Phlebology

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Phlebology is a medical speciality that is concerned with venous issues including the diagnosis and treatment of disorders of the veins. [1] A medical specialist in this field is known as a phlebologist. The specialty of phlebology has developed to enable physicians sharing an interest in venous disease and health to share knowledge and experience despite being trained in a variety of backgrounds such as dermatology, vascular surgery, haematology, interventional radiology or general medicine. Diagnostic techniques used include the patient's history and physical examination, venous imaging techniques in particular vascular ultrasound and laboratory evaluation related to venous thromboembolism. The American Medical Association and the American Osteopathic Association have added phlebology to their list of self-designated practice specialties.

Contents

Scope of practice

A significant part of a phlebologist's work is involved with the treatment of superficial venous disease, frequently of the leg. Conditions often treated include venous stasis ulcers, varicose veins and spider veins (telangiectasia). Other conditions managed by phlebologists include deep venous thrombosis (DVT), superficial thrombophlebitis, and venous malformations.

Societies and Associations

The Union Internationale de Phlébologie (UIP) is committed to the global expansion of knowledge in the growing field of phlebology and aims to facilitate the advancement of science by encouraging research and education in all aspects of venous and lymphatic disease. The Union is ultimately aiming to facilitate comprehensive training programs in its member countries with the ultimate aim of establishing phlebology as a recognised  multidisciplinary specialty of medicine.  

The Australasian College of Phlebology (ACP) founded in 1993 has established a comprehensive four year training program in phlebology incorporating an online modular curriculum that complements supervised clinical training.

The American Medical Association added phlebology to their list of self-designated practice specialties in 2005. In 2007 the American Board of Phlebology (ABPh), subsequently known as the American Board of Venous & Lymphatic Medicine (ABVLM), was established to improve the standards of phlebologists and the quality of their patient care by establishing a certification examination, as well as requiring maintenance of certification. Although As of 2017 not a Member Board of the American Board of Medical Specialties (ABMS), the American Board of Venous & Lymphatic Medicine uses a certification exam based on ABMS standards.

The American Vein and Lymphatic Society (AVLS), formerly the American College of Phlebology (ACP) one of the largest medical societies in the world for physicians and allied health professionals working in the field of phlebology, has 2000 members. The AVLS encourages education and training to improve the standards of medical practitioners and the quality of patient care.

The American Venous Forum (AVF) is a medical society for physicians and allied health professionals dedicated to improving the care of patients with venous and lymphatic disease. The majority of its members manage the entire spectrum of venous and lymphatic diseases – from varicose veins to congenital abnormalities to deep vein thrombosis to chronic venous diseases. Founded in 1987, the AVF encourages research, clinical innovation, hands-on education, data collection and patient outreach.

Certification

Regulatory requirements for phlebology certification are different in Europe and the US.

In the US, licensed physicians with documented experience in treating veins and adequate vascular ultrasound experience can receive certification by passing a test created by the American Board of Venous and Lymphatic Medicine a privately owned corporation committed to maintaining a high standard of care for venous disease. The test addresses knowledge of venous disease, clotting disorders, imaging modalities, pharmacokinetics, vascular malformations, lymphatics disorders and venous embryology. The American Board of Venous and Lymphatic Medicine results in certification as a "Diplomate of the American Board of Venous and Lymphatic Medicine" which is based on standards set by the American Board of Medical Specialities. Providers with this designation have completed rigorous criteria to sit for the exam and comprehension of vein care principles to pass the exam according to the Board.[ citation needed ]

In Australasia, the Australian College of Phlebologists requires that applicants be residents in Australia or New Zealand; have current registration as a medical practitioner in Australia or New Zealand; have a recognised post-graduate qualification (e.g., FRACGP) or more than 3 years post-graduate experience in clinical medicine; have a Medicare provider number to apply for advanced training; and are a person who has satisfied the prerequisites is eligible to apply for admission to the College Training Program. There is Basic Training (minimum of 10 days' supervised training, the Written Exam and the Clinical Exam), completion of which leads to the award of the title "Certified Sclerotherapist"; Advanced Training (20 days' supervised training, the Written Exam and the Clinical Exam); and Fellowship Training, completion of which leads to Fellowship of the Australasian College of Phlebology and entitlement to use the title "Phlebologist". [2]

Related Research Articles

<span class="mw-page-title-main">Varicose veins</span> Medical condition in which superficial veins become large and twisted

Varicose veins, also known as varicoses, are a medical condition in which superficial veins become enlarged and twisted. These veins typically develop in the legs, just under the skin. Varicose veins usually cause few symptoms. However, some individuals may experience fatigue or pain in the area. Complications can include bleeding or superficial thrombophlebitis. Varices in the scrotum are known as a varicocele, while those around the anus are known as hemorrhoids. Due to the various physical, social, and psychological effects of varicose veins, they can negatively affect one's quality of life.

