said.

“With the debut of the inaugural SVS Keynote Speaker Series, SVS Connect@VAM taking place at Soldier Field, and the many increased opportunities to network with colleagues, friends and industry, I am more excited for this year’s SVS VAM than any other we have had in the past.”

Between the plenary, How I Do It video, and Vascular and Endovascular Surgery Society (VESS) sessions, alongside international and poster presentations, more than 50% of the abstract submissions were accepted for VAM 2024, according to Schanzer. Then, of course, will come Mills’ presidential swansong, followed on Friday night by the annual Gala. Schanzer and Robinson both worked with VAM 2024 faculty, the SVS Young Surgeons Section (YSS) and SVS staff to increase promotion of high-impact work that was done by investigators to get more people interested in what the conference is offering.

For the third year in a row, YSS volunteers worked with the chairs to develop the visual VAM campaign, which hosts visual representations of abstracts and invited sessions that will debut at VAM 2024. Weekly videos were posted across SVS social media accounts to give viewers a quick glimpse into clinical education that will be covered at the meeting. “It has been great to see SVS members and other vascular surgery community members interact with the content on social media,” said Schanzer, “I only hope that this is half of the excitement that we are going to see from the attendees at VAM.”

With the meeting set for record-breaking attendance numbers, a larger focus on networking and togetherness, an expanded number of educational sessions with innovative formats, and a broadening of the VAM travel scholarship program, to name a few, Robinson and Schanzer have set a high bar for VAM going forward.

To register, visit vascular.org/VAM24Reg

CHANGES TO CAROTID STENTING LANDSCAPE IN UNITED STATES SET TO BE DISSECTED

MD,

OF THE

OF

Surgery at Cleveland Clinic’s Heart, Vascular and Thoracic Institute in Cleveland, Ohio, will discuss the national coverage determination (NCD) changes passed by the Centers for Medicare & Medicaid Services (CMS) on carotid artery stenting (CAS) during VAM.

His presentation—“Contemporary management of carotid disease after the coverage decision change and prior to CREST-2 results”—will address new options and responsibilities for clinicians and health systems in light of these updates.

Lyden will highlight new data covering transfemoral carotid stenting and new technologies since the last NCD. He will emphasize how the updated NCD equates transfemoral CAS and transcarotid artery revascularization (TCAR) with carotid endarterectomy (CEA) for Medicare reimbursement. This change has expanded coverage to include symptomatic patients with 50% or greater stenosis and asymptomatic patients with 70% or greater stenosis.

Last year, Vascular Specialist reported how nearly one-third of the public comments submitted to CMS on the then proposed coverage decision affecting carotid stenting were from SVS members. Of approximately 760 responses, at least 237 were initially identified as being from SVS members. In October, CMS released its final decision regarding NCD 20.7, covering CAS, essentially confirming the coverage expansion outlined in a July proposed decision memo.

Marlén Gomez and Bryan Kay

SEAN P. LYDEN,

CHAIRMAN

DEPARTMENT

VASCULAR

Sean P. Lyden

I

VAM 2024 COVERAGE

PUSHING THE BOUNDARIES OF VASCULAR CARE: VQI MEETING SET TO KICK OFF AT VAM

By Marlén Gomez

THE VASCULAR QUALITY INITIATIVE (VQI) will host its two-day annual conference at VAM 2024 from June 18–19, drawing healthcare professionals dedicated to advancing the quality and safety of vascular care.

This event, organized with the assistance of the Society for Vascular Surgery (SVS), aims to foster collaboration and knowledge exchange among medical practitioners.

The VQI has assembled a network of 14 registries, compiling comprehensive data from more than one million vascular procedures conducted across the U.S., Canada and Singapore. This dataset, which tracks patient information from initial hospitalization through one-year follow-up, enables medical centers and providers to benchmark their performance against regional and national standards.

Participants in the VQI receive biannual dashboards and regular performance reports, empowering them to implement effective quality improvement measures. Additionally, biannual regional meetings provide a platform for physicians, nurses, data managers, quality officers and oth-

VASCULAR TRAUMA QUALITY IN CARE

Pediatric vascular care in focus: Raising awareness of supportive care processes

By Marlén Gomez

er stakeholders to share insights and best practices in a collaborative environment.

The biannual Mid-America meeting will take place during the VQI meeting on Wednesday, June 19, at 5 p.m. Central Time.

Jens Eldrup-Jorgensen, MD, the medical director of the SVS Patient Safety Organization (PSO), emphasized the transformative impact of VQI data on vascular care. “By leveraging comprehensive clinical data, we can enhance the quality of care at both local and national levels, reducing complications and healthcare costs,” he stated. The data support risk stratification, outcomes analysis, quality improvement initiatives and the development of best practices.

A key technological underpinning of the VQI is the Fivos PATHWAYS platform, a secure, cloud-based system that facilitates real-time data collection and long-term outcomes assessment. This technology has been instrumental in helping participating centers improve patient care, driving scientific discoveries and ultimately saving lives.

During the sessions on Tuesday, June 18, VQI will showcase updates and enhancements to its Fivos registry reporting and

n 2021, the Society for Vascular Surgery (SVS) and the American Pediatric Surgical Association (APSA) established a task force dedicated to optimizing pediatric vascular care through a multidisciplinary educational approach. The task force created a Pediatric Vascular Surgery Interest Group, and now, following three previously completed recorded sessions, the task force will host its fourth Pediatric Vascular Surgery Interest Group session at VAM 2024 that will tackle pediatric vascular trauma topics.

