Welcome to the Vein Experts Online Educational CME Program. Original Release Date: 3/1/2013 Termination Date: 1/31/2016 Price: 25.00 for Vein Experts Members & $40.00 for Non-Members Processing/CME Fees
Accreditation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The University of Toledo and VeinExperts.org. The University of Toledo is accredited by ACCME to provide continuing medical education for physicians. The University of Toledo designates this enduring activity for a maximum of 1.00 AMA PRA Category Credits™. Physicians should claim only credit commensurate with the extent of their participation in the activity. For nurses, we are also able to issue a certificate of attendance stating the course is AMA approved, which may be eligible for credit. Nurses are responsible for submitting the certificate to their board. Please note only one certificate can be issued for each purchase. Disclosure: Ronald Bush, MD, FACS, faculty and planning member discloses he is on the Speaker’s Bureau for Dornier/Refine USA and is employed by Midwest Vein & Laser Center. Richard L. Mueller, MD, faculty and planning member, discloses he receives grant/research support from Vascular Insights, LLC Peggy Bush, APN, planning member, has no disclosures or financial interests and is employed by Midwest Vein & Laser Center.
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Becky Roberts, planning member, has no financial interest or other relationships with any manufacturer of commercial product or service to disclose.
Mission: Our objective is to provide current evidence based information, as well as new technology that is being developed for the treatment of venous disease presented in a virtual format. Target Audience: The target audience for this activity includes physicians and other health care professionals in Cardiology, Dermatology, Interventional Radiology, Phlebology, Surgery, Vascular Surgery, Wound Care Specialists who care for patients with venous disease. CME Credit Instructions Steps to successfully complete this activity: 1. Register for CME activity & pay your CME fees. 2. Read the Vein Journal entitled ‘Histology of Venous Disease: From Spider Veins to Aneurysms.’ 3. Take the post test (score of 80% or greater must be achieved. (A pdf copy of the exam can be emailed to you if requested). 4. Scan and email post test and evaluation to pbush@veinexperts.org or you can fax completed paperwork to 937-281-0200. 5. You will be contacted by the University of Toledo CME office for instruction of how to sign on and print your certificate. Technical Support Email your questions/concerns to pbush@veinexperts.org or you can call us at 407-900-8346 and we will respond in 24 hours.
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2/21/13 Ronald Bush, MD, FACS Peggy Bush, APN
This activity will describe the histological characteristics of spider veins, varicose veins and venous aneurysms. Learning Objectives As a result of this activity, the participant should be able to: 1) Identify the normal layers that constitute a vein. 2) Describe what constitutes the anatomy of a varicose vein. 3) Identify the effects of sustained hypertension on normal venous anatomy. 4) Discuss with your patients in simple terms what constitutes a varicose vein.
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This schematic illustration demonstrates the layers of a vein in a simplified fashion. Notice that the valve tissue is a continuation of the endothelium. This is important to remember in the upcoming discussion.
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! ! ! This is a 1 mm punch biopsy of a 0.4 mm spider varicosity. The red arrow points to the spider vein. The blue arrow points to the endothelium. Superior to the vein is the papillary dermis and the squamous epithelium. The reticular dermis contains adipose tissue.
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! ! ! This is an excised varicose segment. The blue arrow points to the scarred valvular tissue from long standing venous hypertension. The red arrow points to a normal appearing vein just distal to the dilatation. I will discuss this later, but remember an essentially normal vein follows a varicosity‌‌.it is all one branch.
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! ! ! ! This is a microscopic examination of the previous vein. The blue, red, & green arrows represent the varicosity. Notice the increased collagen content and hypertrophied smooth muscle. The black line & arrows represent a normal appearing vein just distal to the varicosity. Note the normal collagen content in the intima and the normal amount of smooth muscle. Increased collagen is a result of venous hypertension and is not responsible for varicose formation.
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! ! ! ! This!is!a!histological!slide!of!a!venous!aneurysm!in!the!mid!GSV.!You!can!see!again!
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the!large!amount!of!collagen!and!the!thickened!smooth!muscle!in!this!special!stain.!! Aneurysms!and!varices!have!the!same!histological!findings,!however,!only!aneuryms! occur!in!the!truncal!vessels.!(AAGSV,!GSV,!&!SSV)!! !
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Complete the exam & evaluation below and email your results to pbush@veinexperts.org along with your contact information. A score of 80% or greater must be achieved on the post-test and be completed in less than 3 attempts. Exam 1. Valves are simply extensions of what tissue? a. Endothelium b. Tunica Media c. Both 2. The etiology of varicosities is a. Increased collagen b. Smooth muscle hypertrophy c. Valvular dysfunction 3. MMP’s are a. Abnormal in varicose veins b. Responsible for abnormal collagen c. Both a and b d. Neither 4. Aneurysm of the popliteal vein are histologically similar to the following a. GSV b. SSV c. AAGSV d. None of the above
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Evaluationჼჼ ჼ 1. How well did this activity present the objectives? Excellent
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2. How do you rate the overall usefulness of the online material to meeting your needs? Excellent
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3. How do you rate the overall presentation material? Excellent
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4. Was any commercial bias presented in the material? No
Yes (Please explain)
____________________________________________________ 5. I will be able to change my clinical practice as a result of participating in this activity. Yes
No
6. What topics about venous disease would you like to hear about in the future? ____________________________________________________ 7. Additional comments/recommendations: ____________________________________________________ ___________________________________________________
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Contact Information Name & Credentials_______________________________________________ Address ________________________________________________________ Phone Number ___________________________________________________ Email address ___________________________________________________
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