Society News

“BLACK PATIENTS PRESENT WITH MORE SEVERE VASCULAR DISEASE AND A GREATER BURDEN OF RISK FACTORS THAN WHITE PATIENTS AT TIME OF MAJOR VASCULAR INTERVENTION.” Journal of Vascular Surgery, February 2018.

African Americans come into the vascular operating room with significant co-morbidities that may explain their more severe level of disease and higher risk factors, report researchers who reviewed 76,000 vascular cases for their report in the February edition of the Journal of Vascular Surgery.

This study drills deeper into the severity of vascular disease in African Americans, adding more fuel to the discussion of health disparities between racial and ethnic groups explored by the American Medical Association, which found that minorities are less likely to receive routine medical care and face higher rates of morbidity and mortality than non-minorities.

Invited commentator Dr. William R. Flinn found the study so profound he stated, “It should be read by every vascular surgeon, in fact, by every physician.”

Researchers have observed similar outcomes in vascular surgical procedures, but determining the cause of these disparities is difficult, since databases do not provide detail on disease severity.

For this report, a multi-institutional team of vascular surgeons led by vascular surgeon Dr. Marc Schermerhorn from Beth Israel Deaconess Medical Center took direct aim at this problem. Using de-identified data from the Vascular Quality Initiative gathered between 2009 and 2014, they found that compared to white patients, black patients were:

• Younger
• More likely to smoke
• More often diagnosed with insulin-dependent diabetes, hypertension, congestive heart failure and end-stage renal disease
• Less often medicated with statins
• Less often insured

Black patients also were sicker at the time of surgery. Compared with whites, black patients had more severe:

• Carotid disease (36% versus 31% symptomatic lesions)
• AAA (27% versus 16% symptoms/rupture, and more iliac aneurysm)
• PAD (73% versus 62% critical limb ischemia)

Furthermore, black patients were less likely to be discharged on aspirin and statin therapy after treatment for AAA and PAD than whites.

The authors note that their study is limited by factors common to all database studies including missing data, variability in definitions, and no way to adjust for socio-economic factors, compliance, family support, hospital type and timing of referral.

“Even in hospitals invested in quality improvement – as evidenced by participation in the VQI – black patients present with more advanced disease and more comorbidities compared with whites, despite presenting at a younger age,” states first author Dr. Peter Soden.  “And these disparities were uniform across the spectrum of vascular disease, including carotids, AAA and PAD.” 

The increase in presenting risk factors, along with disparity in medical management, offers clues as to the well-reported worse outcomes for black patients after major vascular procedures.

“The majority of the disparities highlighted in this manuscript are not from biologic differences, but instead from social, economic and health care delivery factors,” noted Dr. Flinn. “What this most clearly suggests is that there are untold numbers of black [patients] throughout the country with undiagnosed and untreated carotid disease, abdominal aortic aneurysm and PAD (and hypertension, and diabetes, and chronic kidney disease) because they do not have equitable access to health care in the United States in the 21^st century.

“The vascular community has a unique opportunity to contribute to the health care debate in this country,” he added. “I hope we have both the scientific rigor and the political courage to pursue it aggressively.”

To download the complete article (freely available Jan.  22 - March 31), click: vsweb.org/JVS-Severe.

“BLACK PATIENTS PRESENT WITH MORE SEVERE VASCULAR DISEASE AND A GREATER BURDEN OF RISK FACTORS THAN WHITE PATIENTS AT TIME OF MAJOR VASCULAR INTERVENTION.” Journal of Vascular Surgery, February 2018.

African Americans come into the vascular operating room with significant co-morbidities that may explain their more severe level of disease and higher risk factors, report researchers who reviewed 76,000 vascular cases for their report in the February edition of the Journal of Vascular Surgery.

This study drills deeper into the severity of vascular disease in African Americans, adding more fuel to the discussion of health disparities between racial and ethnic groups explored by the American Medical Association, which found that minorities are less likely to receive routine medical care and face higher rates of morbidity and mortality than non-minorities.

Invited commentator Dr. William R. Flinn found the study so profound he stated, “It should be read by every vascular surgeon, in fact, by every physician.”

Researchers have observed similar outcomes in vascular surgical procedures, but determining the cause of these disparities is difficult, since databases do not provide detail on disease severity.

