33 minute read
Western Vascular
WESTERN VASCULAR STUDY PROBES WHO BENEFITS FROM EVAR AMONG PATIENTS WITH CHRONIC KIDNEY DISEASE
Patients with advanced chronic kidney disease (CKD) represent a high-risk group who may not benefit from elective endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) under traditional sizing criteria.
By Bryan Kay
THAT WAS AMONG THE CHIEF
findings in a paper presented by Mitri Khoury, MD, who recently completed his residency at the University of Texas Southwestern in Dallas and a current fellow at the Massachusetts General Hospital, and colleagues, presented at the 2022 Western Vascular Society annual meeting in Victoria, British Columbia, Canada (Sept. 17–20). Those with CKD ranked 3b, 4, and 5—found to be high-risk—had worse one-year mortality rates compared to the remainder of the cohort, Khoury et al report, with CKD 1–3b patients showing a one-year mortality benefit following EVAR regardless of AAA size. “CKD 4 patients had no demonstrable benefit following EVAR at any AAA size. CKD 5 patients had worse actual one-year mortality rates with EVAR than predicted one-year mortality without EVAR for AAAs <5.5cm, although there was a mortality benefit with EVAR for AAAs >7.0cm in the CKD 5 group,” they elaborate.
The patient pool was derived from the Vascular Quality Initiative (VQI), with nearly 35,000 patients meeting the study criteria. Some 8,183 (23.4%) were classed as CKD 1 patients, 16,888 (48.4%) CKD 2, 6,038 (17.3%) 3a, 2,708 (7.8%) 3b, 624 (1.8%) 4, and 485 (1.4%) CKD 5. The research team noted notable differences in the baseline and operative characteristics: CKD 5 patients were less likely to be fully functional and were more likely to have a prior aortic aneurysm repair than the remainder of the cohort, while patients with CKD 1 and 2 had the lowest Gagne Indices, the measure used “to understand which subset of patients with CKD are most likely to experience a survival benefit following elective EVAR for AAAs,” while patients with CKD 3b and 4 had the highest. Patients with CKD 3b, 4, and 5 had the longest operative times, they find. Khoury and colleagues comment that their study is noteworthy owing to the fact that it suggested CKD 5 patients Mitri Khoury being intervened on for AAAs less than 5.5cm “may be harmed if offered EVAR.”
They explain: “The indication for repair for AAAs <5.5cm is unclear in this study. Nonetheless, we did find that CKD 5, in addition to CKD 1, had the highest proportion of patients with concomitant iliac artery aneurysms. Therefore, there is a possibility that the indication for repair was the iliac artery aneurysm rather than the AAA. This would lead to an underestimation of the predicted one-year mortality rate in these patients since the rupture risk of the iliac artery aneurysm was not accounted for with our methodology. The VQI defines an iliac artery aneurysm as anything greater than 2cm, which is below the recommended threshold for repair of 3.5cm, so we are unable to ascertain in the current study whether the iliac artery aneurysm was the indication for repair among patients with AAAs <5.5cm.”
In an interview with Vascular Specialist, Khoury explained that combining the Gagne index and the predictive aneurysm-related mortality based off aneurysm size yields the prediction without repair. “We compared the prediction of one-year mortality without EVAR vs. what their actual one-year mortality is with EVAR, and then figure out which patients may benefit for repair,” he said. “This is obviously not a randomized-controlled trial, but what we found suggests that with advanced CKD patients, the underlying comorbidities are so high, the size threshold should be a little bit higher in these patients.”
MITRI KHOURY
Save the Date
June 14-17, 2023 National Harbor, MD
Four full days that include: Education & Research Forums & Lectures Industry Exhibits Networking & Camaraderie And so much more...
CODING WORKSHOP What you don’t know can hurt you
DON’T NECESSARILY BELIEVE THAT OLD SAW, “What you don’t know can’t hurt you.” When it comes to coding procedures for reimbursement, that adage is completely incorrect. What vascular surgeons and their staffs don’t know definitely can—and does—hurt the bottom line.
That’s just one of the reasons the Society for Vascular Surgery holds a Coding and Reimbursement Workshop annually. It’s the only vascular surgery-specific coding course in the country and covers all the details vascular surgeons and their staffs need to know for coding. It is invaluable for teaching attendees how to get reimbursement and documentation down pat the first time.
Proper coding and documentation will:
◆ Reduce the risk and hassle of an audit ◆ Give surgeons all the appropriate reimbursement to which they are entitled ◆ Help surgeons and their team get it right the first time.
