Looking Forward By Looking Back

What would you consider to be the best accomplishments of your year as AVF President?

Thomas F. O'Donnell, Jr., MD - AVF President 1998-1999

During the years 1998/1999 the Executive Committee (EC) focused on two major goals: 1) improving the financial stability of the AVF; and 2) developing a dialogue between the NIH and the AVF to enhance federally-sponsored research in venous disease. Three years prior to the 1999 Dana Point meeting the late Bob Hobson, Bob Kistner, the late Gene Strandness, and I met informally at the Ft. Lauderdale meeting, to discuss the precarious financial status of the AVF and develop steps to correct it. Like any non-profit society revenue was dependent on several sources; membership dues, the annual meeting with exhibit fees by industry, and educational grants from industry. The Vein Educational Institute of North America (VEIN) was eventually formed in collaboration with the health marketing firm, Goble and associates, to strengthen the relationships between the AVF and its industrial colleagues. Several major companies made significant educational grants through VEIN, which helped to stabilize the organization. Other steps that were taken in 1999 to provide financial stability were: to increase the general AVF membership as well as to create two new memberships categories-associate and candidate.  In addition the EC felt that the AVF/AVFF relationship had to be restructured to facilitate educational grants, so that from 1999 all assets of the AVF would reside in the AVFF. Thereafter, the AVF would submit proposals to the AVFF for funding of projects.

Regarding the NIH research proposal Tom Wakefield headed an ad hoc committee, which had a series of meetings with leaders in the NIH to discuss how surgeon-investigators could secure federal funding for venous research. To highlight this relationship I invited David Robinson Ph. D., the Director of the Vascular Research Program at the NIH, to deliver the Presidential Lecture (now the Strandness Lecture) at Dana Point. The number of surgeon P.I.s funded by NIH increased subsequently.

Peter Pappas, MD - AVF President 2010-2011

During my tenure as President of the AVF I had three main goals:  1.  Move the AVF towards physician and patient advocacy, 2, Have the foundation become the primary fund raising arm of the organization and 3.  Restructure the operational aspect of the organization.  In order to achieve the first goal the AVF developed a government relations committee that would focus on improving third party reimbursement for venous procedures and developing coverage policy decisions for third party payors.  The AVF had tried letter writing in the past without success.  To influence third party payors we needed national data.  As a result the AVF established the American Venous Registry.  The registry committee was chaired by Dr. BK Lal with the intent of developing the following several modules:  Varicose Veins, Vena cava filters, and Venous Stenting were developed and data collected.  We were successful in developing the first three registries and published two annual reports with the data thanks to a three hundred thousand grant from the GORE company.  The registry was eventually given to the Society for Vascular Surgery as part of their nation Vascular Quality Initiative.  The Government Relations committee has grown significantly over the years and has achieved numerous coverage policy decision wins.

Robert L. Kistner, MD - AVF President 1995-1996

On the day that I took over as the 8th president of the AVF in 1996-1997 there was serious (bad) news when our professional management organization informed us that their charges would not be financially sustainable by the AVF as it existed at the time.  This critical news immediately established our top priority as the need to review our activities and create a program that we could afford.   The fledgling society had to survive long enough to convince supporters of its importance while it became financially stable.  This required clarification of our basic mission in a form that would attract sufficient aid from our supporters to become financially stable.

Our early response to this challenge was to re-affirm the basic mission to create an annual venous forum of the highest quality devoted to presentation of research reports and high quality clinical data.  It was the underlying intent to develop an organized body of knowledge about venous disease based upon a scientific approach to venous pathology, anatomy, and physiology.

The original administrative organization was replaced by devoted administrative support with expertise in producing a first rate professional program able to attract a wider audience to the annual meeting.  New membership was encouraged to grow from the approximate 180 members at that time to the goal of at least 300 members.  The new members were limited to recognized experts in the venous field including practitioners who already had a significant percentage of their practice caring for venous patients.  Publishing of venous papers was necessary for initial members to join.

We invited the initial Advisory group of lay supporters to become more active in decision-making and participation.  We recognized the potential for a lay group to give us guidance in building a financially responsible and successful organization.  They responded with vigor and began to organize themselves for our support.

We sought the financial support of allied business and realized tremendous support from the stocking industry that essentially kept the organization alive during the first years of its existence, and have continued to provide essential support with funded scholarships and individual grants in addition to exhibiting their latest innovations at the annual meetings.  The list of financially supporting businesses has grown significantly through the years.

With time the administrative function has grown and continues to emerge.  As an organization we learned it takes time to mature into a functioning team that develops priorities and fulfills its commitments.  Strong central leadership is needed to attract the respect and trust needed to earn the respect that leads to larger grants from funding sources. 

What is one thing you wish you could have accomplished during your year as President?

Thomas F. O'Donnell, Jr., MD

Our limited funding at that point in the AVF’s history severely hampered the opportunity for new programs and initiatives, which I am pleased to see, have grown over the subsequent decade and a half. To specifically address the question- In conjunction with our NIH initiative we would have hoped to develop supporting funds to supplement any KO-8 awards from NIH with a Mentored Clinical Scientist Development award. These awards would be similar to those developed by our sister society, the Society for Vascular Surgery’s Lifeline Foundation, which provided support to the career development of young research-oriented vascular surgeons. This program would stimulate further research in venous disease.