<span class="mw-page-title-main">Vein</span> Blood vessels that carry blood towards the heart

Veins are blood vessels in humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and fetal circulations which carry oxygenated blood to the heart. In the systemic circulation arteries carry oxygenated blood away from the heart, and veins return deoxygenated blood to the heart.

<span class="mw-page-title-main">Radiology</span> Branch of Medicine

Radiology is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography, but today it includes all imaging modalities, including those that use no electromagnetic radiation, as well as others that do, such as computed tomography (CT), fluoroscopy, and nuclear medicine including positron emission tomography (PET). Interventional radiology is the performance of usually minimally invasive medical procedures with the guidance of imaging technologies such as those mentioned above.

A podiatrist is a medical professional devoted to the treatment of disorders of the foot, ankle, and related structures of the leg. The term originated in North America but has now become the accepted term in the English-speaking world for all practitioners of podiatric medicine. The word chiropodist was previously used in the United States, but it is now regarded as antiquated.

<span class="mw-page-title-main">Vascular surgery</span> Medical specialty, operative procedures for the treatment of vascular disorders

Vascular surgery is a surgical subspecialty in which diseases of the vascular system, or arteries, veins and lymphatic circulation, are managed by medical therapy, minimally-invasive catheter procedures and surgical reconstruction. The specialty evolved from general and cardiac surgery and includes treatment of the body's other major and essential veins and arteries. Open surgery techniques, as well as endovascular techniques are used to treat vascular diseases. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system excluding the coronaries and intracranial vasculature. Vascular surgeons often assist other physicians to address traumatic vascular injury, hemorrhage control, and safe exposure of vascular structures.

<span class="mw-page-title-main">Sclerotherapy</span>

Sclerotherapy is a procedure used to treat blood vessel malformations and also malformations of the lymphatic system. A medicine is injected into the vessels, which makes them shrink. It is used for children and young adults with vascular or lymphatic malformations. In adults, sclerotherapy is often used to treat spider veins, smaller varicose veins, hemorrhoids, and hydroceles.

<span class="mw-page-title-main">Angiology</span> Branch of internal medicine, which deals with vascular disease

Angiology is the medical specialty dedicated to studying the circulatory system and of the lymphatic system, i.e., arteries, veins and lymphatic vessels.

A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include those branches of medicine that deal exclusively with children (paediatrics), cancer (oncology), laboratory medicine (pathology), or primary care. After completing medical school or other basic training, physicians or surgeons and other clinicians usually further their medical education in a specific specialty of medicine by completing a multiple-year residency to become a specialist.

The term venous translucence has been used in phlebology since 1996 by surgeon Pedro Fernandes Neto during ambulatory clinical exams in Brazil. His results were published in the annals of the national and international congresses of angiology. Venous translucence is the process of reflective image visualization of veins by light, which reaches up to the superficial venous system. It is a non-invasive method. Since it is a simple, low-cost technique it can be repeated as needed, which is useful in disease-process monitoring. It is a new diagnostic procedure, still undergoing investigation; more analysis is necessary to hone its technical aspects. Venous translucence is based on optical physics. It is caused by the refraction, absorption and reflection of light. The color which is not absorbed is reflected, and is the one that is seen. Therefore, venous translumination is based on the incidence of luminosity on the vein, where part of the light is absorbed and another reflected.

<span class="mw-page-title-main">Chronic venous insufficiency</span> Medical condition

Chronic venous insufficiency (CVI) is a medical condition in which blood pools in the veins, straining the walls of the vein. The most common cause of CVI is superficial venous reflux which is a treatable condition. As functional venous valves are required to provide for efficient blood return from the lower extremities, this condition typically affects the legs. If the impaired vein function causes significant symptoms, such as swelling and ulcer formation, it is referred to as chronic venous disease. It is sometimes called chronic peripheral venous insufficiency and should not be confused with post-thrombotic syndrome in which the deep veins have been damaged by previous deep vein thrombosis.

A vascular malformation is a blood vessel or lymph vessel abnormality. Vascular malformations are one of the classifications of vascular anomalies, the other grouping is vascular tumors. They may cause aesthetic problems as they have a growth cycle, and can continue to grow throughout life.

<span class="mw-page-title-main">Superficial thrombophlebitis</span> Medical condition

Superficial thrombophlebitis is a thrombosis and inflammation of superficial veins which presents as a painful induration with erythema, often in a linear or branching configuration forming cords.