For this report, a multi-institutional team of vascular surgeons led by vascular surgeon Dr. Marc Schermerhorn from Beth Israel Deaconess Medical Center took direct aim at this problem. Using de-identified data from the Vascular Quality Initiative gathered between 2009 and 2014, they found that compared to white patients, black patients were:

• Younger
• More likely to smoke
• More often diagnosed with insulin-dependent diabetes, hypertension, congestive heart failure and end-stage renal disease
• Less often medicated with statins
• Less often insured

Black patients also were sicker at the time of surgery. Compared with whites, black patients had more severe:

• Carotid disease (36% versus 31% symptomatic lesions)
• AAA (27% versus 16% symptoms/rupture, and more iliac aneurysm)
• PAD (73% versus 62% critical limb ischemia)

Furthermore, black patients were less likely to be discharged on aspirin and statin therapy after treatment for AAA and PAD than whites.

The authors note that their study is limited by factors common to all database studies including missing data, variability in definitions, and no way to adjust for socio-economic factors, compliance, family support, hospital type and timing of referral.

“Even in hospitals invested in quality improvement – as evidenced by participation in the VQI – black patients present with more advanced disease and more comorbidities compared with whites, despite presenting at a younger age,” states first author Dr. Peter Soden.  “And these disparities were uniform across the spectrum of vascular disease, including carotids, AAA and PAD.” 

The increase in presenting risk factors, along with disparity in medical management, offers clues as to the well-reported worse outcomes for black patients after major vascular procedures.

“The majority of the disparities highlighted in this manuscript are not from biologic differences, but instead from social, economic and health care delivery factors,” noted Dr. Flinn. “What this most clearly suggests is that there are untold numbers of black [patients] throughout the country with undiagnosed and untreated carotid disease, abdominal aortic aneurysm and PAD (and hypertension, and diabetes, and chronic kidney disease) because they do not have equitable access to health care in the United States in the 21^st century.

“The vascular community has a unique opportunity to contribute to the health care debate in this country,” he added. “I hope we have both the scientific rigor and the political courage to pursue it aggressively.”

To download the complete article (freely available Jan.  22 - March 31), click: vsweb.org/JVS-Severe.

“BLACK PATIENTS PRESENT WITH MORE SEVERE VASCULAR DISEASE AND A GREATER BURDEN OF RISK FACTORS THAN WHITE PATIENTS AT TIME OF MAJOR VASCULAR INTERVENTION.” Journal of Vascular Surgery, February 2018.

African Americans come into the vascular operating room with significant co-morbidities that may explain their more severe level of disease and higher risk factors, report researchers who reviewed 76,000 vascular cases for their report in the February edition of the Journal of Vascular Surgery.

This study drills deeper into the severity of vascular disease in African Americans, adding more fuel to the discussion of health disparities between racial and ethnic groups explored by the American Medical Association, which found that minorities are less likely to receive routine medical care and face higher rates of morbidity and mortality than non-minorities.

Invited commentator Dr. William R. Flinn found the study so profound he stated, “It should be read by every vascular surgeon, in fact, by every physician.”

Researchers have observed similar outcomes in vascular surgical procedures, but determining the cause of these disparities is difficult, since databases do not provide detail on disease severity.

For this report, a multi-institutional team of vascular surgeons led by vascular surgeon Dr. Marc Schermerhorn from Beth Israel Deaconess Medical Center took direct aim at this problem. Using de-identified data from the Vascular Quality Initiative gathered between 2009 and 2014, they found that compared to white patients, black patients were:

• Younger
• More likely to smoke
• More often diagnosed with insulin-dependent diabetes, hypertension, congestive heart failure and end-stage renal disease
• Less often medicated with statins
• Less often insured

Black patients also were sicker at the time of surgery. Compared with whites, black patients had more severe:

• Carotid disease (36% versus 31% symptomatic lesions)
• AAA (27% versus 16% symptoms/rupture, and more iliac aneurysm)
• PAD (73% versus 62% critical limb ischemia)

Furthermore, black patients were less likely to be discharged on aspirin and statin therapy after treatment for AAA and PAD than whites.

The authors note that their study is limited by factors common to all database studies including missing data, variability in definitions, and no way to adjust for socio-economic factors, compliance, family support, hospital type and timing of referral.

