achieving the best clinical results post ablation...ak]ancek cases larne ]aricosities ]eno\s stasis...

8 5 5 - 8 3 5 - V E I N ( 8 5 5 - 8 3 5 - 8 3 4 6 ) w w w . c e n t e r f o r v e i n . c o m 1

Patients with chronic lower extremity

eno s ins ciency classically resent with

com laints o le ati e achin itchin

an some element o e ema n more

a ance cases lar e aricosities eno s

stasis chan es o the s in an lcerations

may e elo

lex ltraso n e al ation o these

atients s ally re eals si ni cant re x

in the reater an lesser sa heno s

eins an may in ol e se eral accessory

eins tri taries an er orator eins t is

enerally acce te that en o eno s laser

an ra io re ency a lation ha e

ecome the ol stan ar in the treatment

o s er cial lower extremity eno s

ins ciency

e eral ros ecti e ran omi e trials on

the res lts o these treatment mo alities

com are with ein stri in an hi h li ation

show si ni cant clinical s eriority o these

less in asi e roce res he o erwhelmin

ma ority o these atients show si ni cant

im ro ement in their sym toms ollowin

or a lation

o their

incom etent

eins hese

results are

u s u a l l y

i m m e d i a t e

and ood

e year data

has een

o tained with

over 85%

r e l u x r e e

and vein occlusion rates

Identifying Potential Causes

su set o atients will have residual

sym toms ost a lation des ite ade uate

treatment o su er cial venous insu ciency

here ore it is critical to o tain an initial

extensive medical history rom all atients to

T h e O f f i c i a l J o u r n a l o f C e n t e r f o r V e i n R e s t o r a t i o n

Continued on Page 3Copyright © 2014 Center for Vein Restoration. All rights reserved.

Editorial Staff

ditor in hie President enter or ein estoration

Sanjiv Lakhanpal, MD

ssociate ditorirector o esearch irector o ascular a s

Sh k S an, MD, S

ana in ditor a hl n a

5 Print 5 5 nline

Podiatry & Vein Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 2New Cl in ic: North Bergen, New Jersey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 3CME Courses & Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 4Pi lot Partnership Helps Pat ients & Their Physicians Address DVT. . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 5Q&As . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 5Community Outreach:Educat ion Mixes with Fun in the Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 6Our Physicians & Locat ions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 7

