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American Venous Registry - The First National Registry for the Treatment of Varicose Veins
JOURNAL OF VASCULAR SURGERY: VENOUS AND LYMPHATIC DISORDERS Volume 1, Number 1
Table. Cross-tabulation summary correlating the Villalta scale (VS) against other assessments
VS CEAP VCSS VSDS
CEAP
VCSS
VSDS
VFI
r ¼ .556 P < .0005 X X X X X X
r ¼ .609 P < .0005 r ¼ .822 P < .0005 X X X x
r ¼ .046 P ¼ .779 r ¼ .147 P ¼ .365 r ¼ .181 P ¼ .264 x x
r ¼ .499 P ¼ .001 r ¼ .279 P ¼ .082 r ¼ .480 P ¼ .002 r ¼ .219 P ¼ .175
VS between the patients’ symptoms and their clinical signs (P ¼ .175 and r ¼ .219). Conclusions: These results indicate that the VCSS and the C of CEAP may also be useful in the assessment of PTS severity, and that the VFI may provide a clinically meaningful hemodynamic evaluation. These results also confirm that the VS remains the gold standard disease specific assessment in the evaluation of PTS. American Venous Registry - The First National Registry for the Treatment of Varicose Veins B. K. Lal1, J. I. Almeida2, L. Kabnick3, T. W. Wakefield4, R. B. McLafferty5, P. J. Pappas6, J. D. Raffetto7, S. Raju8, J. Blebea9, M. C. Dalsing10, M. Meissner11, J. Rectenwald4, D. L. Gillespie12, U. Onyeachom13, R. Kinsman14, 1University of Maryland School of Medicine, Baltimore, Md; 2 Miami Vein Center, Miami, Fla; 3New York University, New York, NY; 4 University of Michigan, Ann Arbor, Mich; 5Southern Illinois Medical Center, Springfield, Ill; 6Brooklyn Hospital Center, New York, NY; 7 Veterans Affairs Harvard Medical School, Boston, Mass; 8River Oaks Hospital, Flowood, Miss; 9University of Oklahoma College of Medicine, Tulsa, Okla; 10Indiana University, Indianapolis, Ind; 11University of Washington, Seattle, Wash; 12University of Rochester School of Medicine, Rochester, NY; 13American Venous Forum, Milwaukee, Wisc; 14University of Maryland, Baltimore, Md Background: Chronic venous diseases affect one-third of all adults and are more common than coronary, carotid, and peripheral artery diseases combined. However, their effect on public health remains understudied and under-estimated. These challenges are compounded by the fact that these patients are treated by numerous professionals with non-standardized training and variable outcomes. There is a need for identifying practice patterns across specialties and geographic boundaries in a standardized fashion. This report describes the development and initial results from the first national venous registry, the American Venous Registry (AVR).
Abstracts 105
by participating physicians. Information collected for each patient included demographics, clinical severity score, noninvasive testing results, treatment details, and short and longer-term outcome details. The Registry is managed by a Steering Committee appointed by the AVF. Data integrity is monitored by a dedicated registry administrator. It is free and available to all physicians treating varicose veins. Sponsored by the American Venous Forum, it has been endorsed by the American College of Phlebology, American College of Surgeons, and the Society for Vascular Surgery. Results: A total of 4014 venous ablation procedures were entered in the database spanning the calendar years 2007 through 2011, comprising 3930 patients (Fig). Forty-one physicians from 37 hospitals or clinical practices from 27 states entered data. Of the total, 71% of patients were Caucasian; 77% were female, and the median age was 54 years. Seventyfive percent of treated legs were graded as CEAP-2 or -3 at presentation; 3% as class 6, while only 1% of treated patients had class 1 disease. Ninety-nine percent of treated legs were of primary (non-thrombotic) etiology, 99% had superficial system involvement, 98% presented with reflux alone, and 2% with combined reflux and obstruction. Seventy nine percent of treatment procedures involved the great saphenous vein, 15% the small saphenous vein, and 15% the anterior accessory saphenous vein. Conclusions: This report describes the development of the first ever nationwide registry for the sampling of demographics, disease profile, diagnostics, treatment, and outcome of chronic venous insufficiency management across the United States. This is an important step towards improving the care of venous disease by standardized collection and analysis of clinical information. The Real Costs of Treating Venous Ulcers in a Contemporary Vascular Practice H. Ma, N. A. Rosen, M. D. Iafrati, T. F. O'Donnell, Tufts Medical Center, Boston, Mass Background: Venous leg ulcers (VLU) are a prevalent and morbid disease that consumes considerable resources. Estimates place the total costs of treating VLU at 1% of healthcare budgets in industrialized countries. Unfortunately, there is little contemporary information on total cost of treating VLU in a vascular surgery practice. The purpose of this study was to define the actual cost of treating VLU and identify factors influencing costs. Methods: A cohort of 84 patients with active VLU (CEAP VI disease), treated in a wound center by five vascular surgeons with