“Even in hospitals invested in quality improvement – as evidenced by participation in the VQI – black patients present with more advanced disease and more comorbidities compared with whites, despite presenting at a younger age,” states first author Dr. Peter Soden.  “And these disparities were uniform across the spectrum of vascular disease, including carotids, AAA and PAD.” 

The increase in presenting risk factors, along with disparity in medical management, offers clues as to the well-reported worse outcomes for black patients after major vascular procedures.

“The majority of the disparities highlighted in this manuscript are not from biologic differences, but instead from social, economic and health care delivery factors,” noted Dr. Flinn. “What this most clearly suggests is that there are untold numbers of black [patients] throughout the country with undiagnosed and untreated carotid disease, abdominal aortic aneurysm and PAD (and hypertension, and diabetes, and chronic kidney disease) because they do not have equitable access to health care in the United States in the 21^st century.

“The vascular community has a unique opportunity to contribute to the health care debate in this country,” he added. “I hope we have both the scientific rigor and the political courage to pursue it aggressively.”

To download the complete article (freely available Jan.  22 - March 31), click: vsweb.org/JVS-Severe.

Applications are due March 2 for the Wylie Scholar Award, co-sponsored by the SVS Foundation and Vascular Cures. The three-year, $150,000 grant is awarded to a promising vascular surgeon-scientist in North America and is designed to support outstanding surgeon-scientists conducting innovative academic research in the early stages of their careers.

Applications are due March 2 for the Wylie Scholar Award, co-sponsored by the SVS Foundation and Vascular Cures. The three-year, $150,000 grant is awarded to a promising vascular surgeon-scientist in North America and is designed to support outstanding surgeon-scientists conducting innovative academic research in the early stages of their careers.

Applications are due March 2 for the Wylie Scholar Award, co-sponsored by the SVS Foundation and Vascular Cures. The three-year, $150,000 grant is awarded to a promising vascular surgeon-scientist in North America and is designed to support outstanding surgeon-scientists conducting innovative academic research in the early stages of their careers.

SVS members, please remind any vascular PAs with whom you work to consider submitting an abstract for the inaugural PA programming or be a speaker during our 2018 Vascular Annual Meeting. More information is here -- please forward to your PAs!

SVS members, please remind any vascular PAs with whom you work to consider submitting an abstract for the inaugural PA programming or be a speaker during our 2018 Vascular Annual Meeting. More information is here -- please forward to your PAs!

SVS members, please remind any vascular PAs with whom you work to consider submitting an abstract for the inaugural PA programming or be a speaker during our 2018 Vascular Annual Meeting. More information is here -- please forward to your PAs!

The Society for Vascular Ultrasound (SVU), the Society for Vascular Surgery (SVS), and Medstreaming-M2S, announce the development of the Vascular Quality Initiative (VQI) Vascular Ultrasound Registry.  This Registry represents an expansion of the SVS VQI which will combine noninvasive (vascular ultrasound) testing data with vascular treatment and outcomes data, making it possible to analyze the relationships between diagnosis and care provided to patients with vascular disease.

The Vascular Ultrasound Registry’s initial efforts will focus on collection and analysis of data associated with the diagnosis and treatment of carotid artery disease. The development of the registry and ongoing research related activities are being led by a VQI Vascular Ultrasound Registry Task Force, chaired by Drs. David Dawson and Gregory Moneta. Groundbreaking in this registry will be the inclusion of actual ultrasound images which will make future machine analysis and learning possible from the collected registry, which currently does not exist.

It is anticipated that the registry will provide the means and an impetus to promote vascular laboratory standardization and thereby improve patient care. “Non-invasive vascular testing has evolved to the point where it is being relied upon heavily to direct patient medical management decisions”, said James Wilkinson, SVU Executive Director. “With the rapid growth and diversification in the number of medical specialties providing testing, there is a lack of standardization in the delivery of testing and the reporting of results. Targeted, yet broad based research will significantly contribute to standardization efforts.”