Vol. 7, Issue 3

September 2014

inside this issue

Achieving The Best Clinical Results Post Ablation


s a ractice s eciali in in vein disease we are o ten

as ed y re errin hysicians that are Podiatrists

e o ten encounter atients with varicose veins

what should my sta and now considerin our

s ecialty

Support from Podiatrists

hen you consider an estimated 8 to million

mericans have eri heral artery disease P and

ten times more eo le su er rom venous disease

than P in the nited tates it is not sur risin that

vascular dia nosis is ex andin to s ecialties eyond

vascular sur ery ne o the s ecialties em racin

vascular dia nostics is odiatric medicine ince

the merican Podiatric edical ssociation

P the nation s leadin ro essional or ani ation

or odiatrists has su orted a coalition o leadin

medical societies committed to em owerin

individuals to ethin aricose eins as a health

concern worthy o medical dia nosis and treatment

enous disease most o ten a ects the le s and

eet which is why an increasin num er o odiatric

atients are ein dia nosed and re erred to vein

s ecialists

What To Look For

ore than million merican have varicose veins

o the le s an les and eet nd the rst clinical

si ns o venous disease o ten include an le swellin

so odiatrists are ali ned er ectly to ma e the initial

dia nosis

Wound Care

urthermore odiatrists have always een ex erts

in mana in dia etic wounds o the eet any

have roadened their ex ertise to include wounds

involvin not only the eet ut also the lower le any

o the current estimates show that a roximately

ercent o le ulcers in the nited tates are venous

ulcers or o mixed arterial venous etiolo y hen it

comes to atients with lower extremity ulcers one

must a roach them as i they have some de ree o

venous insu ciency es ecially i they have visi le

edema varicose veins or hemosiderin stainin and

or a history o dee vein throm osis t is

recommended to always order early venous studies

that can detect incom etent veins and er orators

hese sono ra hic studies are very im ortant as

identi yin and treatin diseased vessels can o ten

e the ey to healin hen orderin the venous

studies rovide s eci c instructions to loo or

venous re ux in the sa henous veins tri utary veins

and er orators

An Underdiagnosed Condition

he vast ma ority o the more than million

mericans su erin rom venous disease remain

undia nosed and untreated le t untreated varicose

veins can ro ress to a more serious orm o disease

called chronic venous insu ciency ym toms

o include s in dama e swellin severe ain

and ulcers and the disease itsel is associated with

si ni cant mor idity loss o roductivity and reduced

uality o li e here ore atients rely on odiatric

roviders to loo or si ns o vein disease includin

varicose veins lower extremity edema stasis

dermatitis li odermatosclerosis atro hie lanche

and ulcerations and rovide timely re errals to local

vein s ecialists

Podiatry & Vein DiseaseBy Sean K. Stewart, MD, Regional Medical DirectorB

Ulceration

Atrophie Blanche

Lipodermatosclerosis

Ulce ation


Continued from Page 1

exclude other otential causes urther control o hy ertension

dia etes and con estive heart ailure is aramount rior to

er ormance o any a lation thera y

dema in articular has multi le etiolo ies this is the only

com laint caution must e exercised in recommendin a lation

rocedures unless the re ux times are si ni cant ven i venous

re ux is the only cause or the edema resolution may ta e

some time and use o com ression stoc in s is

mandatory until com lete resolution is achieved

Patients with ersistent ain des ite success ul

a lation rocedures may have to e ruled out or

scleroderma or other connective tissue disorders

as well as neurolo ical disorders

nother cause or residual sym toms is the resence

o dee venous insu ciency resent in a out

5% o atients with su er cial venous insu ciency

his is not a contraindication to er ormin a lation

o the su er cial venous system n the a sence o

su er cial emoral or o liteal vein re ux common

emoral vein re ux is enerally eni n and in most cases resolves

a ter a lation o the re uxin reat sa henous vein n act most

atients su erin rom dee re ux ex erience si ni cant relie o

their sym toms ost a lation and reduction in their venous clinical

severity score

Diagnostic Testing is Critical

urther dia nostic testin is indicated in atients with residual

sym toms with or without dee venous insu ciency Proximal

ilio emoral o struction stenosis or occlusion is common in

these atients and ima in modalities are necessary to ma e

this determination com uteri ed tomo ra hy an io ram

with delayed venous hase ma netic resonance veno ra hy

and more recently intravascular ultrasound are

the ima in modalities o choice eno ra hy once the old

standard is dia nostic in only 5% o cases and is now used

only as a roadma once the dia nosis has een made

he etiolo y o ilio emoral o struction is most commonly ost

throm otic in atients with rior or rimary % he

ty ical ost throm otic ilio emoral lesion involves the

common and external iliac veins nly a out % o

atients with ilio emoral will recanali e com letely

a ter anticoa ulation thera y while the remainder

recanali e only artially and develo varyin de rees

o o struction and collateral vein ormation

t has een estimated that u to 5% o the o ulation

has some de ree o extrinsic com ression o the iliac

veins Primary o struction is due to intraluminal we s

or more commonly external com ression hese

lesions do not ecome clinically a arent until other

com onents o the venous circulation ail nce a

clinically a arent o structive lesion has een ound it can e

treated with endovascular stentin which has re laced o en

sur ical re air and in s illed hands has had excellent results

is mandatory to uide the lacement o the stent

Conclusion

t is im ortant or hysicians involved in the care o venous

disorders to e aware o the ossi ility o roximal o struction

in atients with residual sym toms ost a lation o incom etent

su er cial veins imitin wor u to du lex ultrasound alone is

insu cient and hysicians should e re ared to ta e the ste s

noted to achieve the est clinical results

Achieving The Best Clinical Results Post Ablation

Center for Vein Restoration is proud to announce the opening of our newest clinic in North Bergen, New Jersey. The clinic is now open and taking referrals.

The North Bergen clinic is located at 8901 Kennedy Blvd., Suite 3E, North Bergen, NJ 07047, Phone: (201) 868-6713. As with all our locations, the North Bergen clinic is under the supervision of our senior medical team: Sanjiv Lakhanpal, MD, CVR President and CEO; and Khan Nguyen, DO, CVR

Corporate Medical Of cer.

Our New Jersey medical team leader is Shubha Varma, M.D.. Dr. Varma has been chief of vascular surgery at Palisades Medical Center in New Jersey for the past 10 years. Formerly Dr. Varma was Assistant Professor, Department of Surgery at Columbia University in New York, and was a Clinical Instructor at the New Jersey

Medical School in Newark. She attended Maulana Azad Medical College at the University of Delhi, and served a general surgery residency at the New York Hospital in Queens; she did a vascular fellowship at the University of Medicine and Dentistry of New Jersey.