Peter Pappas, MD

One of my major goals was to reorganize the operational structure of the AVF.  The executive committee engaged the services of a consulting group that interviewed all stake holders in the organization and presented their findings at the annual meeting’s executive committee meeting.  My biggest regret is that we did not have a formal retreat to address operational and organizational issues.  Although a report was given and delivered to the executive committee, no consensus regarding what changes should be made and no five year implementation strategy was ever developed.

Robert L. Kistner, MD

The personal intent that was not achieved in my presidential year was the desire for the AVF to assume a functional role of upgrading the practice of venous treatment into a systematic pattern of venous diagnosis and treatment in the United States.  These aspirations for the AVF to become a beacon of leadership nationally were premature due to my lack of understanding about the complexity involved in creating an organization that can influence public opinion.  Time has allowed an increasing number of these aspirations to emerge with growth and hard slugging by the successive leadership teams.  We need to thank those in the community of lay advisors and business supporters who have helped us through the years.

How has the "personality" of the AVF changed since your presidency?

Thomas F. O'Donnell, Jr., MD

In 1999 the AVF was a smaller society composed principally of vascular surgeons, who desired a venue to discuss venous disease. Our society has grown four-fold over the 15 years, with a more intimate character, where you knew most of the 212 members to now over 800 members.  In a sense the Annual Meeting was the major focus of the AVF, so that a vigorous discussion of a limited number of presentations was the rule. Thirty papers were presented in 1999 with 190 professional attendees.  The clinical papers reflected treatment options at that time and focused on catheter-directed thrombolysis for acute venous disease and the role of perforators and their treatment by SEPS for chronic venous disease. The number of industrial exhibitors (106) reflected the contemporary treatment of those diseases.  Endovenous ablation by radiofrequency was approved by the FDA that year (1999) and the first report of the technique in the US, a multicenter trial, was presented at that 1999 AVF meeting. The minimally invasive thermal catheter technique led to a tectonic shift in the treatment of varicose veins and as a result to our society for several reasons: 1) the lower morbidity of this minimally invasive treatment and faster return to activities increased the number of patients undergoing varicose vein surgery ten-fold; 2) the shift of site from an OR procedure to an office-based setting broadened the specialty of those performing the procedure. The annual meeting has become a multi-centered event due to the more varied technology and increased interest in venous disease-not unlike the ACS meeting. At the 2014 meeting 40 + papers were delivered, while at this year’s 2015 meeting attended by 355 professionals parallel plenary sessions were added to the specialty sessions and Postgraduate Courses. In the end I would cite as the best example of  the positive transformative changes in our society’s personality the major programs and initiatives made by the subsequent executive committees, such as the expanded educational programs, national screening programs, VQI, guidelines and our new journal-the Journal of Vascular Surgery: Venous and Lymphatic Disorders.

Peter Pappas, MD

Although the AVFF has always been the charitable wing of the AVF, the organization was never charged with active fund raising.  During my tenure, the bylaws were rewritten and the AVFF was charged with developing fund raising activities within and outside of industry.  After the bylaws were written subsequent presidents refined the bylaws even further and developed an organizational structure that delineated the relationship between the AVF and AVFF.  The AVFF is now responsible for all the fund raising activities of the society and the AVF focuses on their primary mission.

Robert L. Kistner, MD

The question of how a young physician can remain vital in the venous field has been raised and I believe it has more than one answer.  One obvious way is to devote time and energy to the activities of this and other venous organizations where there are ongoing tasks that benefit the society.  These can be professional or administrative subcommittees.

Other ways are to become involved with ongoing research activities, to remain clinically active in private practice, to develop a niche type of expertise, to cover part time locum tenens, to become active in research at both clinical and basic levels, and to teach awareness of venous disease to the public and the medical profession.

Venous disease provides many avenues of interest and mystery that remain to be solved and understood.  This ranges from the development of varicose veins in their progressive journey from a minor problem in young life to a sometimes crippling problem in the later years.  The influence of blood clotting and of the inflammatory cascade upon progression of both post-thrombotic and primary venous disease remains to be understood.  The total role of the venous valve and the degeneration of the venous wall over time are not well understood.  Both clinical and fundamental basic research is sorely needed to advance the field.                                                                                                         

Perhaps the greatest need in the venous field is to develop public and professional awareness of venous disease and its anatomic and pathologic development over the course of a long lifetime.

Within these aspects of venous disease there is a broad range of activities that can attract long-term involvements in the leg veins.  We are at the brink of understanding the importance of spreading awareness about this long neglected field of venous disease so that the community at large can be made aware of the breadth of its effect upon society and the potential for timely interventions to prevent progression of its pathology into crippling disabilities in later life.  There are great opportunities for young physicians to become trained in what is known about acute and chronic venous disease, and participants in creating fundamental and clinical improvements over the long term.

We need to be thankful for the many hard working and dedicated physicians that have brought us to our present state of innovation in venous disease.  For future growth we need many more of these kinds of minds to join the team.

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