Fundamental to the VQI Vascular Ultrasound Registry is the ability to link technical data and images to the clinical data collected from the SVS VQI’s existing registries. “The addition of the VQI Vascular Ultrasound Registry, to the existing VQI registries, will further aid the VQI’s mission of improving vascular care by enhancing the data we can make available to our members.  We are also pleased that this registry expands the reach of the VQI to include vascular technologists, sonographers and other professionals in the vascular laboratory setting. The VQI has long embraced a team-approach to care with 59% of VQI membership coming from specialties outside of Vascular Surgery, including Cardiology and Radiology,” said Dr. Jens Eldrup-Jorgensen, Medical Director of the SVS Patient Safety Organization.

A key to the success of any registry is providing means for efficient data capture. The VQI Vascular Ultrasound Registry leverages the infrastructure of the preexisting registry with linkages to ultrasound images from the vascular laboratory. “Medstreaming-M2S’s specialty based workflow solutions, along with its clinical data management system for structured data aggregation can be used for uploading of data and images,” noted Wael Elseaidy, Medstreaming-M2S CEO. Initially, only a select number of current VQI sites will participate, but Vascular Ultrasound Registry participation is expected to be broadly available in the next phase of the program, along with an increase in registry content and scope of projects.

 “Unique to the VQI Vascular Ultrasound Registry is the inclusion of an imaged based registry component, which will include the actual ultrasound images acquired during patient studies. When combined with powerful analytics and potential for machine learning, we foresee opportunity to normalize ultrasound image data submitted from different sites, develop new benchmarking standards, further explore and promote utilization of all the information embedded in the images, and provide the ultrasound industry with an entirely new platform from which to conduct research and drive product development,” Elseaidy continued.

Ultimately, the Registry will provide opportunity for VQI members to improve quality and conduct additional research regarding vascular ultrasound. “The Registry will provide greater opportunity for members to participate in research, whether through contribution of data pertaining to Society sponsored research projects or their own projects utilizing Registry data, all with the overall objective of quality improvement and better patient care,” Wilkinson concluded.

The Society for Vascular Ultrasound (SVU), the Society for Vascular Surgery (SVS), and Medstreaming-M2S, announce the development of the Vascular Quality Initiative (VQI) Vascular Ultrasound Registry.  This Registry represents an expansion of the SVS VQI which will combine noninvasive (vascular ultrasound) testing data with vascular treatment and outcomes data, making it possible to analyze the relationships between diagnosis and care provided to patients with vascular disease.

The Vascular Ultrasound Registry’s initial efforts will focus on collection and analysis of data associated with the diagnosis and treatment of carotid artery disease. The development of the registry and ongoing research related activities are being led by a VQI Vascular Ultrasound Registry Task Force, chaired by Drs. David Dawson and Gregory Moneta. Groundbreaking in this registry will be the inclusion of actual ultrasound images which will make future machine analysis and learning possible from the collected registry, which currently does not exist.

It is anticipated that the registry will provide the means and an impetus to promote vascular laboratory standardization and thereby improve patient care. “Non-invasive vascular testing has evolved to the point where it is being relied upon heavily to direct patient medical management decisions”, said James Wilkinson, SVU Executive Director. “With the rapid growth and diversification in the number of medical specialties providing testing, there is a lack of standardization in the delivery of testing and the reporting of results. Targeted, yet broad based research will significantly contribute to standardization efforts.”

Fundamental to the VQI Vascular Ultrasound Registry is the ability to link technical data and images to the clinical data collected from the SVS VQI’s existing registries. “The addition of the VQI Vascular Ultrasound Registry, to the existing VQI registries, will further aid the VQI’s mission of improving vascular care by enhancing the data we can make available to our members.  We are also pleased that this registry expands the reach of the VQI to include vascular technologists, sonographers and other professionals in the vascular laboratory setting. The VQI has long embraced a team-approach to care with 59% of VQI membership coming from specialties outside of Vascular Surgery, including Cardiology and Radiology,” said Dr. Jens Eldrup-Jorgensen, Medical Director of the SVS Patient Safety Organization.

A key to the success of any registry is providing means for efficient data capture. The VQI Vascular Ultrasound Registry leverages the infrastructure of the preexisting registry with linkages to ultrasound images from the vascular laboratory. “Medstreaming-M2S’s specialty based workflow solutions, along with its clinical data management system for structured data aggregation can be used for uploading of data and images,” noted Wael Elseaidy, Medstreaming-M2S CEO. Initially, only a select number of current VQI sites will participate, but Vascular Ultrasound Registry participation is expected to be broadly available in the next phase of the program, along with an increase in registry content and scope of projects.