a minimum follow up of 6 months and up to a year (median, 368 days; range, 336-483 days) were retrospectively studied. Actual costs (not charges) were obtained for outpatient and inpatient facility, visiting nurse services, and our physician practice group to yield true cost. The proportion and time to complete healing of VLU was determined to calculate time to healing as well as ulcer-free intervals. Cost/ulcer free days and cost to complete healing for the entire follow-up period were carried out and as well as univariate analysis of factors affecting cost. Results: The median total cost (TC) of treating VLU during this follow up period was $10,976. A total of 50 patients (60%) healed their VLU without recurrence in a median time of 91 days (range, 6-379 days) at a cost of $8,183 (range, $430-$50,967). This translated to $80/day to heal and $29/ulcer-free day. In comparison, the TC was three-fold higher at $26,280 (range, $390-$132,730) for the patients (n ¼ 17, 20%) who did not heal their VLU. Significant contributing factors were outpatient facility fees ($4,354) and visiting nurse services ($12,600), related to extended treatment of the open VLU. Patients who recurred but re-healed their VLU (n ¼ 7. 8%) had aTC of $10,867. Those who recurred but did not re-heal during follow up (n ¼ 10, 20%) had a TC of $10,244. Inpatient admission increased TC to $27,487. Nearly two-thirds of admissions were for treatment of cellulitis with IV antibiotics. VLU treated with surgical intervention did not significantly increase TC ($8,604 vs. $12,893; P > .05) but significantly reduced recurrence rates (34% vs 5%). Patients treated for outflow obstruction had a two-fold increase in TC ($21,891 vs $10,404). However, in three patients treated for outflow obstruction, complications occurred that dramatically increased the TC to $50,967. Conclusions: This economic analysis with true costs show the importance of early aggressive treatment of infection can reduce costly inpatient admissions. Careful selection of outflow stenting candidates may reduce TC by preventing complications.
Fig. Methods: The AVR was developed to facilitate collection and analysis of information on venous diseases in the US. It has a web-based, multimodular, interactive design to accommodate the wide variety of venous disorders. The varicose vein module is the first of these modules begun in February 2011. De-identified patient data was entered for patients treated
Prolonged Mechanical Stretch Alters the Metabolic Profile in Rat Inferior Vena Cava M. A. Anwar1, P. Vorkas1, J. Li1, O. Resslan2, E. Want1, J. D. Raffetto2, R. A. Khalil2, E. Holmes1, A. H. Davies1, 1Imperial College London, London, United Kingdom; 2Harvard Medical School, Brigham and Women's Hospital, Boston, Mass
Table. Cross-tabulation summary correlating the Villalta scale (VS) against other assessments
VS CEAP VCSS VSDS
CEAP
VCSS
VSDS
VFI
r ¼ .556 P < .0005 X X X X X X
r ¼ .609 P < .0005 r ¼ .822 P < .0005 X X X x
r ¼ .046 P ¼ .779 r ¼ .147 P ¼ .365 r ¼ .181 P ¼ .264 x x
r ¼ .499 P ¼ .001 r ¼ .279 P ¼ .082 r ¼ .480 P ¼ .002 r ¼ .219 P ¼ .175
VS between the patients’ symptoms and their clinical signs (P ¼ .175 and r ¼ .219). Conclusions: These results indicate that the VCSS and the C of CEAP may also be useful in the assessment of PTS severity, and that the VFI may provide a clinically meaningful hemodynamic evaluation. These results also confirm that the VS remains the gold standard disease specific assessment in the evaluation of PTS. American Venous Registry - The First National Registry for the Treatment of Varicose Veins B. K. Lal1, J. I. Almeida2, L. Kabnick3, T. W. Wakefield4, R. B. McLafferty5, P. J. Pappas6, J. D. Raffetto7, S. Raju8, J. Blebea9, M. C. Dalsing10, M. Meissner11, J. Rectenwald4, D. L. Gillespie12, U. Onyeachom13, R. Kinsman14, 1University of Maryland School of Medicine, Baltimore, Md; 2 Miami Vein Center, Miami, Fla; 3New York University, New York, NY; 4 University of Michigan, Ann Arbor, Mich; 5Southern Illinois Medical Center, Springfield, Ill; 6Brooklyn Hospital Center, New York, NY; 7 Veterans Affairs Harvard Medical School, Boston, Mass; 8River Oaks Hospital, Flowood, Miss; 9University of Oklahoma College of Medicine, Tulsa, Okla; 10Indiana University, Indianapolis, Ind; 11University of Washington, Seattle, Wash; 12University of Rochester School of Medicine, Rochester, NY; 13American Venous Forum, Milwaukee, Wisc; 14University of Maryland, Baltimore, Md Background: Chronic venous diseases affect one-third of all adults and are more common than coronary, carotid, and peripheral artery diseases combined. However, their effect on public health remains understudied and under-estimated. These challenges are compounded by the fact that these patients are treated by numerous professionals with non-standardized training and variable outcomes. There is a need for identifying practice patterns across specialties and geographic boundaries in a standardized fashion. This report describes the development and initial results from the first national venous registry, the American Venous Registry (AVR).