Scheduled for Wednesday, June 19, this case-based session will cover pediatric vascular trauma’s diagnostic and technical considerations. Session discussions will include diagnostic imaging for children that consider contrast media and radiation exposure, technical aspects of open surgery, as well as growing endovascular options and the management of iatrogenic vascular trauma. Additionally, the session aims to raise awareness

product offerings. These improvements aim to better integrate electronic medical records (EMR), enhance reporting capabilities and update product features. Fivos has introduced reports covering various procedures, including carotid artery stenting (CAS), carotid endarterectomy (CEA), endovascular aneurysm repair (EVAR), peripheral vascular intervention, thoracic endovascular aortic repair (TEVAR), hemodialysis access, venous, inferior vena cava (IVC) filter and infrainguinal bypass.

The 2023 claims validation process has significantly improved, with reminders sent to all relevant centers. The deadline for completing the validation—including all reconciliation steps and corrections to PATHWAYS data—is July 15.

Also on Wednesday, the conference will delve into 30-day readmissions and their relation to initial index procedures. A re-

“By leveraging comprehensive clinical data, we can enhance the quality of care at both local and national levels, reducing complications and healthcare costs”

JENS ELDRUP-JORGENSEN

among practitioners about supportive care processes and specialized resources needed for pediatric vascular trauma patients and their families, particularly considering social challenges such as domestic and gun violence.

Dawn Coleman, MD, division chief at Duke University in Durham, North Carolina, and SVS co-chair of the task force, highlights the practical benefits of attending, stating, “this session will equip attendees with valuable insights and practical guidance, empowering them to enhance patient outcomes and address pressing issues in pediatric vascular care.”

To facilitate ongoing education and resource sharing, SVS staff on the task force have launched a website featuring recordings of past sessions. These include “Extracorporeal life support: Cannulation strategies, decannulation strategies and long-term follow-up,” “Pediatric vascular trauma” and “Developmental vascular disease.” For more information, visit vascular.org/SVSAPSAtaskforce

The most recent recording on developmental vascular disease highlighted the task force’s commitment to multidisciplinary discourse on developmental vascular anomalies. Pediatric surgeon and task force member Sandra Tomita, MD, emphasized the importance of a multidisciplinary approach in the management of these anomalies, setting the stage for collaborative

cent study analyzed one-month readmission rates to understand their relationship to initial procedures, aiming to identify patterns and potential improvements in patient outcomes.

Conducted from October 2018 to November 2023 with a sample size of 3,443 procedures, the study collected readmission data on 3,395 patients, with 331 readmitted within 30 days. The findings underscore the complexity of readmissions and highlight the need for a nuanced classification system to address patient care post-procedure.

“As VQI and VAM 2024 continue to push the boundaries of vascular care, the collaborative spirit and innovative advancements showcased at this year’s meeting highlight the ongoing dedication to improving patient outcomes and advancing the field of vascular surgery,” said Eldrup-Jorgensen.

To register for the VQI conference, visit vascular.org/VQI24

case presentations and discussions featuring experts such as Francine Blei, MD, and Dana LeBlanc, MD. Multidisciplinary case presentations and discussions, labeled “How We Do It,” showcased innovative approaches and best practices from institutions nationwide where experts shared insights into their respective areas of expertise.

SVS co-chair John White, MD, chair of surgery at Advocate Lutheran General Hospital in Park Ridge, Illinois, underscores the task force’s dedication to advancing pediatric vascular care: “By identifying key areas for education, guideline development and training, we aim to elevate the standard of care for pediatric vascular patients.”

The task force is also working on a collaborative special issue on pediatric vascular surgery, which will be co-published in the Journal of Vascular Surgery (JVS) and the Journal of Pediatric Surgery. “The special issue copublished in the journals will be a landmark resource, bringing together cutting-edge research and clinical expertise to transform pediatric vascular care,” said Coleman.

“Our partnership allows us to harness vascular and pediatric surgery expertise, ensuring comprehensive and effective care for pediatric patients with vascular conditions. By disseminating our findings through journals, we aim to reach a wider audience, ultimately improving outcomes for children with vascular issues worldwide.”

Jens EldrupJorgensen

Dawn Coleman

VasQ: The next standardof-care innovation

At the 2024 Charing Cross (CX) International Symposium (April 23–25) in London, England, the Vascular Access Masterclass Controversies session delved into the question, “We have new technology, but do we need it?” Among the notable presentations, Ellen Dillavou, MD, division chief of vascular surgery at WakeMed Hospitals in Raleigh, North Carolina, ignited discourse on whether extravascular support should redefine the standard of care in surgical fistula creation. Advocating for the adoption of the VasQ extravascular nitinol support by Laminate Medical, Dillavou underscored its potential to address numerous prevalent challenges in fistula creation, positioning it as a pivotal innovation in dialysis access.

“Sometimes, it is difficult to see a change in the standard of care as it happens,” Dillavou said as she began her presentation, acknowledging the gradual evolution of medical standards and drawing parallels with the transformative impact of guidelines such as those set forth by the Kidney Disease Outcomes Quality Initiative (KDOQI) in the United States. “We can look back in the U.S. and see that the KDOQI guidelines emphasizing fistula use definitely changed the way we practiced. [They] made more fistulas available for standard use, but it came with costs like increased catheter use, more procedures per usable fistula and a decrease in primary patency results.”