 “Unique to the VQI Vascular Ultrasound Registry is the inclusion of an imaged based registry component, which will include the actual ultrasound images acquired during patient studies. When combined with powerful analytics and potential for machine learning, we foresee opportunity to normalize ultrasound image data submitted from different sites, develop new benchmarking standards, further explore and promote utilization of all the information embedded in the images, and provide the ultrasound industry with an entirely new platform from which to conduct research and drive product development,” Elseaidy continued.

Ultimately, the Registry will provide opportunity for VQI members to improve quality and conduct additional research regarding vascular ultrasound. “The Registry will provide greater opportunity for members to participate in research, whether through contribution of data pertaining to Society sponsored research projects or their own projects utilizing Registry data, all with the overall objective of quality improvement and better patient care,” Wilkinson concluded.

The Society for Vascular Ultrasound (SVU), the Society for Vascular Surgery (SVS), and Medstreaming-M2S, announce the development of the Vascular Quality Initiative (VQI) Vascular Ultrasound Registry.  This Registry represents an expansion of the SVS VQI which will combine noninvasive (vascular ultrasound) testing data with vascular treatment and outcomes data, making it possible to analyze the relationships between diagnosis and care provided to patients with vascular disease.

The Vascular Ultrasound Registry’s initial efforts will focus on collection and analysis of data associated with the diagnosis and treatment of carotid artery disease. The development of the registry and ongoing research related activities are being led by a VQI Vascular Ultrasound Registry Task Force, chaired by Drs. David Dawson and Gregory Moneta. Groundbreaking in this registry will be the inclusion of actual ultrasound images which will make future machine analysis and learning possible from the collected registry, which currently does not exist.

It is anticipated that the registry will provide the means and an impetus to promote vascular laboratory standardization and thereby improve patient care. “Non-invasive vascular testing has evolved to the point where it is being relied upon heavily to direct patient medical management decisions”, said James Wilkinson, SVU Executive Director. “With the rapid growth and diversification in the number of medical specialties providing testing, there is a lack of standardization in the delivery of testing and the reporting of results. Targeted, yet broad based research will significantly contribute to standardization efforts.”

Fundamental to the VQI Vascular Ultrasound Registry is the ability to link technical data and images to the clinical data collected from the SVS VQI’s existing registries. “The addition of the VQI Vascular Ultrasound Registry, to the existing VQI registries, will further aid the VQI’s mission of improving vascular care by enhancing the data we can make available to our members.  We are also pleased that this registry expands the reach of the VQI to include vascular technologists, sonographers and other professionals in the vascular laboratory setting. The VQI has long embraced a team-approach to care with 59% of VQI membership coming from specialties outside of Vascular Surgery, including Cardiology and Radiology,” said Dr. Jens Eldrup-Jorgensen, Medical Director of the SVS Patient Safety Organization.

A key to the success of any registry is providing means for efficient data capture. The VQI Vascular Ultrasound Registry leverages the infrastructure of the preexisting registry with linkages to ultrasound images from the vascular laboratory. “Medstreaming-M2S’s specialty based workflow solutions, along with its clinical data management system for structured data aggregation can be used for uploading of data and images,” noted Wael Elseaidy, Medstreaming-M2S CEO. Initially, only a select number of current VQI sites will participate, but Vascular Ultrasound Registry participation is expected to be broadly available in the next phase of the program, along with an increase in registry content and scope of projects.

 “Unique to the VQI Vascular Ultrasound Registry is the inclusion of an imaged based registry component, which will include the actual ultrasound images acquired during patient studies. When combined with powerful analytics and potential for machine learning, we foresee opportunity to normalize ultrasound image data submitted from different sites, develop new benchmarking standards, further explore and promote utilization of all the information embedded in the images, and provide the ultrasound industry with an entirely new platform from which to conduct research and drive product development,” Elseaidy continued.

Ultimately, the Registry will provide opportunity for VQI members to improve quality and conduct additional research regarding vascular ultrasound. “The Registry will provide greater opportunity for members to participate in research, whether through contribution of data pertaining to Society sponsored research projects or their own projects utilizing Registry data, all with the overall objective of quality improvement and better patient care,” Wilkinson concluded.