<span class="mw-page-title-main">Klippel–Trénaunay syndrome</span> Medical condition

Klippel–Trénaunay syndrome, formerly Klippel–Trénaunay–Weber syndrome and sometimes angioosteohypertrophy syndrome and hemangiectatic hypertrophy, is a rare congenital medical condition in which blood vessels and/or lymph vessels fail to form properly. The three main features are nevus flammeus, venous and lymphatic malformations, and soft-tissue hypertrophy of the affected limb. It is similar to, though distinctly separate from, the less common Parkes Weber syndrome.

<i>Phlebology</i> (journal) Academic journal

Phlebology, The Journal of Venous Disease, is a peer-reviewed medical journal covering research on vascular disease. It is published by SAGE Publications and is an official journal of the American College of Phlebology, the Australasian College of Phlebology, the Venous Forum of the Royal Society of Medicine, the European Venous Forum, and the Benelux Society. The editor-in-chief is Alun Davies.

<span class="mw-page-title-main">Perforator vein</span>

Perforator veins are so called because they perforate the deep fascia of muscles, to connect the superficial veins to the deep veins where they drain.

<span class="mw-page-title-main">Ultrasonography of chronic venous insufficiency of the legs</span> Non-invasive medical procedure

Ultrasonography of suspected or previously confirmed chronic venous insufficiency of leg veins is a risk-free, non-invasive procedure. It gives information about the anatomy, physiology and pathology of mainly superficial veins. As with heart ultrasound (echocardiography) studies, venous ultrasonography requires an understanding of hemodynamics in order to give useful examination reports. In chronic venous insufficiency, sonographic examination is of most benefit; in confirming varicose disease, making an assessment of the hemodynamics, and charting the progression of the disease and its response to treatment. It has become the reference standard for examining the condition and hemodynamics of the lower limb veins. Particular veins of the deep venous system (DVS), and the superficial venous system (SVS) are looked at. The great saphenous vein (GSV), and the small saphenous vein (SSV) are superficial veins which drain into respectively, the common femoral vein and the popliteal vein. These veins are deep veins. Perforator veins drain superficial veins into the deep veins. Three anatomic compartments are described, (N1) containing the deep veins, (N2) containing the perforator veins, and (N3) containing the superficial veins, known as the saphenous compartment. This compartmentalisation makes it easier for the examiner to systematize and map. The GSV can be located in the saphenous compartment where together with the Giacomini vein and the accessory saphenous vein (ASV) an image resembling an eye, known as the 'eye sign' can be seen. The ASV which is often responsible for varicose veins, can be located at the 'alignment sign', where it is seen to align with the femoral vessels.

<span class="mw-page-title-main">Dinker Belle Rai</span> Indian American surgeon

Dinker Belle Rai is an Indian American vascular surgeon who serves as the chairman of the Department of Surgery and as the Chief of the Department of Vascular Surgery / Vascular Laboratory at the Interfaith Medical Center, Brooklyn, New York. He is a visiting clinical professor at the Health & Science Center of the State University of New York in Brooklyn and a visiting professor at the Rajiv Gandhi University in Bangalore, India. Rai is a Fellow of the American College of Surgeons and a Fellow of the Royal Canadian College of Surgeons. He is credited with developing the first ever method for retrograde catheterization of the venous tree. This invention was given a United States patent in 1988. Based on this patent, a company called The Ideas For Medicine, Inc. manufactured and still distributes out a series of catheters, known as Rai’s Catheters for use in performing descending phlebographic tests and for venous embolectomies. He is also credited with the discovery of the motion of venous valves in human beings. His original research on histopathological specimens of patients with saphenofemoral – incompetency resulted in a paradigm shift in management of varicose veins. He performed the first ever vein transplantation below the knee. The discovery of right atrial mechanical function is a pivotal discovery in his medical research work. He is an editor for the International Journal of Angiology. Rai has been featured in the book "Jewels of India" for his contributions in the medicine, art, sports and cultural arenas.

<span class="mw-page-title-main">Ultrasonography of deep vein thrombosis</span>

Ultrasonography in suspected deep vein thrombosis focuses primarily on the femoral vein and the popliteal vein, because thrombi in these veins are associated with the greatest risk of harmful pulmonary embolism.

<span class="mw-page-title-main">American Venous Forum</span> American Venous Forum Logo

The American Venous Forum (AVF) is the major national academic society focused on venous and lymphatic disease in the United States. Its mission includes education, research, and advocacy. The AVF is the sponsor organization for the Journal of Vascular Surgery Venous and Lymphatic and for the American Venous Forum meeting.

Kenneth Arthur Myers FRACS FACS was an Australian surgeon specialising in phlebology.

References

  1. "Phlebology" . Retrieved 9 January 2023.
  2. "The Australasian College of Phlebology". Australasian College of Phlebology. Retrieved 12 January 2022.