That’s important because odds for full reimbursement decrease upon re-submission ◆ The course, which particularly attracts surgeons’ staff coders, will be in the OLC Education and Conference
Center at 9400 W. Higgins Road, Rosemont, Illinois
The optional E&M Workshop will be from 8 a.m. to 12 p.m. CDT Oct. 1 and the main workshop will follow, from 1 to 5 p.m. that same day and from 7:30 a.m. to 4:30 p.m. Oct. 2. The optional E&M Workshop is available only to those registering for the full Coding Workshop.
“Correct coding is key to reimbursement and correct documentation is key to proper coding,” said course director Sean Roddy, MD. The information participants learn at this course helps surgeons reduce their risk for an audit. “And an audit—even if the outcome is favorable to the surgeon – costs staff time and money.”
It’s better to get it right the first time around, he stressed, because odds for successful reimbursement decrease with each submission. “We have participants tell us that what they learn can more than pay for the course in very short order.”
The workshop is designed for all members of the vascular team, including surgeons and their office staff such as practice managers, nurse practitioners, physician assistants, nurses, surgery schedulers and coders.
Critical updates to be covered include:
◆ 2022–2023 Medicare update: proposed reduction in the physician fee schedule for 2023 ◆ Relative value units (RVUs) and physician compensation:
Concerned that all RVUs are not being captured? Make sure the “count” is correct ◆ Audit targets, risk areas for vascular surgeons and responding to a payer audit. RAC, UPIC and OIG audits, CBR let-
ters—understanding the alphabet soup of Medicare audits ◆ Does practicing in an outpatient-based facility an OBL put a surgeon at higher risk? What about a vein center?
The optional E&M workshop will provide an understanding of and incorporating the new guidelines for outpatient E&M coding, a first look at the new 2023 Facility E&M guidelines plus code revisions and deletions.
SVS members and their staffs receive a discount on registration. Cost for the main workshop is $425 for candidate members and $475 for non-member candidates; $995 for members and office staff; and $1,095 for non-members. Cost for the optional workshop is $150 for candidate members and $175 for non-member candidates; $250 for members and office staff; and $300 for non-members.—Beth Bales
Learn more, see the agendas and register at vascular.org/
Coding22.
SEAN RODDY
SVS ADVOCACY IN ACTION: PROTECTING AND ADVANCING THE INTERESTS OF VASCULAR SURGERY
By Kenneth Madsen, MD
Deep in to the second half of the year, there is no rest for the weary regarding Society for Vascular Surgery (SVS) advocacy initiatives. In July the Centers for Medicare & Medicaid Services (CMS) released its calendar year 2023 proposed rule to revise payment policies under the Medicare physician fee schedule. Thus, we are now poised to fight yet another round of payment cuts that could significantly impact vascular surgery. Having submitted a detailed comment letter to CMS at the start of this month, we are now redoubling our efforts to engage lawmakers on Capitol Hill and ensure policies to mitigate the pending cuts are included in must-pass legislation before the end of the year. With this scenario on the horizon, and an acute need for increased engagement from SVS members, it feels like a good time to provide a refresher regarding our advocacy offerings.
As I hope you are aware, the SVS utilizes a multi-faceted approach for advocacy with an overarching goal of protecting and advancing the interests of vascular surgery. This includes traditional legislative advocacy and lobbying with federal lawmakers on Capitol Hill, activating our SVS colleagues to engage in grassroots campaigns via our “Voter Voice” system and supporting the campaigns of candidate and incumbent lawmakers through the SVS’ political action committee, SVS Political Action Committee (PAC).
By simultaneously engaging in these core tenets of effective advocacy, the SVS has achieved many successes over the last several years, including (but not limited to): mitigating scheduled Medicare physician payment reductions, securing passage of legislation to address physician wellness and garnering significant bipartisan and bicameral support for legislation designed to ease the burdens of prior authorizations. But let’s take a closer look at each of these advocacy tools in action.
Working the legislative process
A significant achievement during the current 117th Congress was passage of the Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667). This critical legislation authorized grants for programs that offer behavioral health services for front-line healthcare workers. It also requires the Department of Health and Human Services to recommend strategies to facilitate healthcare provider well-being and launch a campaign encouraging health care workers to seek assistance when needed. The bill was signed into law by President Joseph Biden in March 2022.