To improve access, efficiency and service to existing and future SVS members, the Society is now reviewing and approving membership applications quarterly, instead of yearly. The first deadline for 2018 is March 1.

Learn more at vsweb.org/JoinSVS and apply today.

To improve access, efficiency and service to existing and future SVS members, the Society is now reviewing and approving membership applications quarterly, instead of yearly. The first deadline for 2018 is March 1.

Learn more at vsweb.org/JoinSVS and apply today.

To improve access, efficiency and service to existing and future SVS members, the Society is now reviewing and approving membership applications quarterly, instead of yearly. The first deadline for 2018 is March 1.

Learn more at vsweb.org/JoinSVS and apply today.

There’s only a month left to apply for the new SVS Foundation grant program for our community practice members and designed at improving community health.

Applications are due March 1 for the new Community Awareness and Prevention Project Grant, intended to help members in community practice environments conduct projects that address wellness and disease prevention and emphasize patient education, public awareness or risk assessment.

Awardees will receive up to $10,000 for an innovative, community-based initiative. Priority will go to projects that will benefit under-served areas or that include community partnerships.

Learn more vsweb.org/CommunityGrants.

The new program complements the Foundation’s expanded mission, which includes not only basic research but also increased public awareness about vascular disease and treatments and efforts to improve patient vascular care.

There’s only a month left to apply for the new SVS Foundation grant program for our community practice members and designed at improving community health.

Applications are due March 1 for the new Community Awareness and Prevention Project Grant, intended to help members in community practice environments conduct projects that address wellness and disease prevention and emphasize patient education, public awareness or risk assessment.

Awardees will receive up to $10,000 for an innovative, community-based initiative. Priority will go to projects that will benefit under-served areas or that include community partnerships.

Learn more vsweb.org/CommunityGrants.

The new program complements the Foundation’s expanded mission, which includes not only basic research but also increased public awareness about vascular disease and treatments and efforts to improve patient vascular care.

There’s only a month left to apply for the new SVS Foundation grant program for our community practice members and designed at improving community health.

Applications are due March 1 for the new Community Awareness and Prevention Project Grant, intended to help members in community practice environments conduct projects that address wellness and disease prevention and emphasize patient education, public awareness or risk assessment.

Awardees will receive up to $10,000 for an innovative, community-based initiative. Priority will go to projects that will benefit under-served areas or that include community partnerships.

Learn more vsweb.org/CommunityGrants.

The new program complements the Foundation’s expanded mission, which includes not only basic research but also increased public awareness about vascular disease and treatments and efforts to improve patient vascular care.

SVS members, please encourage medical or pre-med students interested in vascular surgery to apply for scholarships to attend the 2018 Vascular Annual Meeting. Scholarship applications are due by Feb. 1.

The awards are the General Surgery Resident/Medical Student Travel Scholarship and the Diversity Medical Student Travel Scholarship. Recipients become part of the hugely popular scholarship program, designed to let residents and students explore their interest in vascular surgery.

VAM will be held June 20 to 23, 2018, in Boston, with scientific sessions on June 21-23 and exhibits open June 21-22.) 

The SVS Foundation seeks applicants for its Student Research Fellowship awards, designed to stimulate laboratory and clinical vascular research by undergraduate college students and medical students attending universities in the United States and Canada. Urge students you know with an interest in research to apply today.

SVS members, please encourage medical or pre-med students interested in vascular surgery to apply for scholarships to attend the 2018 Vascular Annual Meeting. Scholarship applications are due by Feb. 1.

The awards are the General Surgery Resident/Medical Student Travel Scholarship and the Diversity Medical Student Travel Scholarship. Recipients become part of the hugely popular scholarship program, designed to let residents and students explore their interest in vascular surgery.

VAM will be held June 20 to 23, 2018, in Boston, with scientific sessions on June 21-23 and exhibits open June 21-22.) 

The SVS Foundation seeks applicants for its Student Research Fellowship awards, designed to stimulate laboratory and clinical vascular research by undergraduate college students and medical students attending universities in the United States and Canada. Urge students you know with an interest in research to apply today.

