The intersection of art and science is found throughout medicine, most notably in the field of image-guided vascular intervention, in which we both observe and manipulate the picture in front of us. Of course, the picture is also a patient, and even the most dynamic, high-resolution rendering captures only a fraction of the whole.
In vascular congresses and publications around the world, endovenous therapies continue to garner increased attention. Dedicated minimally invasive technologies emerged to treat venous pathologies that previously necessitated surgery or off-label applications. Next-generation modalities have further raised our expectations. There is a lot going on. However, we still have much to learn about best practices and the ethics of pushing the envelope. We must understand how to meet the global needs of the patient, rather than how to improve the picture alone.
In this venous-centric edition of Endovascular Today, we have invited experts from around the world to provide current perspectives on both the progress and shortcomings in our understanding and abilities. As a community, we must advance the discussion of venous disease in a way that incorporates the causes and effects of the disease, be it deep, superficial—or both—and most importantly, our patients’ quality of life. In 2017, it is not just about the vein; it’s mostly about the patient.
First, William Marston, MD, describes the growth in treatment for venous obstruction and the need for a disease classification system to identify the right patients and appropriate therapies. He shares a novel system that is currently in development but hopefully represents a step forward in optimizing treatment in this patient population. Stephen A. Black, MD, continues with a discussion on the difficulties that arise when the common femoral vein is involved in the presentation of deep vein thrombosis (DVT), including the best methods of assessment for acute and chronic DVT and available treatment options to consider.
Next, Drs. Vincent G. Helyar, Stephen A. Black, and Narayan Karunanithy outline the use of various noninvasive imaging modalities and their roles in providing essential information on the extent and severity of acute and chronic deep venous obstruction to help guide treatment decisions.
Another recent topic of much discussion and interest is the various techniques used to successfully retrieve inferior vena cava filters. Kush R. Desai, MD; Robert K. Ryu, MD; and Robert J. Lewandowski, MD, detail the various ways to remove retrievable filters that are no longer indicated.
On the superficial venous side, Dr. Sarah Onida and Prof. Alun Huw Davies share an approach to treating chronic venous disease that focuses on data-driven decision making and patient quality of life. By utilizing all the information that this methodology offers, we can make the most informed and patient-tailored choices.
Steve Elias, MD, moderates a roundtable discussion of industry representatives David Goodman, Eric Heil, and Sandra Lesenfants that centers on industry’s roles and responsibilities in the physician training process and how their devices are used in the field.
Finally, we conclude our annual venous issue by asking a panel of experts including Sergio Gianesini, MD; Ellen D. Dillavou, MD; Thomas F. O’Donnell, Jr, MD; and Michael Tal, MD, what they think is the “next big thing” needed in superficial vein care.
Our goals in this expanded coverage regarding the state of venous disease care are to assist vein specialists in finding real solutions for complex disease presentations based on solid data regarding patient-specific therapies, ethical applications, and proven benefits. Enjoy the art, and enjoy the science.
Steve Elias, MD, FACS, FACPh
Rick de Graaf, MD, PhD
Guest Chief Medical Editors