In addition, the SVS, in collaboration with a broad coalition of physician organizations, has successfully sought legislation over the last two years to significantly reduce scheduled payment cuts within the Medicare physician fee schedule. Led by physician lawmakers Reps. Drs. Larry Bucshon, MD (R-IN), and Ami Bera, MD (D-CA), the physician community continues to make the strong argument that the payment system is broken, and Congress must act to provide greater stability while relevant stakeholders and lawmakers can identify long-term policy reforms.
In addition to sponsoring legislation and delivering letters to both CMS and congressional leadership, Bucshon and Bera have worked to raise awareness among their colleagues regarding this healthcare crisis and are in the process of facilitating a roundtable meeting to discuss this ongoing issue and build upon our work over the last two years to advance the goal of systemic payment reform.
With few healthcare professionals in Congress, the support of Bucshon and Bera is critical, as they are important assets in terms of the cumbersome process of educating lawmakers who are not familiar with the healthcare delivery system and/or the intricacies associated with physician payment. The SVS is engaging in similar efforts this year and we anticipate continued work on these issues through the remainder of the year.
Building momentum with grassroots
Although lawmakers are accustomed to meeting with lobbyists and other organizational representatives, what really matters most to them is you— their constituents. As a result, all SVS members
should be looking for, and participating in, every “Voter Voice” grassroots call to action they receive.
This easy-to-use grassroots platform allows SVS members to send pre-written messages to their lawmakers to articulate the SVS’ position on a variety of active legislative or regulatory issues. This sort of “at-home” engagement is often an essential component for securing a lawmaker’s support for a piece of legislation or sign-on letter.
Since mid-2020, SVS members have sent more than 5,000 messages to their federal lawmakers. This is a great measure of engagement, but we still have room to grow and continue to leverage this important advocacy strategy. To help provide a more comprehensive foundation for our grassroots outreach, the SVS has launched a new key contacts program—REACH 535—to identify contacts for each legislative district and ultimately amplify our messages to lawmakers. To learn more about this critical program, I encourage you to contact our advocacy team at
SVSadvocacy@vascularsociey.
org or visit vascular.org/ REACH535.
Tying it together with SVS PAC
SVS PAC is the collective voice of vascular surgery on Capitol Hill and serves as the political arm of our ongoing advocacy efforts. Via contributions from our members, the SVS PAC supports incumbent lawmakers and candidates who will champion the issues important to vascular surgery and the patients we serve. SVS PAC is non-partisan and issue-driven.
With more than 4,000 federally registered political action committees, SVS PAC is the only one focused on identifying and supporting pro-vascular surgery lawmakers. To help facilitate the development of strong relationships with lawmakers, representatives from the SVS PAC Committee and/or our Advocacy staff, attend fundraising events where SVS’ top legislative priorities are discussed directly with the member of Congress and his or her top staff. During one such event with Rep. Angie Craig (MN-2nd District), Dr. Patrick Ryan was able to eloquently outline the plight of office-based practices as well as the immense value these practices offer in terms of providing care in an efficient and cost-effective manner. Following the exchange, Rep. Craig vowed to further investigate the issue and articulated an interest in becoming more involved. This is the
type of dialogue SVS PAC helps to facilitate. Members of Congress are busy on many fronts and are often not familiar with these healthcare issues. It is our opportunity to organize (let them see that we are thoughtful and united), to educate (help them plainly see the consequences of inaction) and to advocate (present them with viable proposals and ask for their support).
Our challenge: Building a unified coalition
Various threads on SVSConnect have pointed out that financial decisions by CMS affect all of us and our ability to plan for our practices and deliver high-quality care to our patients. Recent SVSConnect posts have stressed that we are all in this together. Having these discussions is healthy and resolving differences of opinion in a healthy fashion will help us solidify our message and our ability to support the specialty. However, we must also transform these discussions into action and work collaboratively to ensure that the strength of each of the aforementioned advocacy tools continues to grow. We must continue to build a coalition of congressional representatives who are willing to bring our issues to light to the Congress. We need to guide these representatives so that appropriate legislation can be drafted and passed such as recent legislative successes. Our engagement as individuals, group practices and academic centers is crucial to this cause! PAC donations raise money needed to gain audience with members of Congress and build our platform. More importantly the percentage of us donating is a direct and tangible metric demonstrating our level of commitment. Writing to our local representatives has been stressed by the lawmakers with whom we have met, especially in “vulnerable” districts. Everyone’s congressional representative needs to know that there is a healthcare ADVOCACY WEEK OF crisis that is threatening their constituents’ access to vascular care! ACTION PLANNED FOR Our representatives need to know that it is SEPT. 26 TO 30 not fiscally responsible for us to invest in staff, supplies or in any other meaningful ways Society for Vascular Surgery when we know that there will be budget members should mark their cuts looming every single year. The reprecalendars for Sept. 26 to 30 for a special virtual “Week of Action” on advocacy. sentatives are sympathetic to these issues but only when the issues are put before them in
The week occurs during a direct and concise manner. Congress’ critical September This is not the time for complacency. Just work period; members will be as surely as night follows day, we find ourasked to participate in a series of simple, short advocacyrelated activities, such as selves on the brink of additional reimbursement cut proposals that will surface in the contacting their lawmakers. This coming weeks. Thanks to all who are doing special Week of Action will offer their part but now is the time for all members all SVS members an opportunity of the SVS to step up! to collaboratively amplify the Society’s messages on Capitol Hill. Donate to the PAC at vascular.org/PAC.