Abstracts 105
by participating physicians. Information collected for each patient included demographics, clinical severity score, noninvasive testing results, treatment details, and short and longer-term outcome details. The Registry is managed by a Steering Committee appointed by the AVF. Data integrity is monitored by a dedicated registry administrator. It is free and available to all physicians treating varicose veins. Sponsored by the American Venous Forum, it has been endorsed by the American College of Phlebology, American College of Surgeons, and the Society for Vascular Surgery. Results: A total of 4014 venous ablation procedures were entered in the database spanning the calendar years 2007 through 2011, comprising 3930 patients (Fig). Forty-one physicians from 37 hospitals or clinical practices from 27 states entered data. Of the total, 71% of patients were Caucasian; 77% were female, and the median age was 54 years. Seventyfive percent of treated legs were graded as CEAP-2 or -3 at presentation; 3% as class 6, while only 1% of treated patients had class 1 disease. Ninety-nine percent of treated legs were of primary (non-thrombotic) etiology, 99% had superficial system involvement, 98% presented with reflux alone, and 2% with combined reflux and obstruction. Seventy nine percent of treatment procedures involved the great saphenous vein, 15% the small saphenous vein, and 15% the anterior accessory saphenous vein. Conclusions: This report describes the development of the first ever nationwide registry for the sampling of demographics, disease profile, diagnostics, treatment, and outcome of chronic venous insufficiency management across the United States. This is an important step towards improving the care of venous disease by standardized collection and analysis of clinical information. The Real Costs of Treating Venous Ulcers in a Contemporary Vascular Practice H. Ma, N. A. Rosen, M. D. Iafrati, T. F. O'Donnell, Tufts Medical Center, Boston, Mass Background: Venous leg ulcers (VLU) are a prevalent and morbid disease that consumes considerable resources. Estimates place the total costs of treating VLU at 1% of healthcare budgets in industrialized countries. Unfortunately, there is little contemporary information on total cost of treating VLU in a vascular surgery practice. The purpose of this study was to define the actual cost of treating VLU and identify factors influencing costs. Methods: A cohort of 84 patients with active VLU (CEAP VI disease), treated in a wound center by five vascular surgeons with a minimum follow up of 6 months and up to a year (median, 368 days; range, 336-483 days) were retrospectively studied. Actual costs (not charges) were obtained for outpatient and inpatient facility, visiting nurse services, and our physician practice group to yield true cost. The proportion and time to complete healing of VLU was determined to calculate time to healing as well as ulcer-free intervals. Cost/ulcer free days and cost to complete healing for the entire follow-up period were carried out and as well as univariate analysis of factors affecting cost. Results: The median total cost (TC) of treating VLU during this follow up period was $10,976. A total of 50 patients (60%) healed their VLU without recurrence in a median time of 91 days (range, 6-379 days) at a cost of $8,183 (range, $430-$50,967). This translated to $80/day to heal and $29/ulcer-free day. In comparison, the TC was three-fold higher at $26,280 (range, $390-$132,730) for the patients (n ¼ 17, 20%) who did not heal their VLU. Significant contributing factors were outpatient facility fees ($4,354) and visiting nurse services ($12,600), related to extended treatment of the open VLU. Patients who recurred but re-healed their VLU (n ¼ 7. 8%) had aTC of $10,867. Those who recurred but did not re-heal during follow up (n ¼ 10, 20%) had a TC of $10,244. Inpatient admission increased TC to $27,487. Nearly two-thirds of admissions were for treatment of cellulitis with IV antibiotics. VLU treated with surgical intervention did not significantly increase TC ($8,604 vs. $12,893; P > .05) but significantly reduced recurrence rates (34% vs 5%). Patients treated for outflow obstruction had a two-fold increase in TC ($21,891 vs $10,404). However, in three patients treated for outflow obstruction, complications occurred that dramatically increased the TC to $50,967. Conclusions: This economic analysis with true costs show the importance of early aggressive treatment of infection can reduce costly inpatient admissions. Careful selection of outflow stenting candidates may reduce TC by preventing complications.
Fig. Methods: The AVR was developed to facilitate collection and analysis of information on venous diseases in the US. It has a web-based, multimodular, interactive design to accommodate the wide variety of venous disorders. The varicose vein module is the first of these modules begun in February 2011. De-identified patient data was entered for patients treated
Prolonged Mechanical Stretch Alters the Metabolic Profile in Rat Inferior Vena Cava M. A. Anwar1, P. Vorkas1, J. Li1, O. Resslan2, E. Want1, J. D. Raffetto2, R. A. Khalil2, E. Holmes1, A. H. Davies1, 1Imperial College London, London, United Kingdom; 2Harvard Medical School, Brigham and Women's Hospital, Boston, Mass