Life doesn’t end when you leave the operating table

By: Bo Eklöf, MD - Helsingborg, Sweden

”Age is an issue of mind over matter. If you don’t mind, it doesn’t matter.” -Mark Twain

I was privileged to work together with Bob Kistner for almost 13 years in Paradise (Hawaii) where the vascular surgery team also included Elna Masuda and Dean Sato. One deciding event occurred at the annual AVF meeting in Cancun 2003 when I was chosen as President Elect and was escorted to the podium by Bob Kistner and Tony Comerota, which made my choice as to what to do when I left operative surgery. We take different directions reaching ”retirement age”: My last operative procedure was performed at Straub hospital in Honolulu June 2003 at the age of 67, after which I returned to Sweden. Bob still continues to work at his Vein Clinic, leaving home with a smile in the morning. My friend Wes Moore finished operating last June, but continues to be his patients’ advocate using his long experience. I left Hawaii as elected President for the AVF, but with Helsingborg, Sweden as base I continued to serve AVF for another 6 years in different interesting capacities. During this period I had a close and inspiring collaboration with Tom Wakefield, Mike Dalsing, Mark Meissner, Joann Lohr and Joe Caprini, not to forget Sandra Shaw in our mission to promote the AVF vision to our industrial partners.

Bob and I started the Pacific Vascular Symposium (PVS) with the first meeting at Mauna Lani on the Big Island in 1993: Controversies in the management of venous disorders, which led to the creation of the CEAP classification in 1994. CEAP was revised in 2004, and AVF should initiate a new revision now, 20 years after its establishment. The following PVS in 1996, 1999 and 2002 were open meetings with participants from all over the world. Fedor Lurie joined our group and from 2006 PVS 5 became the think tank of AVF. This symposium with 75 invited experts from Asia, Australia, Europe and North/South America on acute and chronic venous disease led to the establishment of the AVF vascular registries as well as the guidelines in collaboration with SVS for varicose veins and early thrombus removal. PVS 6 in 2009 resulted in a call to action: reducing venous ulcers by fifty percent in 10 years. This initiated the consensus work under the leadership of Monika Gloviczki, Tom O’Donnell and Marc Passman that resulted in the joint SVS/AVF guidelines on management of venous leg ulcers published in 2014.

The third edition of the Handbook of Venous Disorders was published in 2009 under Peter Gloviczki’s leadership – a significant manifestation from AVF where I had the privilege to join the editors. The work on the 4th edition has just begun. To fill up the time I fullfilled an old desire to convey the story on the development of ultrasound. In 2012 Oxford university press published the book Ultrasound in Clinical Diagnosis: from pioneering developments in Lund to global application in medicine, where I was the first editor.

Back to Sweden I got involved in the consensus work with EVF under Andrew Nicolaides’ leadership where prevention and treatment of venous thromboembolism was published in 2013 and management of chronic venous disorders of the lower limbs in 2014. You can utilize your network and experience to support the creation of new societies in venous disease and I have had the pleasure to assist Tomo Ogawa in Fukushima, Japan, to start the Asian Venous Forum, Dragan Milic in Nis, Serbia to establish the Balkan Venous Forum, and Evgeny Shaydakov in Saint Petersburg, Russia in his excellent work to develop education in venous disease which soon will result in Russian Venous Forum.

It is difficult to satisfy the needs for education in the rapidly expanding venous field. I frequently use the VEITH symposium as an example: when I joined the faculty in 2002 there were only 7 papers on venous disease presented late Friday afternoon when the large audience had left for the pleasures of the Big Apple. In 2014, 12 years later there were 290 presentations in 28 sessions, over 4 days! As an experiment I organized a hands-on workshop on board M/S Trollfjord on Hurtigruten from Bergen to Tromsö along the Norwegian westcoast on the request from my friend Bob Rutherford (he had seen everything but this!) in 2007. During this voyage we also started the consensus on venous terminology (VeinTerm) together with Michel Perrin, Lyon, France, which was completed at the AVF meeting in Charleston in 2008. The Hurtigruten workshop turned out well so in 2010 together with Peter Neglén we organized the first European Venous Forum Hands-on Workshop (EVF HOW) as the educational arm of EVF in Cyprus, the island of Venus. We organized the 2nd EVF HOW in Vienna, Austria, the 3rd EVF HOW again in Cyprus, and the 4th in Stockholm, Sweden. In March 2014 we organized a satelllite hands-on workshop in Tiblisi, Georgia with 150 participants from the neighboring countries Armenia, Azerbaijan, Belarus, Kazakstan, Russia and Ukraine. Interesting group of phlebologists that were meeting during the mounting tensions between Russia and Ukraine. Like with the Balkan Venous Forum, Venus – the Godess of love – can act as a good peacemaker. The 5th EVF HOW was again localized to Cyprus in October 2014 lasting for three full days. We accepted only 100 participants that represented 33 countries from 5 continents. Our faculty included 34 experts from Europe and the US, who delivered more than 30 lectures in the mornings and then spent 12 hours in the afternoons running 24 work stations together with our industrial partners. Each participant in groups of four spent 30 min at each station where they had the opportunity to handle all the new devices and procedures under expert guidance. We have also developed an interactive website – EVF VIP (Venous Interactive Portfolio) – where the participants have access to all the lectures, case presentations, workshop information, guidelines and recommended readings before and one year after the workshop.

The editor for this newsletter, Steve Elias, who was part of the EVF HOW, faculty can attest on the enthusiasm from the participants. For him the beer break at the end of the day was a blessing. In an affectionate editorial on the Original Sin he compared Tom O’Donnell and me with the traditional Bouillon Chartier restaurant in Paris. I will finish by quoting the introduction in the ad for this restaurant: ”A restaurant doesn’t become a legend by accident, and it certainly can’t stay that way by resting on its laurels”.

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