More information will be available in early September. KENNETH MADSEN is a member of the SVS Political Action Committee Steering Committee.
Kenneth Madsen
PAD SURGEONS START STEPPING OFF FOR SVS VASCULAR HEALTH STEP CHALLENGE
By Beth Bales
WITH THE TURN OF THE
calendar page to Thursday, Sept. 1, vascular surgeons, their families, friends and the general public began taking a step or 10 to highlight the significant health benefits of walking.
By the end of August, more than 250 people had signed up for the Society for Vascular Surgery Foundation’s Vascular Health Step Challenge, urging individuals to walk 60 miles during the month’s 30 days. The 60 miles represent the 60,000 miles of blood vessels, arteries and capillaries in the human body.
It’s not too late for anyone who still wants to join the movement to get walking. Visit vascular.org/VascularHealthChallenge to reach the Charity Footprints website, which is hosting the initiative from a technical standpoint.
Participants download the Charity Footprints app on their smartphones and then pair their personal fitness devices, such as a Fitbit or Apple Watch (as well as six other brands) to the site. Those who do not have a fitness tracker can enter steps manually.
Participating SVS members are creating their own teams or joining their respective regional teams. Community participants can form their own team or join an existing one. Then, between Sept.1–30, participants get walking, logging the steps and transferring them to the website. Walkers can seek donors for an overall amount or a per-step contribution, such as a donation for each 100, 1,000 or 10,000 steps.
All proceeds will go to the SVS Foundation, which will use the generated funds to assist vascular patients with exercise therapy.
The Vascular Health Step Challenge was created to take place during National Peripheral Arterial Awareness (PAD) Month. Vascular surgeons frequently see patients with PAD, which can cause pain while walking and threaten overall health. Walking can improve that pain, plus benefit hypertension and cholesterol levels and even slow the growth of abdominal aortic aneurysms.
“We want people—particularly patients—to understand that walking provides a wide range of health benefits, particularly for cardiovascular health,” said Benjamin Pearce, MD, chair of the SVS Public and Professional Outreach (PPO) Subcommittee. As of Sept. 1, the 250 participants had already raised more than $25,000.
Why are members walking? Karen Woo, MD, said she is “committed to improving the care of our patients with vascular disease and promoting vascular habits. Leigh Ann O’Banion, MD, added that the inaugural health challenge “will amplify the importance of vascular health while promoting healthy habits across the country.” Pearce urged all SVS members to get involved. “Step up!” he said. “And get moving.”
SVS Vascular Health Step Challenge participants can register by region
BENJAMIN PEARCE
O C T O B E R 2 3 - 2 4 , 2 0 2 2 R O S E M O N T , I L L I N O I S
CLTI Learn how to diagnose and stage limbs at free roundtable
LIMB STAGING IS OF KEY
importance in triaging care for patients with chronic limbthreatening ischemia (CLTI).
Four internationally known surgeons/speakers in peripheral arterial disease (PAD) will discuss developing a sequence of stages Sept. 12 during the second of three sessions on helping surgeons apply guidelines for CLTI care into their practices. The virtual, free roundtable, “Diagnosis and Staging of the Limb,” will be from 6 to 7:30 p.m. CDT.
The speakers are Elina Quiroga, MD, MPH, of University of Washington; Nobuyoshi Azuma, MD, of Asahikawa Medical University in Japan; Sanjay Misra, MD, Mayo Clinic; and David Armstrong, DPM, PhD, of the University of Southern California. Joseph Mills, MD, will lead the session, joined by co-moderators Michael Conte, MD, and John White, MD.