Dillavou emphasized the need for enhanced access solutions with fewer interventions, lower infection rates, and faster maturation, highlighting that “the VasQ device can solve a lot of these problems” by mitigating common issues encountered in standard fistulas, such as stenosis and aneurysmal dilation by “keeping the fistula at an optimal angle and offering support to that dissected area of the vein to counteract the shear stress.”

Central to her argument were compelling datasets supporting VasQ’s efficacy. Referencing studies including a randomized controlled trial by Nikolaos Karydis, MD, assistant professor in general and transplant surgery at the University of Patras in Patras, Greece, and research by Robert Shahverdyan, MD, head of vascular access at Asklepios Klinik Barmbek in Hamburg, Germany, Dillavou showcased consistent improvements in maturation rates and primary patency with VasQ utilization. Furthermore, she presented findings from an ongoing study comparing VasQ to conventional methods, indicating superior functionality and patency outcomes with the device and pointed to Shahverdyan’s long-term success using the device as standard of care.

“When [Shahverdyan’s] practice shifted

to using VasQ as part of his standard of care, he had a drastic reduction in primary failures and an increase in primary patency at six months,” said Dillavou, who also referred to a study that she had contributed to that compared VasQ to historic controls. “In the U.S., when we contrasted VasQ fistulas to historic controls, we found increased functionality at three and six months, and increased primary patency at all time-points. When we look at the body of literature in historic unsupported fistulas versus VasQ, we see a clear trend towards enhanced patient outcomes when they are externally supported.”

Beyond immediate postoperative benefits, Dillavou emphasized the long-term advantages of VasQ providing permanent structural support. Drawing from retrospective analyses, she illustrated reduced catheter days, decreased infection-related hospitalizations, and diminished incidences of complications such as steal syndrome and aneurysm formation. “This global view shows that patients have fewer catheter days and have fewer infection-related hospitalizations at one year. We also see that two years after creation with an external support device, we are seeing fewer instances of steal, and we’re seeing less aneurysmal formation,” said Dillavou.

Addressing concerns regarding costs, Dillavou highlighted substantial cost savings estimated based on the existing clinical data. The potential for significant healthcare expenditure reduction with VasQ integration has been replicated in multiple countries, such as the United Kingdom, Italy, Germany and the U.S. She also highlighted that VasQ has now reached Asia with Yong Enming, MD, and Zhang Li, MD, both from Tan Tock Seng Hospital in Singapore, underscoring global interest in exploring both the clinical and economic implications of VasQ adoption.

Following Dillavou’s presentation, audience participation was invited, leading to in-

“In

the U.S., when we contrasted VasQ fistulas to historic controls, we found increased functionality at three and six months, and increased primary patency at all time-points”

ELLEN DILLAVOU

quiries delving into technical considerations and comparative efficacy, with insights provided by panelists including experienced VasQ users like Shahverdyan and Nicholas Inston, MBBS, a consultant surgeon at University Hospitals Birmingham in Birmingham, England.

Speaking to Vascular Specialist regarding the role that VasQ has to play in the future of arteriovenous fistulas (AVFs), Inston, the session’s moderator, said: “The signal coming from multiple global studies consistently shows that VasQ has better outcomes than those in traditional surgical studies. If we

strive to improve the outcomes of AVFs, we need to take these data seriously.”

Shahverdyan also shared his thoughts on the device, saying: “Looking at our experience of over six years with almost 300 VasQ implants—mostly for radiocephalic AVF creation, which historically have shown to fail more commonly—and the existing evidence throughout the globe on the outcomes of VasQ device, it consistently demonstrates significantly better outcomes in dialysis patients with extremely low safety concerns: we have observed zero cases of infection, steal or juxta-anastomotic aneurysms. Hence, it is justified to say that we as caregivers should provide our patients with best possible treatment options and consider the application of the VasQ device as standard of care.”

The discourse surrounding VasQ at the CX Symposium underscores a paradigm shift in dialysis access management, with mounting evidence and key experts heralding its potential role as a transformative standard of care. Of course, skepticism still exists based on the bulk of VasQ’s evidence from observational studies, especially compared to the numerous randomized controlled studies for technologies like drug-coated balloons (DCBs).

In response to comments regarding the level of evidence for VasQ in comparison to DCBs, Dillavou closed out the discussion by stating that “there’s more agreement in the VasQ device than there is for DCBs.” This statement highlights that the strength of the VasQ data has been in the consistent clinical benefit across multiple studies that is not typically observed for many new technologies.

Learn more about VasQ at laminatemedical. com

Scan to learn more about VasQ.

Vascular nursing: Real-world insight into role of nurses and PAs in the vascular team

The Society for Vascular Nursing (SVN) 42nd Annual Conference takes place in tandem with VAM 2024.

IT KICKS OFF ON JUNE 19 WITH THE SVN Presidential Welcome from Kristen Alix, MS, ANPBC, and will be followed up by the keynote address, “Disrupting DEI in a disruptive environment,” delivered by Katie Boston Leary, PhD, MBA, MHA, RN, NEA-BC. For the remainder of the two days of the annual gathering, attendees will take part in four educational tracks.

“The education at this year’s conference will be unmatched. We will have faculty from all over the country who are willing to share their expertise and learn from other attendees,” said SVN President

Alix. “The conference has grown so much since I became a member, and being more involved this year as SVN president has been a true highlight. I can’t wait to see what education and opportunities are brought forth in the years to come.”

