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The Emerging Field of Phlebology

March 21, 2016

The Field of Phlebology (vein care) arose because Vascular Surgeons who traditionally treated patients with venous disease were not exclusively focused on veins. In fact, the majority of a Vascular Surgeon’s training is concentrated around the treatment of arterial disease rather than varicose veins. The original emphasis was on arterial surgical procedures leaving the treatment of venous disease as an after thought, which can lead to less than satisfactory results. Vascular Surgery Board Certification does not always mean expertise in Vein Treatment Care. Patients began looking for physicians who focus exclusively on venous disease (varicose and spider veins) and turned away from providers who primarily focus on arterial disease.

 

There are no Board Accredited Phlebology Fellowships in Colorado. The only accredited Phlebology Fellowship is through the medical program at New York University in New York City. Any reference to a “Phlebology Fellowship” in Colorado is unrecognized and non-accredited by the American Board of Venous and Lymphatic Medicine. The same applies to any claim of a Phlebology Fellowship that follows the guidelines set forth by the ABVLM.

 

This claim is not accredited by any overseeing medical organization. Any statement that suggests that completion of a non-accredited Fellowship declares exclusive excellence (top % of nation) is false and misleading.

 

Board Certification of any type is simply an admission ticket to allow a physician to prove his/her value to patients and referring physicians. Passing a written test does not prove anyone’s capability to be a competent Phlebologist. It is a minimum requirement. A combination of a high-level surgical skill set in combination with an extensive experience level in treating venous disease, supported by an exclusive commitment to Phlebology is a good indicator for success.

 

The advancement of minimally-invasive catheter-based ablation technology has radically changed the treatment of venous disease by eliminating the need for inpatient general anesthesia. In fact using general anesthesia for these procedures is no longer considered to be within the standard of care. The fact that general anesthesia is no longer necessary for vein treatments has allowed a variety of physicians with diverse primary specialties to “dabble” in the treatment of venous disease. In the state of Colorado, this includes General Surgeons, Interventional Radiologists, Vascular Surgeons, Family Practice Physicians, Anesthesiologists, and Cardiovascular Surgeons. There are even non-physicians performing vein care. The specialized Field of Phlebology is so new that all of these different specialties are allowed to sit for the Phlebology Board Exam. Since the exam is a didactic test and does not evaluate the physician’s technical ability or the quality of the services provided by the clinic, a false sense of security for patients may result.

 

Advanced medical progress in minimally-invasive venous disease has become a great advantage for patients. Unfortunately, the lack of regulation has created great confusion for patients in understanding the benefits of choosing a qualified physician. This has allowed many providers, with incomplete training, to perform the surgical venous procedures ad provide inadequate follow-up treatment plans, resulting in less than satisfactory results.

 

ADDITIONAL FACTS ABOUT THE TRAINING PROGRAMS OF THE SPECIALITIES LISTED ABOVE INCLUDE:

 

  1. CARDIOVASCULAR SURGEONS have extensive training and experience in vascular and micro-surgical techniques with special expertise pertaining to the saphenous vein, which is used in Coronary Artery Bypass Surgery. This is the same vein that malfunctions in patients with varicose veins. Those Cardiovascular Surgeons who obtain additional training including Board Certification in Phlebology and those who are certified for RPVI (Registered Physician in Vascular Interpretation) are experienced in Ultrasound Interpretation and techniques.
  2. INTERVENTIONAL RADIOLOGISTS have no surgical training, but are well versed in Ultrasound Interpretation and techniques. Many Interventional Radiologists perform Endovenous Laser Ablation but do not perform the micro-surgical Phlebectomy because they have no surgical training. Not using micro-surgical Phlebectomy as part of vein care may result in clotted, painful varicose veins.
  3. SKIN LASER PHYSICIANS. Physicians who primarily do this work without previously having completed formal vascular or surgical residency programs would have had no formal training in Utrasound nor have any training in microsurgical procedures. They work on your skin (topical) versus where the veins are located inside of your body.
  4. ANESTHESIOLOGISTS have no Ultrasound or surgical experience.
  5. GENERAL SURGEONS have surgical experience but are not trained in vascular disease. Ultrasound interpretation or techniques, and vascular surgical techniques, are not a part of their Board Certification.
  6. VASCULAR SURGEONS have vascular surgical training but in general focus on arterial disease. Recent graduates receive some training in Ultrasound Interpretation and techniques; however, RPVI certification (Registered Physician in Vascular Interpretation) is now a prerequisite for vascular surgery Board Certification and should be obtained by Vascular Surgeons treating venous disease.
  7. FAMILY PRACTICE PHYSICIANS have minimal if any microsurgical training and no formal training in Ultrasounds Interpretation and techniques. Some Family Practice Physicians claim to be Phlebologists; however, look for a Board Certified Phlebologist if you are considering a Family Practice Physician for vein care.
  8. There are a variety of physicians and non-physicians claiming to be Phlebologists. Make sure your Phlebologist is Board Certified in Phlebology.

 

In conclusion, patients should consider choosing a medical provider who has Board Certification in Cardiovascular Surgery (which means surgical AND microsurgical experience as well as a comprehensive understanding of the cardiovascular system), who is Board Certified through the Registered Physician in Vascular Interpretation (RPVI) for respected Ultrasound accreditation, has been Board Certified in Phlebology for an extended period of time and is dedicated exclusively to the Field of Phlebology (otherwise, vein care, for the physician or practice not 100% working in the Field of Phlebology is just one of many other medical positions or responsibilities in a practice or hospital system). It is the combination of all of these Board Certifications and Accreditations and the dedicated practice of venous disease that make Dr. James D. Albert one-of-a-kind in the exceptional understanding and skill that he provides to patients at Albert Vein Institute (AVI).

Copyright 2016 Albert Vein Institute

Posted in Blog by Albert Vein Institute ©2016