We look forward to serving patients in North Bergen!

OScMpAaw

Shown in this image: Stenosis of the left common iliac vein

from compression by the right iliac artery.

New Clinic: North Bergen, NJ


CME Courses & Events

November

nn i S a Da L a i n , v

M n a i n

Maureen Jennings, Regional Sales Director, at

[email protected], or C: (203) 858-8752

Ma lan S h n Ma lan h , v , p

h Li h h a an D k a

14636 Solomon’s Island Rd., Solomons, MD

RSVP by Wednesday, October 30 (seating is limited)

To: Michelle Gaynor, Physician Liaison at

[email protected], (202) 320-9484

Ma lan l n ni a , v , p

h S n a an

625 Greenway Road SE, Glen Burnie MD 21061

RSVP by Wednesday, November 4 (seating is limited)

To: Heather Buck, Physician Liaison at


ave you attended one o our

events ur resentations

on venous insu ciency are

conducted y enter or ein

estoration hysicians and sta

hen you rst oin we wor hard to

ma e your ex erience a ood

one and you ll notice a di erence

rom other sessions you may have attended

irst we res ect your usy schedules so we ty ically hold our

s in the evenin s

e start the event with a relaxin dinner and networ in with

collea ues and eers and ollow that with a resentation on the

dia nosis and treatment o atients with venous insu ciency e

discuss the classi cation o venous insu ciency the use o du lex

ultrasound to screen atients review modern a lation techni ues

li e radio re uency and laser oam and visual sclerothera y as

art o a ull s ectrum o care availa le to your atients

ur attendees consistently ive us hi h mar s or their ex erience

at our s in act our est attended s this year avera ed

hysicians

Plan on a rewardin interactive event with ollow u uestions

rom the audience or our anel o resentin hysicians

October

Ma lan a n vill l ia , , p

i a i 6741 Columbia Gateway Dr., Columbia MD 21046

RSVP by Wednesday, September 24 (seating is limited)

To: Karen Komisar, Physician Liaison at


or Jason Bungori, Physician Liaison at


Ma lan nnap li n a , , p

L li a i 2552 Riva Rd., Annapolis, MD 21401

RSVP by Wednesday, October 15 (seating is limited)

To: Kathy Rewa, Regional Sales Director

at [email protected], (410) 271-3559

a hin n D h a , , p

S i h an ll n k 1112 19th Street NW, Washington DC 20036

RSVP by Thursday October 23 (seating is limited)

To: Tara Rochelo, Physician Liaison at



DVT affects at least one person in a thousand, with 60,000-100,000 people dying in the US each year. Additionally, one-third of people with DVT/PE will have a recurrence within 10 years. With older patients the numbers get worse – 1 in 100 in people over 80 will suffer from DVT, according to the Centers for Disease Control.

Many of those cases are linked to venous insuf ciency, which is why Center for Vein Restoration has embarked on a pilot partnership to help screen patients to either rule out DVT or direct them quickly into treatment if it is discovered.

“DVT is a serious condition – 10 to 30% of people will die within one month of diagnosis, and sudden death is the rst symptom in about one-quarter of people who have a PE,” said CVR President Sanjiv Lakhanpal, MD & CEO. “This partnership gives us a unique ability to help local patients both in the short term, as well as identifying potential long-term venous issues and treatment options.”

The pilot project, begun this summer, offers both an easy way for patients to address this potentially life-threatening condition, and also provides an alternative to high-cost emergency room visits for simple screening. Each patient

has been given a CVR/DVT kit, explaining DVTs in laymen’s terms and explaining risks in a simple, 1-2-3 format:

A score of “1” is for highest risk, calling for immediate emergency-room admittance for testing,

A score of “2” is elevated risk – patients are given a dose of blood thinning medication, and an appointment is made at a local CVR for screening within 24 hours.

A score of “3” indicates moderate risk, with patients being offered a screening at CVR within 24 hours, without medication.

We will be monitoring and assessing the effectiveness of the pilot in the coming months, but thus far we think the program has potential to help save lives and improve quality of life in our local communities in an easy and cost-effective way.

For more information on the DVT program or to schedule a preventive scan for your patient, call 877-SCAN-DVT.

Pilot Partnership Helps Patients & Their Physicians Address DVT

Webtie

Fs8

In each issue of the Venous Review, members of our medical team answer questions we’ve received from referring physicians.

This issue’s guest Q & A Editor is

Q: My patient is a teacher with varicose

veins. She spends long hours on her

eet at wor . ow speci cally does this

contribute to her symptoms – and what

can I recommend for her?

