Summer is Approaching – Take Care of Your Legs Now

MelanieS — Tue, 08 May 2012 15:40:00 +0000

With Memorial Day and the official kick-off of summer around the corner, people are becoming increasingly aware of how their legs look in summer attire. It is much easier to conceal bulging varicose veins and spider veins under the long pants of winter, but the constant reminder of the presence of those leg veins can send people running to day spas or laser vein centers to have the veins treated. While it is important to have self-confidence and self-esteem in your summer clothes, it is important to remember that varicose veins and leg spider veins are a symptom of a larger health problem. The underlying cause of these veins is chronic venous insufficiency, a progressive disease that can lead to serious and even life-threatening conditions if not treated properly. Because of the medical necessity of treating these veins properly, varicose vein treatment is typically covered by insurance.

If you have prominent leg veins, with or without other symptoms such as leg heaviness, edema (leg swelling), achy or tired legs, or more severe symptoms such as leg ulcers or DVTs, you should seek out a physician who specializes in the vasculature and who can conduct a proper ultrasound diagnosis of the underlying cause of your varicose veins. A Vascular Surgeon is well-equipped to handle the diagnosis and the treatment of these leg veins.

Laser vein centers typically use surface lasers to treat only the superficial appearance of the veins, resulting in recurrence and providing only temporary visual relief. If the chronic venous insufficiency is not addressed, these veins will return and the disease will continue to progress to more painful and more bulging veins. Endovenous laser therapy is a minimally invasive surgical procedure with very little to no downtime. New modalities, such as the VenaCure EVLT 1470 laser, have been proven to cause very little pain and can help prevent a lifetime of chronic symptoms. Because this is a minimally invasive surgical procedure, it should be performed by a Vascular Surgeon in an office setting that is established for the procedure. This ensures the complete safety and efficacy of the vein treatment. In addition to endovenous treatments, vascular surgeons can also perform injection sclerotherapy into smaller, less tortuous spider veins. This procedure is often offered as an adjunctive treatment with endovenous therapy, or it can be offered as a stand-alone procedure or series of sessions to immediately collapse spider veins, resulting in an immediate improvement in the appearance of these veins.

Don’t delay in taking care of your legs – and your health! Why wait to look AND feel better?

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New Jersey Viewpoint on ABC

MelanieS — Tue, 27 Mar 2012 16:57:30 +0000

Dr. Lowell Kabnick and patient Deputy Police Chief of Jersey City, New Jersey, Ronald Sprofera, appeared on the ABC show “New Jersey Viewpoint”. Varicose veins are often perceived to only affect women, but they occur quite frequently in men as well. It is also assumed that varicose veins are just a cosmetic issue, but as Deputy Chief Sprofera discusses, they cause pain and can lead to venous ulcers in the legs. Watch the interview and learn about how Deputy Chief Sprofera’s legs now feel good without the discoloration he was experiencing, thanks to Dr. Kabnick and the new endovenous laser treatment for varicose veins – the VenaCure EVLT 1470 wavelength laser.

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Where Will Vein Treatment Be by the Year 2015

MelanieS — Mon, 19 Mar 2012 14:01:47 +0000

There have been significant advances in modern medicine over the past few years, and the varicose vein treatment segment is no exception. While the current modalities of vein treatment are all effective and proven, there always remains room for improvement as scientists, engineers, and physicians learn more and have access to better technology. The most common modalities of vein treatment currently are thermal ablation, either by endovenous laser or radiofrequency, or injection of a sclerosant into the vein. Typically sclerotherapy is performed for smaller veins, such as spider veins, while endovenous ablative therapies (VenaCure EVLT® laser vein treatment or VNUS Closure™ radiofrequency treatment) are used in larger veins.

There are multiple factors that will play a role in determining where the next standard of treatment will fall. It is a combination of economics and of patient outcomes. Ideally, improved patient outcomes would drive improved economics, but this, unfortunately, is not always the case when it comes to Medicare or other insurance. Additionally, medical device and pharmaceutical companies must have appropriate financial resources to continue to invest heavily in developing and testing new methods of treatment, with the goal of constantly improving care while reducing costs.