Outside of the four tracks, there will be additional sessions and learning opportunities for advanced practice providers (APPs). One opportunity of note is Vascular Jeopardy, which will take place on Wednesday evening, June 19, in conjunction with the Society for Vascular Surgery (SVS) Physician Assistant (PA) Section. Members of the PA Section and SVN attendees will participate in a vascular-themed game of jeopardy.

In addition, the SVN and SVS PA Section will also host a collaborative session on Thursday that will include team talks, diagnostic discussions and hands-on simulation.

“These collaborative events create a real-world example of how nurses and PAs work together on a day-to-day basis within the vascular team,” said Alix. “Working closely with the PA Section has been a great experience to create a bridge between these two types of APPs within the SVS and SVN membership bases.”

Anyone interested in attending the SVN conference, or in finding out more about vascular nursing, can visit svnnet.org/page/annualconference

SVU TO CO-LOCATE ANNUAL CONFERENCE WITH VAM

The Society for Vascular Ultrasound (SVU) will co-locate its annual conference with VAM.

The co-location of the two meetings coordinates with VAM 2024’s theme of “unity” and SVU’s “connected” theme, which promotes vascular surgeons bringing their ultrasound staff to Chicago so the whole team can learn together.

The co-located meetings will consist of opportunities for attendees of both to experience

including the SVU Marketplace happening alongside the VAM Exhibit Hall, the inaugural SVS Keynote Speaker Series address given by Karith Foster, sponsored by Boston Scientific, and SVS Connect@VAM: Building Community, which will take place at the iconic Soldier Field. Meeting attendees will be able to use these opportunities to network and unify their overall meeting experience.

“Bringing the SVU Annual

Conference to Chicago allows for a more cohesive experience amongst the vascular team,” said Program Chair Andres Schanzer, MD. “Having the opportunity for so many members of the vascular team to take in exceptional education at the same time and place is rare, and I hope many vascular teams will take advantage of it.”

Registration for both events is open, visit vascular.org/VAM for more details.

Enhancing clinical practice and patient interaction in CLTI

A key event on informed decision-making in chronic limb-threatening ischemia (CLTI) promises to be a highlight this year. Funded by a grant from the Council of Medical Specialty Societies (CMSS) awarded to the SVS, the event aims to expand physician knowledge and improve clinical confidence in treating CLTI. The breakfast event, scheduled for 7 a.m. Central Time on Saturday, June 22, will focus on individualizing treatment recommendations for CLTI patients. It will emphasize staging and setting patient expectations to facilitate better decision-making. The session will review the importance of using the Vascular Quality Initiative (VQI) CLTI risk calculator, Wound, Ischemia and foot Infection (WIfI) classification and Global Anatomic Staging System (GLASS) to guide treatment, along with vein mapping and angiography.

“The goal of this session is to equip physicians with the tools and knowledge needed to engage in meaningful, informed conversations with their patients about CLTI,” said Michael Conte, MD, professor and division chief of Vascular and Endovascular Surgery at the University of California, San Francisco. “By focusing on the PLAN (Patient risk, Limb severity, ANatomic complexity of disease) algorithm, we can set expectations and treatment plans to individual patient needs.” The event aims to provide a practical framework for enhancing clinical practice and patient interactions. Participants will also learn effective communication strategies for engaging with patients. This patient-centered approach aims to improve clinical confidence and effectiveness in treating CLTI. To register, visit vascular.org/informedCLTI

INCREASE BLOOD FLOW, EMERGE AS TOP WALKER

LACE UP YOUR WALKING SHOES AND GET READY TO compete to be the 2024 Vascular Annual Meeting’s (VAM 2024) Top Walker. The Society for Vascular Surgery (SVS) Foundation’s Vascular Health Step Challenge at VAM is again encouraging attendees to keep moving throughout the conference. The participant with the highest step count on June 21 at 5 p.m. Central Time will receive a $100 gift card.

“We want to keep movement and blood flow at the forefront of everyone’s mind, even while at a conference,” said SVS Foundation Chair Michael Dalsing, MD. “It may seem like second nature to us as vascular surgeons, but we’re still people who get busy and make movement a lower priority than it should be. I am hopeful that having the Step Challenge at VAM will be the reminder we need to keep moving.”

The Vascular Health Step Challenge at VAM is a foreshadowing of the Vascular Health Step Challenge that takes place throughout the entire month of September to draw attention to Vascular Health Awareness Month and raise vital funds for the future of vascular health. During the challenge, participants are encouraged to walk 60 miles throughout the month to symbolize the 60,000 miles of blood vessels in the human body.

Anyone who signs up for the challenge at VAM will be automatically signed up for the September challenge, receive a commemorative lapel pin at VAM and mailed a challenge t-shirt. VAM participants will also be eligible to win over $250 worth of prizes through the Passport to Prizes Sponsorship where walkers will take their “passport” into the exhibit hall and visit designated booths where they’ll receive a stamp from each one. Prizes will be announced soon but are guaranteed to make walks more enjoyable.

Registration is now open. Learn more at vascular.org.

VAM HONORS CONTRIBUTIONS TO VASCULAR HEALTH

VAM will honor the contributions and achievements of this year’s award recipients at a special networking event on Thursday, June 20, at 3 p.m. Central Time. These awards honor individuals who have significantly impacted vascular care within their communities.