This is the second session of “Translating Guidelines into Practice: Global Vascular Guideline on the Management of Patients with CLTI.” The first, on overall medical care of CLTI patients, drew nearly 450 participants.. The sessions answer the challenge for practicing physicians, said White, of determining “how these recommendations apply to our own patients. These three instructional webinars are devoted to informing you how to apply the guidelines to the care of your patients, the limb and anatomy.”
Wound, Ischemia and Foot Infection (WIfI) staging, and hemodynamics and foot assessment are the main focus of the September session, said Mills. Topics will include:
◆ WIfI staging and the use of the
WIfI stage calculator (Quiroga) ◆ A review of contemporary data on the relationship between WIfI staging and important clinical outcomes in CLTI patients (Azuma) ◆ Current approaches and limitations to hemodynamic assessment and
perfusion measurement in the foot and how they are employed in both pre- and post-revascularization (Misra) ◆ How WIfI staging drives triaging of care (Armstrong)
The three sessions feature one sample patient for whom to design treatment strategies; session leaders and speakers will use this patient to demonstrate how to put the global vascular care guidelines into practice.
Surgeons also will cover the importance of repetitive staging to guide the course of treatment and review potential changes in the treatment plan if such alterations are required.
The third and final session, “Revascularization,” will be Monday, Oct. 10. Conte, who was the lead author for the Global Vascular Guidelines, will moderate the session.
This concept and content of this educational was solely developed by the Society for Vascular Surgery. This activity is partially funded by a block grant from W.L. Gore and Associates, Inc.—Beth Bales
WIFI classification system
Learn more and register today at
vascular.org/CLTIroundtable2.
JOHN WHITE
CANADIAN VASCULAR PAD: ENDOVASCULAR REVASCULARIZATION ‘SUPERIOR OR NOT SIGNIFICANTLY DIFFERENT OUTCOMES’ VERSUS OPEN REPAIR
A REAL-WORLD ANALYSIS OF PERIPHERAL arterial disease (PAD) patients in Canada indicated open revascularization may not offer a long-term benefit over endovascular intervention. In a population-based retrospective cohort study, researchers from the University of Toronto in Toronto, Ontario, found that in PAD patients eligible for both strategies, endovascular revascularization is associated with “superior or not significantly different outcomes” relative to open repair.
The findings are part of research presented at the Canadian Society for Vascular Surgery (CSVS) annual meeting in Vancouver, British Columbia (Sept. 9–10) by Jean Jacob-Brassard, MD, and colleagues from the Department of Surgery at the University of Toronto. The investigators looked at all Ontarians 40 years or older revascularized between April 1, 2005, and March 31, 2020, through either an endovascular or open approach, with a primary 17,661 outcome of amputation-free survival and secondary outcomes of major amputation, death, major adverse limb events (MALE), and major adverse cardiovascular events (MACE). They used Cox proportional haz11,203 ards models to compare patients undergoing endovascular vs. open revascularization, with weighting by propensity score-based overlap weights to account for baseline characteristics. Analyses were repeated for pre-specified subgroups: diabetes, isolated infrainguinal disease, and tissue loss.
Among the 28,864 patients identified as having been revascularized for PAD, 39% (n=11,203) underwent endovascular revascularization. Median follow-up time was 4.42 years.
In the full cohort weighted analyses, endovascular revascularization was associated with better amputation-free survival, no difference in major amputation, lower mortality, and lower hazard of MALE after four years, the researchers found. There were no differences in MACE. “Among subgroups, there were no differences in [amputation-free survival], major amputation or death,” Jacob-Brassard et al report. “Endovascular revascularization resulted in lower long-term MALE for those with infrainguinal disease only and those with tissue loss. There was no difference in MACE.”—Bryan Kay
No matter if you’re a surgeon with a few years—or a few decades—of experience, faculty members of a new, upcoming Society for Vascular Surgery course say you’re sure to learn valuable skills and strategies to help in treating patients with peripheral arterial disease.
“This is going to be a great course with experts in the field teaching novel endovascular technologies,” said Leigh Ann O’Banion, MD, one of 18 faculty members for the Society for Vascular Surgery’s Complex Peripheral Vascular Intervention (CPVI) Skills course.
The two-day course, with a dedicated hands-on component, will be Oct. 23 and 24 at the OLC Education and Learning Center at 9400 W. Higgins Road, Rosemont, Ill. The center is minutes from O’Hare International Airport. Discounted early-bird pricing ends Sept. 23.
