Phlebology is a body of knowledge that encompasses the totality of venous disease, not just varicose veins. Varicose veins are a chronic condition symptomatic of underlying venous insufficiency. Left untreated, venous insufficiency can produce tissue congestion, edema and eventual impairment of tissue nutrition resulting in stasis and varicose ulcers. At any time, 2-3 million people in the United States have ulceration due to venous disease. One out of 10 is classified as disabled. This accounts for 100,000 lost work days at a cost/day of $19,672,000.00. This often neglected part of the circulation is now close taking over heart disease as the number one killer of Americans.
Venous ulcers occur in 1-2% of the general adult population2. Eighty percent have superficial reflux as an underlying component (7). Without expert treatment, 20% of these ulcers remain unhealed at 2 years. Over 66% of patients with ulcers will continue to have ulceration recurrence for at least 5 years without proper treatment. (16)
To attain board certification in Phlebology, a physician must demonstrate comprehensive knowledge of venous disease as well as expert skill in performing venous vascular surgeries and procedures. Dr Wright is one of the first two hundred physicians nationally and one of two in the state of Missouri to demonstrate this commitment to obtain board certification. As a phlebologist, using newer technologies, he can effect healing in a fraction of the time and cost. As a result, patient satisfaction and quality of life are greatly enhanced.
By approaching the treatment of venous patients from a comprehensive understanding of the whole spectrum of venous disease, board certified phlebologists, such as Dr Wright, are able provide complete care of chronic venous insufficiency, venous thromboembolic disease, varicose veins, telangiectatic (“spider”) veins and venous ulcers.
Treatment of patients begins with a comprehensive evaluation at Dr Wright’s office which includes:
- Assessing the patient’s concerns regarding varicose veins with a history of vein disease and focused physical exam. Validating the diagnosis of reflux venous by using vascular ultrasound. Dr Wright is a certified medical sonographer.
- Preparing a plan of care that addresses the diagnosis.
- Implementing a plan of care that is safe and efficacious, and is satisfactory to the patient.
- Treating venous reflux before complications occur: venous stasis, hyperpigmentation, lipidodermatosclerosis (skin discoloration and changes) or ulcers occur.
- Treating and lessening (“blood clot”) thromboembolic risk factors before progression.
- Evaluating the results of previous intervention and adjusting treatments.
In summary, a phlebologist is best able to address vein problems in systematic and research driven way that can lead to multiple benefits such as improved clinical outcomes, improved quality of life and cost saving.
BIBLIOGRAPHY
1. Barclay, Laurie MD, Vega, Charles MD, FAAFP, “Venous Stripping Best for Venous Leg Ulcers”, Medscape Medical News, June 7, 2004
2. Barwell, et. al. “Comparison of Surgery and Compression with Compression Alone in Chronic Venous Ulceration (ESCHAR Study): Randomised Controlled Trial”, The Lancet, Vol. 363, June 5, 2004, P1854 – 1858
3. Bolton, Laura PhD, “Evidence Corner”, Wounds, 14(8); A12-14, 2002, Health Management Publications, Inc.
4. Gloviczki P. Merril SW, “Surgical treatment of Venous Disease”, Cardiovascul Clinics, 22(3): 81- 100
5. Kantor, Jonathan MA, Margolis, David J. MD, MSCE, “Expected Healing Rates from Chronic Wounds”, Wounds, Health Management Publications, Inc.
6. Kumar, RN, Gupehup GV, Dodd MA, Shah B, Iskedjian M, Einarson TR, Raish DW, “Direct Health Care Costs of 4 Common Skin Ulcers in New Mexico Medicaid Fee-For-Service Patients”, Adv Skin Wound Care, @004 Apr; 17(3): 143-9
7. Lopez, Ann P. MD, Phillips, Tania J. MD, “Venous Ulcers”, Wounds, 10(5); 149-157, 1998, Health Management Publications, Inc.
8. Olin JW, Beusterein KM, Childs MB, Seavey C, McHugh L., Griffiths RI, “Medical Costs of Treating Venous Stasis Ulcers From a Retrospective Cohort Study”, Vasc. Med. 1999; 4(1): 1-7
9. Perkowski P, ravi R, Gowda RC, Olsen D, Ramaiah V, Rodriguez-Lopez JA, Diethrich EB, “Endovenous Laser Ablation of the Saphenous Vein for Treatment of Venous Insufficiency and Varicose Veins: Early Results from a Large Single-Center Experience”, Journal Endovascular Therapy, April, 2004; 11(2): 132-8
10. Phillips, MD, “How to Approach Acute and Chronic Wound Healing in the Elderly”, Wounds, 11(6); 145-151, 1999, He4alth Management Publications, Inc.
11. Puggioni, Alessandra MD, Kalra, Manju MBBS, Charboneau, William J., MD, Gloviczki, Peter MD, “EVLT? For Venous Ulcer”, Endovascular Today, November/December, 2004
12. Shafritz, Randy MD, FACS: “Combining Bilayered Living Cell Therapy with Minimally Invasive Vein Surgery: Current Treatment Strategies for Venous Ulcers”, Supplement Vascular Disease Management, March/April, 2007
13. Soon, Seaver L. MD, Chen, Suephy C. MD, MS, “What Are Wound Care Outcomes?”, Wounds, 16(5); 150-156, 2004, Health Management Publications, Inc.
14. United States Department of Labor, Bureau of Labor Statistics, 2004 Internet Web Site
15. Wall, N. Blair, MHS, PT, CWS, McNeil, Paul M., MD, Rosenberg, Garth MD, Keeney-Sherlock, Monica PT, “A Comprehensive Surgical Approach to the Management of Venous Hypertension Wounds”, Wounds, Abstract from 16th Annual Symposium on Advanced Wound Care.
16. White, JV, Ryjewski, C, “Chronic Venous Insufficiency”, Perspect Vasc Surg Endovasc Ther., Dec. 17, 2005 (4): 319-27. For more information go to www.phlebology.org