The Excellence in Community Practice Awards will be presented. This year’s distinguished recipients are: Enrico Ascher, MD, Sachinder Hans, MD, Christopher LeSar, MD, and Manish Mehta, MD. Sub-Section on Outpatient & Office Vascular Care (SOOVC) Research Seed Grant recipients will also be presented with their awards, which are designed to support innovative research projects to improve vascular health outcomes.

SVS Connect@VAM

The VAM networking event, SVS Connect@VAM—Building Community returns for its second year and will take place at the home of the Chicago Bears, iconic Soldier Field. All VAM attendees are encouraged to attend on Wednesday, June 19, at 6:30 p.m. Central Time. Families are welcome.

A shuttle service will depart from the Marriott Marquis located across from McCormick Place beginning at 6:20 p.m.

The Philips-sponsored event will consist of tailgate-inspired games as well as food trucks,

drinks, music and much more. This event will provide VAM attendees the chance to see the iconic Soldier Field before the home of the Chicago Bears is expected to move locations.

The networking event will also serve as the grand kickoff to the Vascular Health Step Challenge at VAM with a fifteen-minute walk to Soldier Field for those wishing to participate.

Those interested in attending should indicate their interest by logging into the VAM 2024 registration site. Learn more at vascular.org/SVSConnectAdd

Compiled by Kristin Spencer and Marlén Gomez

Michael Conte

Cardioroot Aortic Graft

Innovative, anatomically designed aortic root graft provides predictable handling properties and versatility in all types of aortic root repair and replacement surgeries.1,2

1. Tasca G, Lindner J, Barandon L, et al. Aortic root surgery with the CARDIOROOT vascular graft: results of a prospective multicenter post-market surveillance study. J Cardiothorac Surg. 2019 May 21;14(1):94.

2. Urbanski PP, Frank S. New vascular graft for simplification of the aortic valve reimplantation technique. Interact Cardiovasc Thorac Surg. 2008 Aug;7(4):552–4.

COMMENT& ANALYSIS

WOMEN IN LEADERSHIP— IT MATTERS TO TRAINEES TOO CORNER STITCH

By Saranya Sundaram, MD

DR. ERICA MITCHELL SAID IT BEST IN HER SVS community post titled “Women in leadership: Why it matters.” She wrote that “the presence of women in leadership positions is an important consideration to Americans in choosing where to work and commit our efforts.” And while we have recruited a new generation of vascular trainees—among whom there is more female representation than in our specialty as a whole—it remains just as important we can see what’s possible in leadership. First, let’s give credit where it’s absolutely due—female trainees have witnessed some incredible progress over the past few years. We experienced a slew of women leaders take on prominent roles across the vascular surgery landscape. The increased visibility of female vascular surgeons has played a large role in female recruitment to this specialty. Most medical students/trainees witness this first-hand while working with 14.6% of all board-

FROM THE EDITOR HOUSE OF CARDS

more than 50% during this time. Perhaps this strain between a burgeoning workforce and dwindling case volume pushed more cardiologists to the periphery.

I trained in the late 1990s and early 2000s, and cannot recall many cardiologists with an interest in peripheral vascular disease. Most treated cardiovascular disorders with the intention of preventing heart attack and stroke. Any peripheral vascular benefits were ancillary or unmentioned. I will admit that the peripheral vascular space likely became a free-for-all because most vascular surgeons were slow to adopt interventional techniques. To make up for this, however, we have undergone a revolution in training and assessment. Our case requirements, training duration, residency paradigms, and exam blueprints have all been completely rewritten to ensure that vascular surgeons achieved documented proficiency in all aspects of peripheral interventions. Vascular surgery is now the sole training pathway to gain competence across medical, surgical and endovascular treatment.

The ABMS definition of our specialty states that vascular surgery “encompasses the diagnosis and comprehensive, longitudinal management of disorders of the arterial, venous and lymphatic systems, exclusive of the intracranial and coronary arteries.” The ACGME affirms “vascular surgery is the surgical specialty involving diseases of the arterial, venous and lymphatic circulatory systems, exclusive of those circulatory vessels intrinsic to the heart and intracranial vessels. Specialists in

certified vascular surgeons.

In February, the American Heart Association (AHA) published an official statement addressing barriers to entry and retention of women in interventional vascular specialties. They address possible “concerns about specialty culture and work environment,” citing one study in which nearly 38% of integrated vascular trainees reported some form of “gender-based discrimination,” which was highly associated with burnout. A similar study by Bernardi et al (2020) found dissatisfaction among female surgical trainees was highly correlated to both perceived “gender-disparity” and lack of a role model who had “faced similar obstacles.” Nearly 33% of female surgical residents even reported considering “leaving medicine/ retiring early” in another study, compared to only 6% of their male counterparts.

in the “past 43 years,” as our first and only past female SVS President Julie Frieschlag puts it. Female abstract presentations and committee members have doubled to nearly 20% across our regional and national societies, Humphries and colleagues (2020) report. However, the increase in female leadership is “not yet seen uniformly across societies nor is it seen in the highest levels of leadership among society officers.” Per Dr. Humphries, we will be unlikely to see a change until we perhaps change our goal to “achieve approximately 50% female representation.”

In order to address these barriers, the AHA taskforce urged institutional and industry action on behalf of women through promotion to leadership positions, increased industry/societal sponsorship, and interspecialty collaboration.

And in some ways, the vascular specialty has changed

continued from page 2

this discipline demonstrate the knowledge, skills and understanding of the medical science relative to the vascular system, as well as mature technical skills and surgical judgment.” Our country’s leading training and certification authorities have delivered a clear and consistent message. So why is the public confused?