SVS members, please encourage medical or pre-med students interested in vascular surgery to apply for scholarships to attend the 2018 Vascular Annual Meeting. Scholarship applications are due by Feb. 1.

The awards are the General Surgery Resident/Medical Student Travel Scholarship and the Diversity Medical Student Travel Scholarship. Recipients become part of the hugely popular scholarship program, designed to let residents and students explore their interest in vascular surgery.

VAM will be held June 20 to 23, 2018, in Boston, with scientific sessions on June 21-23 and exhibits open June 21-22.) 

The SVS Foundation seeks applicants for its Student Research Fellowship awards, designed to stimulate laboratory and clinical vascular research by undergraduate college students and medical students attending universities in the United States and Canada. Urge students you know with an interest in research to apply today.

The way we diagnose and treat patients is thanks to years of research. Decades of research and discoveries by dedicated investigators have revolutionized the care of many digestive disease patients. As the charitable arm of the American Gastroenterological Association (AGA), the AGA Research Foundation contributes to this tradition of discovery.

Federal research funding is at risk. Promising early-stage investigators find it increasingly difficult to secure funding and many leave the field because they are unable to sustain a research career. The foundation provides a key source of funding at a critical juncture in a young investigator’s career.

“As a clinical researcher, funding for investigation is critical in scientific breakthroughs to promote more efficient and robust patient care. My project will provide novel insights into the role of distensibility in the treatment of patients with esophageal eosinophilia, potentially resulting in more efficient treatment selection and disease management.”

By joining others in donating to the AGA Research Foundation, you can help fill the funding gap and protect the next generation of investigators.

[email protected]

The way we diagnose and treat patients is thanks to years of research. Decades of research and discoveries by dedicated investigators have revolutionized the care of many digestive disease patients. As the charitable arm of the American Gastroenterological Association (AGA), the AGA Research Foundation contributes to this tradition of discovery.

Federal research funding is at risk. Promising early-stage investigators find it increasingly difficult to secure funding and many leave the field because they are unable to sustain a research career. The foundation provides a key source of funding at a critical juncture in a young investigator’s career.

“As a clinical researcher, funding for investigation is critical in scientific breakthroughs to promote more efficient and robust patient care. My project will provide novel insights into the role of distensibility in the treatment of patients with esophageal eosinophilia, potentially resulting in more efficient treatment selection and disease management.”

By joining others in donating to the AGA Research Foundation, you can help fill the funding gap and protect the next generation of investigators.

[email protected]

The way we diagnose and treat patients is thanks to years of research. Decades of research and discoveries by dedicated investigators have revolutionized the care of many digestive disease patients. As the charitable arm of the American Gastroenterological Association (AGA), the AGA Research Foundation contributes to this tradition of discovery.

Federal research funding is at risk. Promising early-stage investigators find it increasingly difficult to secure funding and many leave the field because they are unable to sustain a research career. The foundation provides a key source of funding at a critical juncture in a young investigator’s career.

“As a clinical researcher, funding for investigation is critical in scientific breakthroughs to promote more efficient and robust patient care. My project will provide novel insights into the role of distensibility in the treatment of patients with esophageal eosinophilia, potentially resulting in more efficient treatment selection and disease management.”

By joining others in donating to the AGA Research Foundation, you can help fill the funding gap and protect the next generation of investigators.

[email protected]

AGA’s member-only online networking platform, the AGA Community, was the hub for clinical case scenarios in 2017. About 100 deidentified patient cases were submitted to the forum, generating over 475 private and public responses from your peers.

Here is a summary of the three cases that sparked the most discussion among AGA members. You can view all discussions in the forum at community.gastro.org/discussions.
 

#3 “Esophageal hyperkeratosis” (February 2017)

Patient scenario: Patient was having dysphagia. EGD showed circumferential thickening of esophageal lining in the lower half of the esophagus causing partial obstruction; lumen diameter was 7 mm (scope was able to pass with mild resistance). Human papillomavirus (HPV) stain was negative. Multiple biopsies were negative for malignancy, so the practice did not recommend esophagectomy and believed the symptoms were consistent with hyperkeratosis of esophagus. Endoscopic cryotherapy was being considered.

Question: Has anyone come across a case like this?
 