Teachers belong to one of several occupations that commonly contribute to the development of varicose vein and venous insuf ciency. Other patients at particular risk are those who work in healthcare, restaurants, factory, and retail sales. The most signi cant risk factor for venous insuf ciency remains family history, age and sex. However, occupations that require spending long hours standing or sitting may contribute to the earlier development of weakened or failed valves that trap and pool blood in the leg veins of those at risk for venous insuf ciency.

Regular leg muscle movements are very important to lower extremities’ venous ow

and spending long hours regularly in the same position reduces venous ow and increases daily pressures on leg veins. This can result in symptoms such as leg cramps, soreness, aching, swelling and/or fatigue usually noted toward the later part of a work day. The varicose veins seen on your patient are only the visible signs of the venous insuf ciency which commonly involve other super cial veins that are only visualized by ultrasound.

Your patient needs a comprehensive venous consult and duplex ultrasound evaluation of her leg veins available at any of our local CVR clinics. This will identify speci c areas of venous insuf ciency and other associated clinical symptoms. Minimally symptomatic patients can be treated conservatively whereas signi cantly symptomatic patients will bene t from targeted ablative therapy.

Duc Le, MD


enter or ein estoration rides itsel on our ro ram o events

in the community where we can hel educate the u lic on ris

actors sym toms and treatment o tions or venous insu ciency

e ve een articularly usy this summer in the ortheast

rovidin demos screenin s and in ormation at health airs

community icnics and amily tness ex os

hi hli ht was the un and estive nd

nnual ew or iants ealth

itness x o held uly at et i e

tadium n addition to ree health

screenin s and demos artici ants were

a le to wal the eld indul e in a dessert

rom a o he e ins ired y a i est oser listen

to ermaine Paul winner o the nd season o he oice and

even meet one o the newest housewives rom ravo s eal

ousewives o ew ersey uests also learned how to um a

ot to sit in the he oice chair and sha e hands with ew or

iant teve eather ord

ther events sta ed y this summer included the orth

udson ommunity ction or oration s ealth air n lewood

the van elia xodo hurch ealth air nion ity ree

demonstrations at the reen ur h i rary lms ord and ree

scans at the ocal icnic artsdale

han s to our intre id team o community

outreach coordinators vascular technicians

re ional o erations directors ractice

administrators and center coordinators or

rin in education to our local communities

imsi on ale anu ar hese essica onco

arolina elix o aldy te hanie n enito oann

udrewic inda olimine and ulianne e imone

you d li e enter or ein estoration to rovide demonstrations

or ree screenin s to your community event contact o ert owell

at 5 8 8 or o howell center orvein com

Education Mixes with Fun in the Northeast

(L to R) 1. Community outreach coord. Nimsi Gonzalez educating a patient about the risks of venous disease at the North Hudson Community Action Corporation’s Health Fair in Englewood, NJ / 2. Community outreach coord. Nimsi Gonzalez educating patients about the risks of venous disease at the North Hudson Community Action Corporation’s Health Fair in Englewood, NJ / 3. Nimsi Gonzalez helping our Hispanic population fill out an assessment on venous disease at the Iglesi Evangelia Exodo Church Health Fair in Union City, NJ / 4. VT Sanu Varghese scanning veins at the NY Giants Health & Fitness Expo

(L to R) 5. The NY region staff in action at the NY Giants Health & Fitness Expo. VT Stephanie Ingenito and Sanu Varghese and Regional Operations Director Joann Kudrewicz pictured. / 6. Crowds at the NY Giants Health & Fitness Expo

COMMUNITY OUTREACH:


Maryland Trade Center 2, 7474 Greenway Center Dr., Ste. 1000, Greenbelt, MD 20770 Ph: (240) 965-3200

O U R P H Y S I C I A N S & L O C A T I O N S

MarylandAnnapolis108 Forbes St., Annapolis, MD 21401Ph: (410) 266-3820

Baltimore/Towson7300 York Rd., Ste. LL, Towson, MD 21204 Ph: (410) 296-4876

Bel Air620 W. MacPhaill Rd., Ste. 104,Bel Air, MD 21014Ph: (410) 420-3604

Catonsville1001 Pine Heights Ave., Ste., 303,Baltimore, MD 21229Ph: (410) 525-1444

ColumbiaMedical Arts Building, 11085 Little Patuxent Pky, Ste. 203,Columbia, MD 21044 Ph: (410) 730-2784