One would hope that in the face of this lack of clarity a new American Board of Cardiovascular Medicine would offer clear and specific guidelines for cardiologists who wish to pursue peripheral interventions or nebulous interests such as vascular medicine. Well reader, one would be disappointed. While the new board proposal does make an excellent case that cardiology is a growing and increasingly complex specialty, a great deal of the aims confusingly focus on changing the continuous certification process. Much of it reads like my 12-year-old hired a consulting firm to get out of studying for a science exam. “Hey Dad, it’s time to change the conversation around education and home study. We here at the House of LukeTM are prepared to embrace a new paradigm, one that will credit me for my wealth of real-world experiences and not these meaningless high-stakes exams. It is time for continuous learning, not continuous testing.”

Here are some highlights from the proposal: patients and the public expect their physicians to have the ability to deliver high-quality care and should require that there are standards in place to assure continuous competence (agree). Cardiovascular medicine has a clearly defined scope of practice and standards

With our specialty nearing that goal among vascular trainees, the need for appropriate reflection among leadership is more important than ever. Female trainees want to see themselves reflected in the people who they look up to. As of now, there has been a strong showing of female role models. Their mentorship and an increasingly representative leadership will play a large role in the surgeons our trainees will choose to become.

of competence, which have been set by rigorous scientific processes and experts in the specialty (agree to disagree). The rapid acceleration of innovation and advances in cardiovascular medicine since 1941 has transformed the field of cardiovascular medicine and increasingly requires unique skills and training that are markedly different from those in internal medicine to practice effectively (they go on to list a bunch of advances, none of which are related to peripheral vascular disease). Essentially it seems the proposed board would allow physicians to identify their own knowledge gaps and fulfill continuous certification requirements through CMEs provided by the (coincidentally?) sponsoring societies.

In defining professional competence, the 2020 AHA/ACC Consensus Conference on Professionalism and Ethics states: “To maintain competence, physicians must be committed to lifelong learning and be responsible for maintaining the medical knowledge, and clinical and team skills necessary for the provision of quality care. More broadly, the profession must strive to see that all its members are competent and must ensure that appropriate mechanisms are available for physicians to accomplish this goal.” The American Board of Cardiovascular Medicine proposal fails to address this need for cardiologists performing peripheral interventions. Its plan for continuous certification will not only encourage cardiologists to perform outside of their expertise, it will also make it more likely they will not recognize their own deficiencies.

Psychology calls this the Dunning-

Kruger effect. The skills that give us competence in a certain domain are the same skills needed to evaluate competence in that same domain. Competence must be achieved from the competent. Individuals who do not achieve competence dramatically overestimate their ability and are unable to use information about the choices and performances of others to form more accurate impressions of their own ability. Physicians who do not obtain the appropriate skills and training suffer a dual burden. They make poor choices and false conclusions, and their lack of competence robs them of the ability to recognize this. They don’t know what they don’t know. Physicians with properly acquired proficiencies and knowledge are more equipped to recognize and learn from their mistakes.

It is a matter of patient safety that we end the public confusion caused by terms like “cardiovascular” and “vascular medicine.” Physicians need to perform within their expertise. The backbone of U.S. training is graduated responsibility within an ACGME-accredited residency, followed by ABMS board assessment and lifelong learning. Equivalent experience should only be applied in rare and exceptional cases.

Cardiology is a complex field with multiple subspecialties. It likely deserves its own house. Just don’t hide peripheral vascular disease in the basement.

MALACHI SHEAHAN III is a member of the Vascular Surgery Board (VSB) of the American Board of Surgery. His opinions do not reflect VSB policy or positions. .

SARANYA SUNDARAM is a vascular surgery resident at Medical University of South Carolina in Charleston.

Saranya Sundaram

GRAND ROUNDS

SVS PAC and advocating for excellence in healthcare policy on Capitol Hill

By Andrew Kenney

In the realm of healthcare advocacy, the role of political action committees (PACs) cannot be overstated. These entities serve as vital conduits between professional organizations and policymakers, ensuring that the voices of healthcare professionals are heard and their interests represented among critical decision-makers. The SVS PAC primarily advocates for vascular surgeons by supporting federal officeholders. However, it also employs a meticulous process to identify and support candidates for federal office who champion policies conducive to advancing vascular surgery and enhancing patient care.

The process for the SVS PAC to endorse and support candidates is multifaceted, beginning with the identification of individuals whose values and priorities align with the mission of the SVS. Central to this process is a thorough evaluation of candidates’ stances on healthcare issues pertinent to vascular surgery, such as access to care, Medicare reimbursement policies and graduate medical education funding. The SVS PAC collaborates closely with its members of the SVS Advocacy Council, drawing upon their expertise and insights to assess

the potential impact of candidates’ proposed policies on vascular surgeons and their patients.

Once potential candidates have been identified, the SVS PAC engages in a vetting process to ascertain their suitability for support. This can involve reviewing candidates’ voting records (if they’ve held prior political office), public state ments and policy proposals to gauge their alignment with the priorities of the vascular surgery community, as well as their electoral viability. Additionally, SVS staff members are usually invited to engage with candidates, either in-person or virtually, to gain further insight into the candidates’ understanding of key healthcare issues and their willingness to collaborate with med ical professionals and specialty societies to address them effectively.