Limited spots are available for the course, designed by vascular surgeons for vascular surgeons.
“We’re crossing a horizon with a lot of new interventions, especially in the below-the-knee space,” said O’Banion. “Intravascular ultrasounds, retrograde pedal access, Shockwave lithotripsy … these are all new tools we can use to treat patients with advanced chronic limb-threatening ischemia.”
And surgeons at all career stages can add these skills as useful tools in their toolboxes, she added.
Innovations and new devices and technologies in patient treatment are introduced frequently, spurring surgeons to keep themselves updated, O’Banion said. “Maybe I’m biased as a faculty member, but I see value in this course for all vascular surgeons.”
With limited openings, “Run, don’t walk, to sign up for this incredible course,” said faculty member Venita Chandra, MD.
“I don’t think there’s a better course out there to give surgeons a comprehensive hands-on experience and advanced training for these really challenging patients that all of us are seeing more and more frequently in our clinical environment.”
Beyond learning new skills, think of “fun” as a bonus reason to attend.
“Any time you can network with your colleagues, where there are that many people in a room passionate about PAD, where instructors are pushing the limits of limb salvage, constitutes a good experience,” said O’Banion.
“I’m excited to go peek at some of the tables and watch Dr. Dan Clair teaching LimFlow and watch Dr. Venita Chandra do a retrograde peroneal access. There are always new things you can be learning at every stage of your career. We can all learn from each other.”—Beth Bales
GIVE GIFT OF SVS MEMBERSHIP TO VASCULAR NURSES
SEPT. 4 TO 10 IS VASCULAR NURSES WEEK. IT’S THE
perfect opportunity for Society for Vascular Surgery members to “give the gift of dual membership” to both SVS and the Society for Vascular Nursing to their vascular nurses.
The Society for Vascular Nursing (SVN) has made its management home with the Society for Vascular Surgery (SVS) since 2017. All Active SVN members automatically receive affiliate SVS membership as part of their SVN dues. This permits these vascular nurses to receive SVS communications and e-newsletters, discounts on the Journal of Vascular Surgery and SVS meetings, the SVS job board, and the SVN and SVS online communities on SVSConnect. It’s two memberships for the price of one. And it’s as simple as filling out a form, at vascular.org/GiveSVNmembership. “We celebrate vascular nurses throughout the year, but especially during Vascular Nurses Week,” said SVS President Michael Dalsing. “This week celebrates the commitment and dedication that vascular nurses display every day on behalf of their patients, who are our patients. They are invaluable to the vascular surgery world.”
All members who give this gift will be recognized. A group discount of 10% is available for those who give four dual memberships. Incoming SVN President Kristen Alix said, “I joined as a novice bedside nurse, only expecting to glean knowledge of the vascular patient. There was that and so much more. SVN gives the ability to network with national nursing leaders, provides expert content and encourages individual professional growth. I never thought I would lecture on a national stage, be a part of a Board of Directors, or add to vascular education and research.”
Trainees step up to learn coding, reimbursement
The Society for Vascular Surgery’s (SVS) efforts in coding and reimbursement work have taken another step forward, with four new doctors now in training to learn the ins and outs of the entire process.
The SVS has a long tradition of advocacy training under leaders such as David Han, MD, Sunita Srivastava, MD, and Matthew Sideman, MD, plus Robert Zwolak, MD, in creating procedural codes, descriptions of work and relative value (RVU) recommendations. These leaders help guide appropriate reimbursement of vascular surgeons’ work and practice expenses. The SVS actively trains future leaders in the physician payment system or Resource-Based Relative Value Scale (RBRVS) to advocate for present and future coding and reimbursement. Two panels within the American Medical Association (AMA), the Relative Value Scale Update Committee (RUC) and the Current Procedural Terminology (CPT) panels, are critical to ensure the SVS has a voice in shaping CPT, RVUs and Medicare reimbursement.
The advisory work and AMA process representation workload is divided among CPT and RUC teams, each with an advisor, alternate advisors and trainees. The SVS is pleased to announce four new trainees. Joining the CPT team in representation are Jonathan Thompson and Xiaoyi Teng, and for the RUC team are Mark Iafrati and Justin Hurie. The SVS coding and reimbursement team look forward to training the new leaders.