Easton505A Dutchman’s Ln., Ste. A-2, Easton, MD 21601Ph: (410) 770-9401

Germantown19735 Germantown Rd., Ste. 330, Germantown, MD 20874 Ph: (301) 515-7203

Glen Burnie1600 Crain Hway., Ste, 408, Glen Burnie, MD 21061 Ph: (410) 424-2237

Greenbelt7300 Hanover Dr., Ste. 303,Greenbelt, MD 20770 Ph: (301) 441-8807

ort Bet esda/ o ville11921 Rockville Pike, Ste. 401, Rockville, MD 20852Ph: (301) 468-5781

rin e rederi301 Steeple Chase Dr., Ste. 401, Prince Frederick, MD 20678 Ph: (410) 414-6080

Ta oma ar / ilver prin831 University Blvd. E, Ste. 24-25, Silver Spring, MD 20903 Ph: (301) 891-6040

Waldorf12107 Old Line Center, Waldorf, MD 20602 Ph: (301) 374-2047

Conne ti ut

tamford1290 Summer Street, Ste. 2100,Stamford, CT 06905Ph: (203) 324-4220

istri t of ColumbiaDC West3301 New Mexico Ave. NW., Ste. 336, Washington, DC 20016Ph: (202) 244-0783

Mi i an

alama oo/ orta e3810 West Centre Ave., Ste. A, Portage, MI 49024Ph: (269) 323-8000

New Jersey

a ensa211 Essex St., Ste. 403 Hackensack, NJ 07601 Ph: (201) 883-9370

Nort Ber en 8901 Kennedy Blvd., Suite 3E North Bergen, NJ 07047Ph: (201) 868-6713

New or

arsdale700 White Plains Rd., # 241, Scarsdale, NY 10583 Ph: (914) 725-6800

White Plains3010 Westchester Ave., Ste. 105,Purchase, NY 10577 Ph: (914) 251-0100

ir inia

Alexandria2000 N. Beauregard St., Ste. 310, Alexandria, VA 22311Ph: (703) 379-0305

airfax/ air a s 3700 Joseph Siewick Dr., Ste. 207, Fairfax, VA 22033Ph: (703) 453-0443

airfax/Merri eld8316 Arlington Blvd., Ste. 514-A, Fairfax, VA 22031Ph: (703) 289-1122

Herndon 150 Elden St., Ste. 210, Herndon, VA 20170 Ph: (703) 437-0601

Manassas 8140 Ashton Ave., Ste. 216,Manassas, VA 20109 Ph: (703) 369-2220

Woodbrid e2200 Opitz Blvd, Ste. 245, Woodbridge, VA 22191Ph: (703) 490-8585

Ma lan a n n a n D iv

S i n l , MD

It’s back to school time. For many grownups, that conjures memories of reuniting with friends, school shopping, shiny new supplies and a return to a daily routine of reading, writing and arithmetic.

For teachers, it’s a happy time as well, but not always easy. In addition to readying for the challenges that a new year presents, many teachers also are coping with venous issues – namely varicose veins. The nature of their jobs involves long hours on their feet with not much respite, with gravity putting pressure on their lower limbs that can exacerbate symptoms like itching, burning, “heaviness” and fatigue. In more severe or chronic cases, varicose veins can be debilitating and limit a person’s mobility.

We dedicate this issue of Venous Review to teachers for their commitment and remind them that they don’t have to suffer in silence. Through easy, outpatient screening they can get to the bottom of their venous issues and can work with their physicians to determine a course of treatment – and be back in the classroom nearly immediately looking and feeling better.

Also in this issue, we look at several aspects of venous insuf ciency, including podiatric conditions. We also are proud to announce our new pilot partnership to combat DVTs. As always, our physician editors answer your questions, and we highlight our ongoing community outreach efforts – including this summer’s NBC4 New York Giants Health & Fitness Expo.

We hope this information is useful to you and your practice. We look forward to discussing vein health further with you and your patients soon.

Yours in good health,

Sanjiv Lakhanpal, MD Editor-in-Chief

From The

Editor

V i s i t o u r w e b s i t e : w w w . c e n t e r f o r v e i n . c o m

ditor in hie President enter or ein estoration

Sanjiv Lakhanpal, MD

ssociate ditorirector o esearch

irector o ascular a s Sh k S an, MD, S

Center for Vein R e s t o r a t i o n

T h e O f f i c i a l J o u r n a l o f C e n t e r f o r V e i n R e s t o r a t i o n

Now Open:

Our

New Jersey Location

In North Bergen

achieving the best clinical results post ablation...ak]ancek cases larne ]aricosities ]eno\s stasis...

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