Endovenous thermal ablative techniques have been proven for years to be very effective, with very low risk, and minimal pain or down time post-procedure. However, they do require the delivery of tumescent anesthesia. This adds overall time to the procedure and may cause slight discomfort to some patients. A few new methods of treating varicose veins include non-thermal techniques that will not require tumescent anesthesia. These new methods are innovative yet most are based on the same basic science of ablating the veins rather than restoring or repairing the valves.

The V-Block device is being tested in Europe with initial success. This device is implanted into the vein and adjunctive sclerotherapy is administered after it is inserted. It has a CE Mark approval, similar to FDA approval in the U.S., for use in the European Union. In its initial trial in humans after an average of 70 days of follow up, there were no DVTs reported and the great saphenous vein was successfully closed with no sign of venous reflux remaining.

Another new treatment that has been generating some interest is essentially glue. It is called Cyanoacrylate Adhesive and has been used in other endovascular procedures in Europe for decades. The use of this adhesive in varicose vein treatment is new and still must undergo substantial testing to truly validate the long-term efficacy and safety. However, initial results do show that it is promising as an alternative to thermal ablation and offers the cost reduction of not requiring major capital equipment such as a radiofrequency or laser generator.

One device is a new mechanochemical delivery mechanism for delivering a sclerosing agent typically used in sclerotherapy of smaller veins or spider veins into the larger veins that cause tortuous varicosities. The device, called Clarivein, was used with Sotradecol® sclerosant in initial studies. Pain scores, as reported by the patients, during this trial were very low. Effectiveness after six months was good, but not yet as strong as existing ablative techniques.

While my colleagues and I continue to investigate new, improved methods of treating painful varicose veins and venous disease, we are still very pleased with the current modalities of thermal ablation with long-term, proven efficacy with minimal side effects reported. We are hopeful that Medicare will continue to recognize that these treatments are necessary to prevent debilitating and limb or even life threatening complications.

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How to Find a Vascular Surgeon

MelanieS — Tue, 07 Feb 2012 13:23:50 +0000

Finding a doctor can be a daunting task. This is someone with whom you will need to build a deep and rather personal relationship, and for whom the patient must have respect and trust. Often times, people will find a doctor by way of a referral from a friend or family member. Other times people conduct a search online or in the phone book. Some popular sites to search for a physician’s credentials include www.healthgrades.com or www.vitals.com. These are both very effective ways of finding a physician. A combination of credentials, insurances accepted, distance from home, and recommendations from trusted sources should all be taken into account when finding a doctor. Other things to keep in mind are the hospital affiliations for that doctor. You will want to select a doctor who has admitting privileges into a solidly ranked hospital in case of an emergency. Finally, it is wise to double check a specialist with your insurance company to ensure that the doctor accepts your insurance. However, choosing a specialist, such as a Vascular Surgeon, can be a bit trickier if you don’t know what to look for.

At the NYU Vein Center in Morristown, we find that most of our patients have come by a referral from a primary care physician or Cardiologist who noticed that the patient is displaying symptoms of varicose veins or vascular disease. However, varicose veins are often a condition that goes undiagnosed by primary care physicians. It is up to the patient to determine whether or not the discomfort or pain in the legs or the appearance of the veins is significant enough to warrant a visit to a Vascular Surgeon for a duplex ultrasound and proper diagnosis of venous reflux. So how do you know if the local Vascular Surgeon is right for you?

Similarly to finding a primary care physician, when looking for a Vascular Surgeon, it is important to get feedback from others who may have had a procedure performed at the practice. If you don’t know anyone who has had veins treated, searching online for testimonials can be helpful. In addition to the directory websites above, there are other resources for finding a specialist. Specialists such as Vascular Surgeons have gone through extensive training beyond their medical degree in their field of specialty. Most specialties have associations that board-certify these physicians within their specialty. For a Vascular Surgeon, you will typically want to find someone who has completed a fellowship in Vascular Surgery and who is board certified by an organization such as the American College of Phlebology. A Vascular Surgeon should also be board certified by the American Board of Surgery. In the field of diagnosing vascular disease, a new certification has recently been established. This is the Cardiovascular Credentialing International Registered Phlebology Sonographer (indicated as RPhS after the MD). This certificate ensures that you will receive a thorough diagnostic exam. It is important to have such an exam in order for the Vascular Surgeon to determine the best course of treatment for varicose veins or other vein disease.