Obituary
WILLIAM T. MALONEY, 88, of Manchester-By-The-Sea, Massachusetts, died July 30. Maloney was for many years the executive director of the Society for Vascular Surgery/International Society for Cardiovascular Surgery, North American Chapter; the two merged in 2003 to become the Society for Vascular Surgery. He is the only non-doctor interviewed for the SVS History Project. Visit vascular.org/HistoryProject for a list of the video interviewees.
SVS LAUNCHES PROGRAM TO ‘REACH 535’ LAWMAKERS
TO LEVERAGE THE POWER OF
direct engagement with lawmakers on the part of constituents—the SVS Advocacy team is launching a grassroots advocacy plan to help foster this direct communication between SVS members and their federal lawmakers.
The program will serve two purposes, said SVS Advocacy Council Chair Matthew Sideman, MD: connecting SVS members with their lawmakers to establish tangible channels for vascular surgeons to personally advocate on issues that significantly impact their practices and their patients; and establishing a concrete mechanism for the SVS to amplify its advocacy efforts by ensuring advocacy team members can quickly REACH the 535 decision-makers on Capitol Hill
To become a key contact in REACH 535, members should complete the sign-up form to identify their federal representatives and senators.
The form is available at vascular.org/ REACH535form. Information also is available by emailing SVSAdvocacy@
vascularsociety.org.
CLINICAL&DEVICENEWS
Compiled by Jocelyn Hudson, Will Date and Bryan Kay
AngioDynamics announces FDA clearance of expanded indications for Auryon atherectomy system
AngioDynamics recently announced receiving Food and Drug Administration (FDA) 510(k) clearance of an expanded indication for the Auryon atherectomy system to include arterial thrombectomy.
The FDA recently cleared the expanded indication for the Auryon system’s 2mm and 2.35mm catheters to include adjacent thrombus aspiration when treating stenoses in native and stented infrainguinal arteries. Both catheters have aspiration capabilities as atherectomy devices, including in-stent restenosis (ISR).
The Auryon laser can be used to treat all infrainguinal lesion types, including above-the-knee (ATK), below-the-knee (BTK), and ISR, and to date, has been used to treat more than 21,000 patients in the U.S., a company press release reported.
Vascular experts establish appropriate use of IVUS in peripheral interventions
Royal Philips announced an important milestone in the evolving standard of care for treating patients with peripheral vascular disease: the establishment of the first-ever global consensus for the appropriate use of intravascular ultrasound (IVUS) in lower-extremity arterial and venous interventions.
Published in the August 2022 issue of the Journal of the American College of Cardiology: Cardiovascular Interventions, the new consensus document from 30 global vascular experts recommends routine use of IVUS as a preferred imaging modality in all phases in many peripheral vascular disease procedures.
“The voting panelists considered a variety of clinical scenarios and based on their extensive experience, arrived at a strong consensus,” according to lead author Eric A. Secemsky, MD, from Beth Israel Deaconess Medical Center in Boston.
“They recommend routine use of IVUS as a preferred imaging modality in all phases for many peripheral interventions, both diagnostic and therapeutic, as it enables such exquisite visualization of the target vessel and lesion.
“Their recommendations, which withstood the rigor of peer review, can now be considered in the formulation of clinical guidelines for the diagnosis and treatment of peripheral vascular disease.”
Gore acquires InnAVasc Medical
Gore has announced the acquisition of InnAVasc Medical, a privately held medical technology company focused on advancing care for patients with end-stage renal disease who utilize graft circuits for dialysis treatment. Jeffrey Lawson, MD, PhD, and Shawn Gage, PA-C, of Duke University School of Medicine’s Department of Surgery in Durham, North Carolina, developed the InnAVasc device, which is specifically designed to allow for safe, easy, reproduceable and durable access for dialysis treatment of patients with graft circuits.
The investigational InnAVasc device is designed to protect the graft from backwall punctures and reduce the damage associated with frequent needle sticks. This can lead to circuit failure and shortened circuit life. “To be stuck with two needles three times a week for hemodialysis for 52 weeks, that’s 312 times a needle goes into a patient’s graft each year,” said Stephen Hohmann, MD, vascular surgeon at Texas Vascular Associates in Dallas.
Selution SLR receives second FDA IDE approval
Selution SLR, MedAlliance’s sirolimuseluting balloon, has received conditional Food and Drug Administration (FDA) investigational device exemption (IDE) approval to initiate its pivotal clinical trial for the treatment of occlusive disease of the superficial femoral artery (SFA). This comes only a few months after the company received IDE approval for Selution SLR in the treatment of belowthe-knee (BTK) indications (May 2022). Enrollment will begin in the SELUTION SLR IDE SFA study later this year. It will be conducted at over 20 centers in the U.S. and an additional 20 centers around the world.
