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  • Varicose vein treatment

    Posted by Unknown Member on March 23, 2018 at 11:03 am

    My group wants to start varicose vein treatment and I drew the short straw to research and make recommendations on treatment, reimbursement, vendors etc.
     
    Does anyone know of good resources reviewing the apparently many options.  Or has anyone recently gone through this assessment.  Thoughts/ recommendations?  VenaSeal plus/minus EVLT with adjuctive sclerotherapy??
     
    VenaSeal (MedTronics) new CRT codes 1/1/18   US guided glue, no need for extensive lido
    Varithena (BRG)                 ”                    ”             ”
    Clarivein                                            1/1/17
     
    Radiofrequequency ablation    older    some claim being able to treat perforators make is better
         Venefit Covidien
     
    Endovenous Laser Treatment   need extensive lido, compression stockings
        Angiodynamics

    ebshanon replied 1 year ago 7 Members · 21 Replies
  • 21 Replies
  • Unknown Member

    Deleted User
    March 23, 2018 at 2:06 pm

    Removed due to GDPR request

    • phenytoin

      Member
      March 23, 2018 at 7:19 pm

      I do quite a bit of superficial venous work. I use rfa and like it more than laser. Mostly for ease of use and speed. I’ve done some venaseal cases. The reimbursement is better than rfa but it’s much slower. Both products are from Medtronic.

      Btg varithena is nice for distal gsvs or tortuous aagsvs.

      I’m not a fan of clarivein.

      I use polidocanol for sclero.

      All the vendors can get you reimbursement info.

      Good luck.

      • Unknown Member

        Deleted User
        March 26, 2018 at 7:03 am

        Any reason you prefer  polidocanol over STS/Sotradecol

        • ruszja

          Member
          March 26, 2018 at 9:32 am

          Ask them how much you would have to pay to NOT to have anything to do with varicose veins….

          • Unknown Member

            Deleted User
            March 26, 2018 at 10:08 am

            Like I said .. I drew the short straw so I want to make it as efficient and pain free as possible …. maybe we’ll help some painful, heavy legs get better too.  That would make it better …

            • venkysakthi97

              Member
              March 26, 2018 at 4:36 pm

              I left hospital based radiology practice 4yrs ago to start my own phlebology practice after 13 yrs of group practice. Have 2 thriving vein centers now- no call, nites, wknds, or BS to deal with in terms of rad groups/politics, call, etc. Looking to open 3rd center in the next 6 months. I close my office when i want, and make my own schedule. see my kids every nite/wknd. The only regret I have is that I didn’t do this 5 years sooner. 
               
              I do RFA as opposed to laser-my experience is less post procedural pain/bruising.  I also do ambulatory phlebectom, ultrasound guided sclerotherapy, and visual sclera for spider veins. 

              • Unknown Member

                Deleted User
                March 26, 2018 at 5:50 pm

                Quote from eaglebarrett

                I left hospital based radiology practice 4yrs ago to start my own phlebology practice after 13 yrs of group practice. Have 2 thriving vein centers now- no call, nites, wknds, or BS to deal with in terms of rad groups/politics, call, etc. Looking to open 3rd center in the next 6 months. I close my office when i want, and make my own schedule. see my kids every nite/wknd. The only regret I have is that I didn’t do this 5 years sooner. 

                I do RFA as opposed to laser-my experience is less post procedural pain/bruising.  I also do ambulatory phlebectom, ultrasound guided sclerotherapy, and visual sclera for spider veins. 

                 
                I have heard there is a lot of competition. For example, I know even some family doctors do it. 
                 
                Anyway, congratulations!

              • Unknown Member

                Deleted User
                March 29, 2018 at 6:56 am

                Nice! Glad you found something that works well.
                 
                I haven’t done any veins as primary operator, but have done AVMs, and have seen vein ablations.
                 
                It seems like what’s harder than doing the procedure is marketing and getting referrals. I live in a market that is very competitive, and it seems like everyone is doing veins (esp. cardiologists).
                 
                Do you have any pointers on how to set up a practice, do marketing and get referrals?

                • venkysakthi97

                  Member
                  March 29, 2018 at 3:39 pm

                  I am an IR by training.  I was in hospital based rad practice for 13 yrs before i decided to do veins exclusively.
                   
