MDNews - Tennessee Valley

COVER FEATURE Advanced Surgical Concepts: Pioneering Modern Techniques in Phlebology P HLEBOLOGY IS DEFINED as the art and scientific study of vein disorders. This may include a broad spectrum of common maladies among patient populations. Varicose veins, venous malformation, deep vein thrombosis, pulmonary emboli and venous stasis skin changes. The field of phlebology is a sophisticated one, requiring knowledge of venous anatomy, familiarity with normal venous physiology and skilled interpretation of ultrasound findings, including venous anatomy and flow patterns. Accurate methods of diagnosis and modern methods of treatment are essential to the success and primary function of a specialty vein center of excellence. Vein centers and phlebology have exploded on the medical scene in the past few years. Ten years ago, neither patients nor physicians could find anyone much interested in patients with venous problems. Vascular surgeons treated vein patients as the "red-headed stepchildren" of arterial disease. In 2001, Dr. Minn of Cornell University introduced a new minimally invasive endo- venous laser ablation technique for the erradication of varicose veins. Suddenly, vein doctors were common and vein centers appeared in every city. Phlebology was designated as a separate and primary specialty by the American Medical Association in 2007, indicative of the growth and sophistication of this specialty. The featured surgeons, James E. White, M.D., FACS, and Vincent W. Gardner, M.D., FACS, have become regional leaders and teachers of this new and exciting specialty. Their devotion to phlebology is unique and explains their popularity among patients and referring physicians. Advanced Surgical Concepts was founded by Dr. White in 2003. As a general surgeon, he has managed many patients with vein problems throughout his surgical career. His standard treatment was vein stripping and ligation of the abnormal veins along with medical-grade compression therapy. In 2001, Dr. White was privileged to attend a conference by Dr. Minn in regard to the endovenous laser method to close the incompetent saphenous veins. Armed with an 810 nm diode laser, Dr. White began treating patients for venous insufficiency by the new laser ablation technique. Dr. White realized that these modern methods would soon revolutionize the care of patients with vein disorders. By 2004, modern methods for treating vein problems had become increasingly sophisticated and the results were almost surprisingly miraculous. The treatment procedures could be Vincent W. Gardner, M.D., FACS (left), and James E. White, M.D., FACS (right), discuss pathology noted on high-resolution, real-time ultrasonography images. performed in an office surgical setting using tumescent local anesthesia. Patients experienced very little discomfort during or after the endovenous ablation procedure — much less than with traditional stripping surgical interventions. Recovery and return to work and normal activities required only a few days with the new, minimally invasive endovenous ablation techniques. The outcomes proved better than expected results, — leg pain and swelling resolved quickly, ulcers healed within a few short months and unsightly varicose and spider veins were virtually eliminated. Equally as remarkable, the veins did not reoccur, one of the negative considerations given vein treatments of the past. Clearly, these new methods were far more complete and accurate than any other methods used in the past. In previous years, vein stripping was regarded as the only viable option for the treatment of venous disease. This procedure was extremely invasive and generally required patients to abstain from activities for five to 10 days following surgery using general anesthesia. Often, it took up to six weeks for patients to return to optimal function and the chance of patients developing recurrent disease was as high as 40%. Endovenous ablation is now utilized for the treatment of lower extremity venous disease and can be performed in an outpatient surgical setting without the use of general anesthesia. This has enabled its use to treat various patient populations —such as the elderly — who were previously not considered appropriate candidates for vein stripping techniques. Prior to endovenous ablation procedures, a duplex ultrasound is used to confirm the diagnosis and to delineate anatomy. "At Advanced Surgical Concepts, we feel very strongly that the physician who is performing the endovenous ablation procedure should also perform the intraoperative ultrasound imaging," says Dr. Gardner. During endovenous ablation, an IV is placed in the diseased vein. Using ultrasound guidance,

• Cover