This study will enroll 300 patients to demonstrate superiority over balloon angioplasty (POBA). The principal investigator of this study is George Adams, MD, the director of cardiovascular and peripheral vascular research at Rex Hospital in Raleigh, North Carolina.
“We are very excited that U.S. patients suffering from PAD [peripheral arterial disease] will have the opportunity to receive this novel sirolimus drug-coated balloon technology. This is yet another advancement in the field of treating vascular disease and we are confident that this study will enroll quickly,” Adams commented.
VENOUS
Compression duration affects pain during superficial venous intervention, study finds
POSTPROCEDURAL COMPRESSION OF ONE TO
two weeks after superficial venous incompetence (SVI) treatment is associated with reduced pain compared with a shorter duration. This is according to a study published in the August edition of the British Journal of Surgery (BJS).
Authors Abduraheem H. Mohamed, of Hull York Medical School in Hull, England, and colleagues note that international guidelines recommend postprocedural compression when treating symptomatic SVI. However, they stress that there is no agreed timescale for this. In order to investigate the optimal application of postprocedural compression, the research team carried out a systematic review of randomized controlled trials (RCTs).
Mohamed et al write that they used the UK National Institute for Health and Care Excellence’s Healthcare Databases Advanced Search Engine to identify all English-language RCTs of compression following treatment for SVI. Postprocedural pain, venous thromboembolism (VTE), health-related quality of life (HRQoL) and anatomical occlusion were the main outcomes of interest, they note.
The investigators included a total of 18 studies comprising 2,584 treated limbs in their systematic review. Compression was compared with no compression in four studies, nine studies compared different durations of compression, and a further five compared different types of compression, Mohamed and colleagues relay.
Writing in BJS, the authors report that a one to two week period of compression was associated with a mean reduction of 11 (95% confidence interval [CI] 8–13) points in pain score on a 100mm visual analogue scale compared with shorter duration (p<0.001). Mohamed et al also reveal that this was associated with improved HRQoL and patient satisfaction, however note that greater than two weeks’ compression did not add further benefit.
“There was low-quality evidence suggesting that 35mmHg compression with eccentric thigh compression achieved lower pain scores than lower interface pressures,” the authors add, noting also, “there were no significant differences in [VTE] rates or technical success in any group, including no compression”.
In their conclusion, Mohamed et al acknowledge the evidence gaps that persist: “The optimal interface pressure and type of compression, and the impact on [VTE] risk, remain to be determined.”—Jocelyn Hudson
ABDURAHEEM H. MOHAMED
Compression of one to two weeks postprocedure after SVI treatment is found associated with reduced pain
KEY DIFFERENCES IN PRESENTATION, OUTCOMES FOR DISTAL VERSUS PROXIMAL DVT UNCOVERED
A NEW STUDY HIGHLIGHTS KEY
differences in clinical features and comorbidities, as well as short-term and also long-term outcomes for patients with distal deep vein thrombosis (DVT) versus proximal DVT. The findings were recently published in JAMA Cardiology.
The differences between the clinical presentation, short-term and long-term outcomes for patients with isolated distal DVT (smaller thrombi in veins below the knee) versus proximal DVT have been unclear, Behnood Bikdeli, MD, from Brigham and Women’s Hospital in Boston, and colleagues write.
In order to investigate this gap in the literature, the researchers conducted a multicenter, international cohort study in participating sites of the Registro Informatizado Enfermedad Tromboembólica (RIETE) registry from March 1, 2001, though Feb. 28, 2021. The team found that patients with isolated distal DVT had lower comorbidity burden and a lower risk of 90-day mortality. They were also at lower risk of developing a pulmonary embolism or a new venous thromboembolism (VTE) in one year.
The authors note that some of the differences in the outcomes are attributable to the risk profile of these patients. Patients with distal DVT were younger, more likely to have had DVT in the setting of transient provoking factors such as surgery or hormonal use but less likely to have serious comorbidities such as cancer or anemia. “Our findings may have implications for risk stratification and for practice,” said Bikdeli. “While we find less ominous outcomes for isolated, distal DVTs, they are not entirely benign. Even among patients who received initial anticoagulation treatment, almost half had signs or symptoms of post-thrombotic syndrome, a chronic manifestation of these clots.”