When you are on your quest to find a doctor, be sure to check for his or her experience, licensures, location, hospital admitting privileges, location, insurances accepted, and most importantly, schedule a consultation to meet with a physician to establish a rapport before you undergo a procedure. Making sure you are comfortable and able to communicate openly will help ensure a successful outcome.

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Solution to treat DVT & PE with better outcomes and reduced costs

MelanieS — Tue, 31 Jan 2012 18:44:38 +0000

The reduction of DVTs and PEs is a core area of focus for CMS cost reductions, and a standard set of guidelines must be developed and adhered to. There must be a team approach to dealing with and treating patients with DVT. This hospital-based team should include multiple physicians and allied health professionals across a variety of specialties, including but not limited to:

• Vascular Surgeons/Vascular Medicine
• Interventional Radiologists
• Cardiologists
• Hematologists
• Internal Medicine
• Oncologists

Additionally, these patients need to be followed across the continuum of care, beyond just the in-hospital encounter.

It is critical for these specialists to come together as key opinion leaders to help shape the government guidelines for treating these patients. Specialists who deal with these patients every day are in the best position to share their knowledge and experience, to determine the best standards of care to treat patients suffering from venous thromboemboli, and to define preventive measures.

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Medicare Costs of Treating DVT and PE

MelanieS — Mon, 23 Jan 2012 19:22:44 +0000

With the healthcare crisis being battled on Capitol Hill and in the news daily, we are being bombarded with statistics of the cost of care increasing while the quality is decreasing. There are a few primary diseases or chronic conditions that account for the majority of Medicare spending. One of these conditions is deep venous thrombosis (DVT). DVT is not only costly at the time the patient is in the hospital being treated, but it becomes even costlier when it’s not treated and resolved. DVTs lead to emboli. When emboli manifest in the lungs (pulmonary embolism) or brain or other critical organs, they become fatal. There is a very high recurrence rate with DVTs and PEs. This recurrence further increases the total financial burden of the patient on the
Centers for Medicare Services (CMS). CMS is evaluating means to reduce the incidence, and therefore the costs, of DVT.

The Centers for Medicare Services has established core quality measures upon which care providers will be evaluated to determine whether optimal quality of care and reduced costs have been met. These core measures include evaluating DVT incidence and hospital readmissions (DVT and PE are leading causes of costly hospital readmissions). Initially providers will be financially rewarded to reduce or eliminate hospital readmissions within 30 days. Eventually, every hospital and provider will become financially accountable for the outcomes of patients with DVT according to the national guidelines and benchmarks against the quality measures. To ensure they receive their incentives and prevent a reduction in pay down the road, providers are closely evaluating how patients with venous thromboemboli or who are susceptible to DVTs are being treated.

In my next post on the topic of deep vein thromboses and pulmonary emboli, I will present a strategy to treat these conditions in such a way that we can reduce costs while also improving patient outcomes.

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Overview of Deep Vein Thrombosis and Pulmonary Embolism

MelanieS — Mon, 16 Jan 2012 19:38:53 +0000

What are DVT and PE, and why should patients care?

Deep Vein Thrombosis (DVT) is one of the most prevalent medical problems today. DVT, while in some cases life-threatening, can lead to an even more serious condition called pulmonary embolism (PE). In fact, death occurs in about 6% of DVT cases and 12% of PE cases within one month of diagnosis.1 DVT and PE are caused by blood clots in the veins. A pulmonary embolism occurs when one of these clots travels to the lungs where it may obstruct air flow. Annually, it is estimated that 600,000 patients will be diagnosed with venous thromboembolism, and anywhere from 50,000-200,000 will die from PE. PE is stated to be the leading cause of preventable death in hospital patients, responsible for approximately 10% of all hospital deaths.

Who is at risk?

People with varicose veins are more prone to thrombosis and embolism; other factors that contribute to increased risk are advanced age, obesity, and cardiac problems, among other conditions. If you are at risk of DVT, there are preventive measures you can take, such as wearing compression stockings during air travel or for prolonged periods of standing or sitting. Be sure you discuss this with your physician. You should consider asking for a referral to a Venous Specialist if you have any symptoms of varicose veins, leg spider veins, restless leg syndrome, heavy or aching legs, venous ulcers, or if you have a family history of DVT or PE.

