In 2015, we continue to see remarkable advancements in the medical devices created for vascular intervention. Enhancements to previous technologies, such as drug-coated balloons, drug-eluting stents, and atherectomy catheters, enable physicians to perform more procedures percutaneously with better results. Simultaneously, we have seen growth in office-based vascular labs (OBLs), which allow safe, cost-effective outpatient management of vascular disease using these new technologies.1,2 Hence, there needs to be a strong relationship between industry and OBLs. The benefits of a close working relationship will be realized by both parties. Increased utilization of vascular devices by OBLs will help the financial bottom line for industry and bring more therapeutic options to the OBL, which will help patients and doctors alike.
In the January 2014 issue of Endovascular Today, I wrote an article on the economics of freestanding centers, striking a somewhat cautionary note. That article followed the 2013 Proposed Rule, which had included significant decreases in payments for many endovascular procedures when performed in a freestanding center. Those cuts were ultimately not activated at that time, but the Centers for Medicare & Medicaid Services (CMS) made it clear that they would continue to look critically at payments in freestanding centers, alerting parties interested in freestanding centers that changes may be coming.
In 2005, the Centers for Medicare & Medicaid Services established a fee schedule that provided reimbursement for selected peripheral endovascular procedures. During the next few years, office-based labs (OBLs) that performed these procedures slowly opened around the country.
If one includes the entire spectrum of venous disease, from telangiectasias and reticular veins to open leg ulcerations, there are approximately 25 million people in the United States who are affected.1 More than 500,000 patients have active venous ulcers, with approximately 1% of all adults estimated to develop a leg ulcer at some point in their lives (Figure 1).2 This level of disease prevalence is associated with a significant economic burden on the health care system, which is thought to be between $1.5 to $3 billion annually for ulcer care alone.3 Particularly with the advent of less-invasive percutaneous methods for the treatment of venous insufficiency, the number of procedures performed has skyrocketed and has become a focus of concern for both payers and the public.4
Hospitals have become large, integrated systems, as required for the complex infrastructure and teams of people necessary to care for patients with acute, life-threatening vascular disorders. However, for the treatment of patients with chronic vascular conditions, hospital care is bloated and expensive. The physician’s office, or office-based lab (OBL), offers a lower-cost alternative for the delivery of streamlined outpatient vascular care.
To improve patient care in the modern treatment of varicose veins, the Vascular Quality Initiative Varicose Vein Registry (VQI VVR) was established this year. This is a collaboration between the American Venous Forum (AVF) and the Society for Vascular Surgery Patient Safety Organization.
Office-based endovascular labs offer advanced techniques for limb revascularization. Initially, when these labs opened, the primary purpose was to manage and improve the patency of dialysis access. Over the years, these labs have developed to take the lead in managing lower extremity ischemia, including claudication and critical limb ischemia.
Several years ago, our team at Bay Area Vein and Vascular Center decided to open an office-based laboratory (OBL) to deliver better patient care, reduce bureaucracy, and increase access to innovative technology. I was exhausted from the ever-changing hospital schedule leading to unproductive time and defaulting to the same big-name products under contract at the hospital. I wanted freedom of choice and improved efficiency.
The treatment of chronic venous insufficiency of the lower extremity secondary to saphenofemoral junctional valve incompetency has undergone significant changes with the advent of endovascular techniques.
Investigators Konstantinos P. Donas, MD, and Edward Y. Woo, MD, discuss the data from a multicenter European and United States registry of snorkel/chimney technique applications.
A pioneer in vascular surgery and medical education reflects on changes in the open-endovascular tide and what makes a great meeting, as well as a preview of VEITHsymposium 2015.
Daniel G. Clair, MD, discusses the risk factors leading to limb failure and device elements that can help diminish this complication.
Iliac limb occlusion after endovascular aneurysm repair (EVAR) can result in acute ischemic symptoms and subsequent major morbidity or mortality. In contemporary investigational device exemption (IDE) trials, the incidence of limb occlusion at 12 months has ranged from approximately 1% to 8%. Despite the fact that these rates far and away surpassed that of type I endoleaks in these same trials, the importance of improving limb patency has received comparatively little focus.
During the last decade, endovascular aneurysm repair (EVAR) has gained wide acceptance as the preferred method of treating suitable patients with abdominal aortic aneurysms.1 EVAR is associated with lower 30-day mortality and morbidity rates, faster discharge, and fewer complications than with surgery, but seems to be associated with higher secondary intervention rates.2 Graft limb stenosis or thrombosis are important causes of secondary interventions after EVAR.
An expert panel discusses the current role, data, and techniques for the use of drug-coated balloons in tackling PAD.
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