                   

                  • Unknown Member

                    Deleted User
                    April 2, 2018 at 12:46 pm

                    And if do vein clinic would you combine with “pelvic congestion syndrome” or just refer those patients

                    • venkysakthi97

                      Member
                      April 3, 2018 at 10:14 am

                      dealing w/pelvic congestion will require a c-arm, which then brings a lot more cost/set up into the equation since the vein procedures themselves only require ultrasound and local anesthesia. I personally didn’t want to deal w/any more c-arm procedures myself (ie. being on my feet for long periods of time, wearing lead, radiation exposure, etc), so I refer all of these cases out to a local vascular surgeon (PAD cases), and a local IR (pelvic congestion, deep vein stenting, etc), and they send me all their superficial venous reflux stuff so it works out very well. 

                    • phenytoin

                      Member
                      April 4, 2018 at 2:40 am

                      I personally love doing veins. We get great results. You can only accomplish this l by offering full services and going all in. Radiologists are by far the best suited for this work. Unfortunately the cardiologists out there will catch on and start “doing veins”. This usually means a couple poorly done ablations and an Iliac stent. They are difficult to compete with. Make sure you spend a lot of time training your techs, ita a challenging exam.

                    • Unknown Member

                      Deleted User
                      April 9, 2018 at 11:12 am

                      Are you talking about US for reflux
                       
                      PCS studies & IVUS for nutcracker & iliacs seem pretty striaghtforward

                    • phenytoin

                      Member
                      April 10, 2018 at 12:14 pm

                      Yes. Having good techs who know how to find reflux is a challenge.

                    • ebshanon

                      Member
                      May 16, 2023 at 9:19 am

                      Resurrecting this old thread.  Can anyone recommend any good resources or courses to get up to speed with the latest techniques and start a vein clinic? Im IR trained and do deep venous work but haven’t done any superficial work since fellowship.  

                    • Radscatter

                      Member
                      May 20, 2023 at 12:07 pm

                      Superficial Vein work is easy. It’s basically just vascular access. 
                      As part of my practice I do all modalities (EVLT, RF, Venaseal, Foam sclerotherapy, microphlebectomy).  I honestly would try to hook up with your local Medtronic Venous Rep. They would be happy to send you to a course (and pay for it).  
                       
                      The hardest part is the clinical judgement.  I prefer doing wound patients as they seem to be the most happy with the results. Cosmetic patients are the hardest to please. As per reimbursement I think RF and Venaseal are the way to go. Not all insurance companies pay for Venaseal, but medicare does. Sclero doesn’t pay that great but it is necessary to heal some wounds. Some patients need venous and arterial treatments to heal wounds. 

                    • ebshanon

                      Member
                      May 22, 2023 at 12:28 pm

                      Thanks. Im sure I can half ass it but would like to learn it well from someone that does it in high volume and can also offer insight on how to market and get patients.
                       
                      Ill reach out to my medtronic rep. 

            • ruszja

              Member
              March 26, 2018 at 6:47 pm

              Quote from T2relaxation

              Like I said .. I drew the short straw so I want to make it as efficient and pain free as possible …. maybe we’ll help some painful, heavy legs get better too.  That would make it better …

               
              As someone from a family affected with bad varicose veins, yes you are doing the lords work.
              You will however find that there is an inverse relationship between the severity of venous insufficiency and the degree of bullshit you will get from the patients. Those who have experienced ulcers and constant pain will include you in their churches prayer list and send you gift baskets after you help them. Those with a couple of spiderveins and some mostly cosmetic varices will drive you nuts over things like lasting discoloration after sclerotherapy or some post-procedural bruising.

              • Unknown Member

                Deleted User
                March 28, 2018 at 11:13 am

                Yeah I’m already kinda dreading the cosmetic ones.

                • venkysakthi97

                  Member
                  March 28, 2018 at 9:06 pm

                  with my cosmetic patients, i set reasonable expectations:
                  1. Tell them their legs are not going to look they did 20 yrs ago
                  2. I specifically tell them we can make them look better but not perfect. If you’re looking for perfection, I’m not the right person for this type of treatment.
                  3. Luckily for me, 90% of my practice is medical but the little cosmetic i do is still profitable and manageable as long as I set expectations that don’t put me (or the pt ) in a bad position later

                  • Unknown Member

                    Deleted User
                    March 28, 2018 at 9:40 pm

                    Quote from eaglebarrett

                    with my cosmetic patients, i set reasonable expectations:
                    1. Tell them their legs are not going to look they did 20 yrs ago
                    2. I specifically tell them we can make them look better but not perfect. If you’re looking for perfection, I’m not the right person for this type of treatment.
                    3. Luckily for me, 90% of my practice is medical but the little cosmetic i do is still profitable and manageable as long as I set expectations that don’t put me (or the pt ) in a bad position later

                     
                    Are you an IR radiologist by training?