Crucially, the SVS PAC operates in a strictly non-partisan manner, prioritizing the interests of vascular surgeons over political affil iations. While candidates from both major political parties may receive sup port, SVS PAC’s ultimate endorsement is contingent upon their demonstrated commitment to advancing policies that promote high-quality vascular care and improve patient outcomes. By main taining political neutrality, the SVS PAC ensures that its advocacy efforts resonate across party lines, fostering bipartisan support for initiatives vital to the vascular surgery community.

Upon identifying candidates deserv ing of endorsement, the SVS PAC mo

Reach for the Doppler that Works Every Time

The Trans-Q-taneous Intraoperative “TQI” Doppler System is the Doppler you can rely on for all your surgical needs.

VTI’s single-use surgical Doppler probes provide a high degree of reliability since probe failure due to reprocessing is eliminated. RELIABLE

COST EFFECTIVE

The hidden costs associated with reusable probes, including reprocessing and lost OR time due to probe malfunctions, are eliminated.

MULTI-FUNCTIONAL

Provides real-time intraoperative and transcutaneous evaluation of blood flow, for ALL your surgical needs.

Call 800-550-0856 or visit us at VTI-online.com to learn more about our Doppler, including a complimentary analysis of your “hidden costs”. Find out why the TQI Doppler provides a high degree of performance reliability and is a more cost-effective solution for ORs.

Visit our TQI product page on our website.

SOCIETY BRIEFS

Compiled by Marlén Gomez and Kristin Spencer

SVS LAUNCHES REGISTRATION FOR 3RD ANNUAL CPVI SKILLS COURSE

THE SOCIETY FOR VASCULAR SURGERY (SVS) HAS officially launched registration for the annual Complex Peripheral Vascular Initiatives (CPVI) Skills Course. The first course launched in 2022 after being put on hold in 2020 and 2021 due to the COVID-19 pandemic. Vascular surgeons at all career levels and other specialists who wish to remain current in the specialty of vascular surgery and endovascular therapy can attend the course to participate in hands-on and didactic learning led by experts in treating peripheral arterial disease (PAD).

With a maximum capacity of 60 registrants, the CPVI Skills Course ensures that anyone who attends will have ample time to learn from the 19 faculty members leading the course. The curriculum will range from deep venous arterialization and pedal access to percutaneous femoropopliteal bypass and will delve into the Global Vascular Guidelines for treating PAD. Past attendees attribute the course curriculum, faculty, and seven-plus hours of hands-on learning to their feeling completely engaged throughout the two days.

While the course is for vascular surgeons at any career level, the SVS has partnered with the Association of Program Directors in Vascular Surgery (APDVS) to give vascular residents and fellows the opportunity to be mentored and coached by expert faculty and future colleagues in both intermediate and advanced techniques

that they may not otherwise be exposed to in their programs. “The best practices for our PAD patients continue to evolve with new research and improving technologies,” said Elizabeth Genovese, MD, a course co-chair. “It is important that vascular surgeons stay current with the latest advancements, given the increasing complexity of our patient population. This course provides an in-depth opportunity to explore these new endovascular techniques with the leaders in the field.” Stephan Henao, MD, will serve alongside Genovese in the co-chair role. Henao and Genovese have been serving on the course faculty since it began in 2022. Last year, they learned under Vikram Kashyap, MD, Patrick Geraghty, MD, and Daniel McDevitt, MD, to prepare for their new roles as co-chairs. All interested parties are encouraged to register by June 26 to take advantage of early-bird registration prices. Learn more by visiting vascular.org/CPVI24

Pride Month: Voices of Vascular features Lauren N. West-Livingston

The SVS Foundarion’s Voices of Vascular series this month features Lauren N. WestiLivingston, MD, a PGY-2 integrated vascular surgery resident at Duke University, as part of Pride Month. As a spouse, mother and bi/pansexual woman, Westi-Livingston says her identity enriches her professional and personal life.

Westi-Livingston highlights the significance of education and awareness during Pride Month and throughout the year. She encourages people to learn about LGBTQIA+ terminology, history and the issues affecting the community globally and locally.

JVS seeks editorial interns

The Journal of Vascular Surgery (JVS) group is on the lookout for its next batch of editorial interns. The JVS internship program is open to integrated vascular surgery residents and vascular fellows. Successful applicants can expect to learn the entirety of the JVS journals’ editorial and review process.

The program aims to equip future vascular surgeons with the skills to review research papers and diversify the reviewer pool. Interns will be mentored by senior editorial staff, review select papers and co-author at least one commentary. Applications are due by June 30.

‘THE FORGOTTEN STEPCHILD OF VASCULAR SURGERY’: THE QUEST TO PUSH FORWARD BASIC SCIENCE RESEARCH IN VENOUS DISEASE

By Brian McHugh

THE 2024 VENOUS SYMPOSIUM (May 8–11) in New York City, was highlighted by keynote speaker Peter Pappas, MD, regional medical director and program director of the venous and lymphatic medicine fellowship at the Center for Vein Restoration in Morristown and Union, New Jersey. Pappas spoke about new frontiers in venous and lymphatic disease management while looking at the past, present, and future of how disruptive technologies have shaped treatment.

“It is my hope that in the next 20 to 30 minutes, what I’m about to tell you will inspire a new generation of venous clinicians, researchers, and physicians to do better,” Pappas told the audience.

He began his address by speaking about his history as a vascular surgeon. Early on, Pappas said, he was told “we have this field in venous disease in which there is really not a lot of basic science research. It’s the forgotten stepchild of vascular disease and we really want to elevate the quality of the work that’s being done there.