1 http://circ.ahajournals.org/content/107/23_suppl_1/I-4.full

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Highlights from the 38th Annual VEITHsymposium

MelanieS — Thu, 05 Jan 2012 17:59:22 +0000

This past November, I attended and presented at the 38^thannual VEITHsymposium. The symposium is a five day event filled with the world’s leading vascular specialists presenting and educating others on the most current methods of diagnosing and treating patients who suffer from vascular disease. With vascular disease being a leading cause of death and disability for a large percentage of Americans, treating these patients effectively is an important initiative. It was encouraging to see that Venous and Endovenous Diagnosis and Treatment topics monopolized the opening day for the sixth consecutive year. Of the 57 talks given by 41 speakers, topics ranged from the basic anatomy to more advanced discussions, such as Chronic CerebroSpinal Venous Insufficiency: Is This a Real Syndrome? There were two very intriguing debates. The first was whether Hypercoaguable Testing is Needed in Most Cases and the second was We Should Treat Calf Vein DVT with Standard Anticoagulation.

A fellow member of American Venous Forum and the American College of Phlebology (ACP), Dr. Jose Almeida, opened the session with a look forward to new therapies being tested and discussed for the treatment of venous disease in the future. Some of the new therapies discussed include those that don’t require tumescent anesthesia such as glue, foam sclerotherapy, and pharmacomechanical treatments. He also highlighted deep venous pathology with a focus on venous outflow obstruction, intravascular ultrasound, and stents.

Dr. Mauriello, President of the ACP, lectured on the significance of venous anatomy knowledge in order to avoid injury to the saphenous, sural, or peroneal nerves while performing vein ablation or other venous treatments. This highlights the significance of selecting a certified and qualified vascular surgeon to diagnose and treat a venous or vascular condition.

I have been evaluating treatment for Endothermal Heat Induced Thrombosis (EHIT2) post ablation, and am still undecided on whether or not anticoagulation is necessary. I will continue to gather more data and to work with my peers to determine the best method of treatment. It is apparent that more data is needed to ensure the best standard of care based on the fact that 50% of the audience in attendance did anticoagulate with EHIT2 and 50% did not. I also presented a conclusion from my recent pilot studies that both wavelength of a laser and non-contact fibers are important factors in postoperative recovery.

There was also a significant amount of time spent on discussions of treating and diagnosing deep vein thrombosis (DVT). Momentum is gaining in new pharmacomechanical treatments for acute DVT, though there do appear to be some device limitations for now.

Overall, the VEITHsymposium remains one of the leading conferences for the discussion and progression of treatment for venous disease, and I am proud to have been a part of the faculty once again.

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The Grandma Disease that Strikes Young Men

MelanieS — Sat, 03 Dec 2011 22:04:22 +0000

Dr. Lowell Kabnick’s patient, Ronald Sprofera or Jersey City, New Jersey, tells Men’s Health magazine that his procedure to eliminate his painful varicose veins was easier than going to the dentist.

http://news.menshealth.com/varicose-veins-in-young-men/2011/11/27/

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An Introduction

admin — Thu, 01 Dec 2011 23:00:36 +0000

Greetings. I’m Lowell Kabnick, MD, RPHS, FACS, FACPh, Director of the NYU Vein Center, and I would like to personally welcome you to my new blog.

I am a vascular surgeon with over 30 years of experience in treating patients who suffer from vein disease, varicose veins, and other vascular issues, and advising medical device companies in the design of the most cutting-edge technologies to advance the treatment of these diseases. I am a professor and practitioner with various editorial positions on renowned journals and with council or board positions in multiple medical societies and medical device companies, all geared toward advancing the treatment of vascular disease. I practice medicine in New York City at the NYU Vein Center and from my Morristown, NJ office. Read more about my background.

Through this new venue, I hope to provide you with information on vein disease, advances in treatment technologies, thoughts on the political climate of healthcare and what it may mean for patients suffering with varicose veins and other related illnesses, and to respond to user comments or questions.

By watching, reading, and subscribing to this blog, you will learn more about where I believe medicine is headed and learn about multiple treatment options for a variety of vascular conditions. Please stop by often.

Best regards,
Lowell S. Kabnick, MD

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