“I knew nothing about it. As I read the current literature, I quickly realized my men-

tors were correct and that this was a career opportunity,” Pappas continued, explaining how he dedicated his first year to benchwork research and his second year to clinical work.

“I was the first vascular surgeon at that time to get a K08 training grant from the National Institutes of Health [NIH],” he said, “and it opened the door for me for the next 20 years.”

Pappas pointed to the different grants now available, including three types from the American Venous Forum (AVF) for trainees or trained surgeons within the first five years of their careers.

On the current state of benchwork research, Pappas referenced a study conducted in a dermatology lab in Europe that was “the last breakthrough in our understanding of the pathophysiology of venous ulceration,” he explained.

“These investigators determined that macrophages demonstrate different physiologic phenotypes. You have macrophages that regulate tissue destruction (M1 type), and macrophages that regulate tissue repair (M2 type),” Pappas told the audience. “In venous disease, there’s a push towards tis-

CLINICAL&DEVICENEWS

First patient treated in the AAA-SHAPE randomized controlled pivotal trial

SHAPE MEMORY MEDICAL RECENTLY announced that the first patient has been treated in the AAA-SHAPE pivotal trial. AAA-SHAPE (Abdominal aortic aneurysm sac healing and prevention of expansion) is a prospective, multicenter, randomized, open-label trial to determine safety and effectiveness of the Impede-FX RapidFill device to improve AAA sac behavior when used with elective endovascular aneurysm repair (EVAR).

sue destruction.” That iron overload from red blood cell extravasation stimulates macrophages to produce tumor necrosis factor alpha (TNFalpha), he explained. This cytokine keeps macrophages in the M1 phenotype, resulting in ongoing tissue destruction .

Pappas speculated that, based on these observations, possible future clinical applications could include the utilization of existing TNF-alpha blockers and/or iron chelators to promote wound healing. However, he added that, thus far, the current utilization of these drugs have been limited to testing in animal models.

“So let’s talk a little bit about disruptive technologies,” Pappas continued. “Mark Meissner [University of Washington School of Medicine, Seattle] and I were talking one day 15 years ago, and he introduced me to the term disruptive technology when discussing the impact the iPhone had on our daily activities.

“I would submit to you that the major disruptive technology in venous disease was the development of the VNUS catheter, which was originally called the Restore catheter. The original intent of this catheter was to restore venous valvular function and not to destroy the vein.

“After testing the feasibility of restoring valve function, it was discovered that the technique resulted in vein closure and the rise of thermal ablative technologies.

“I remember sitting in the audience in the early 1990s when the first clinical data on thermal ablative technologies was presented. I couldn’t believe this actually worked, and I was a late adopter because I wanted to see the data before subjecting patients to this brave new world,” he stated.

“As a result, this changed my perspective on the management of venous disease.”

Moving from catheters to stents, Pappas also touched on Raju and Neglen’s groundbreaking paper on the efficacy of Wallstents in patients who have venous outflow obstruction.

This work laid the foundation for venous stent outcomes, with Pappas telling the audience that “Raju and Neglen’s results are the gold standard to which all future venous stent trials are measured against.”

“I would submit to you that the major disruptive technology in venous

disease was the development of the VNUS catheter”

PETER PAPPAS

The patient was treated by Raghu Motaganahalli, MD, chief of vascular surgery at Indiana University School of Medicine in Indianapolis, .

Aspirex achieves 78% two-year primary patency rate in P-MAX postmarket observational study

AT THE LEIPZIG INTERVENTIONAL Course (LINC) 2024 (May (28–31) in Leipzig, Germany, Michael Lichtenberg, MD, from Arnsberg Vascular Clinic in Arnsberg, Germany, shared for the first time a 24-month update from the P-MAX study of the Aspirex (BD) endovascular thrombectomy system in the treatment of acute venous occlusions.

The principal investigator highlighted procedural and technical success rates of 97.5% and a 24-month primary patency rate of 77.9% among other key findings presented at LINC.

P-MAX is a prospective, multicenter, postmarket observational study designed to evaluate the outcomes of Aspirex in patients with deep vein thrombosis (DVT) of the pelvis, legs, as well as the inferior vena cava (IVC).

FastWave Medical announces successful 30-day first-in-human data on

peripheral IVL technology

FASTWAVE MEDICAL HAS ANNOUNCED the 30-day results of its first-in-human (FIH) study using the company’s differentiated peripheral intravascular lithotripsy (IVL) technology.

This was a prospective, single-arm study to assess the safety and feasibility of the FastWave IVL system in patients with peripheral arterial disease affecting the superficial femoral artery (SFA) and popliteal artery with moderate to severe calcium.

Eight patients with moderate to severe

calcified occlusions in the superficial femoral artery (SFA) and popliteal arteries were successfully treated, providing encouraging evidence supporting the early safety and feasibility of the FastWave IVL system, the recent press release states.

Of the company’s key procedural findings, they reported 100% procedural success, 0% peri-procedural adverse events, and 5.9% mean residual diameter stenosis post-therapy. FastWave also shared that 0% major adverse events were observed, they identified 100% patency, <2.4 peak systolic velocity ratio (PSVR), no revascularisations, walking impairment questionnaire (WIQ) scores showed improved walking distance and speed, and stair-climbing ability, and finally, ankle-brachial index (ABI) improved from baseline 0.56 to 0.89 at 30 days noting enhanced blood flow.

Peter Pappas

FastWave Medical IVL System

Raghu Motaganahalli