#2 Thickened stomach (May 2017)

Patient scenario: A 74-year-old male presented early satiety, anemia, and dyspepsia. EGD showed diffuse moderate erythema of the stomach sparing the antrum, and two small superficial duodenal ulcers. Biopsies showed mild chronic inflammation, duodenitis, and negative for H. pylori. The patient was started on a proton pump inhibitor (PPI).

One month later, patient reported early satiety, a 40-pound weight loss over last few months, nausea and vomiting, with minimal improvement while using the PPI. A CT scan of the abdomen and pelvis showed diffuse thickening of the stomach, but was otherwise unremarkable.

One month after that, a repeated EGD showed moderate erythema with enlarged gastric folds, cobblestone of mucosa, again all sparing the antrum. The colonoscopy results were unremarkable. Gastric biopsies showed mild chronic inflammation. Endoscopic ultrasound showed a thickened gastric wall to 14 mm (normal 5 mm) and fine needle aspiration showed normal gastric foveolar epithelium. The patient received a PEG-J tube to maintain nutrition, and then had a laparoscopic assisted full thickness gastric biopsy, which showed benign hypertrophic gastric smooth muscle tissue.

Serum protein electrophoresis and urine protein electrophoresis test results were normal, with total IgG and IgA normal, total IgM low at 31 (normal 60-265), albumin low, other proteins normal, and immunofixation negative. Prealbumin was low at 5 (normal 15-45). Albumin initially normal and over a couple of days low at 2.6 (normal 3.4-5.0). Total protein initially normal and over a couple of days was low at 6.3 (normal 6.8-8.8). Gastrin level was insignificant on the PPI, in the 400s. Zollinger Ellison gastrin not impressive, and the patient is HIV negative.

Question: With a negative biopsy and other test results, Menetrier’s, malignancy, sarcoidosis, eosinophilic gastroenteritis, and amyloidosis can be ruled out. What could the diagnosis be?
 

#1 IBD and prior hep B (July 2017)

Patient scenario: A 53-year-old male diagnosed with ulcerative colitis (UC) at outside hospital after presenting with abdominal pain, perforation of sigmoid colon. He underwent total colectomy with ileostomy, which showed he has remnant rectum, and the path of colon showed UC with sigmoid stricture. There is no malignancy or dysplasia, and the terminal ileum included in the resection was normal. He had complicated post-op course with enterocutaneous fistula.

He underwent takedown of ileostomy, small bowel resection and ileostomy revision. Path showed segmental small bowel showing viable mucosa with acute serositis and serial adhesions. Ileal mucosa was normal. Rectum has inflammation, and he has symptoms of mucus, urgency, and blood. He had rectal burning and did not tolerate CANASA^® suppository. He did not seem to improve with hydrocortisone suppository either.

In trying to decipher next treatment step, hepatitis panel was done, which showed positive hepatitis B core antibody (IgM). Hepatitis B viral load was undetectable. Hepatitis B surface antibody test (HBsAb) quantitative was 6 (not quite the range for immunity of greater than 10). Hepatitis B “e” antigen (HBeAg) negative and hepatitis B “e” antibody (HBeAb) positive. This patient’s hep B core total was positive and hep B surface antigen was negative.

Question: How would you treat this patient? Would you use Imuran?

Share your difficult patient case for the GI community to help you solve at community.gastro.org/quickpost.
 

[email protected]

AGA’s member-only online networking platform, the AGA Community, was the hub for clinical case scenarios in 2017. About 100 deidentified patient cases were submitted to the forum, generating over 475 private and public responses from your peers.

Here is a summary of the three cases that sparked the most discussion among AGA members. You can view all discussions in the forum at community.gastro.org/discussions.
 

#3 “Esophageal hyperkeratosis” (February 2017)

Patient scenario: Patient was having dysphagia. EGD showed circumferential thickening of esophageal lining in the lower half of the esophagus causing partial obstruction; lumen diameter was 7 mm (scope was able to pass with mild resistance). Human papillomavirus (HPV) stain was negative. Multiple biopsies were negative for malignancy, so the practice did not recommend esophagectomy and believed the symptoms were consistent with hyperkeratosis of esophagus. Endoscopic cryotherapy was being considered.

Question: Has anyone come across a case like this?
 

#2 Thickened stomach (May 2017)

Patient scenario: A 74-year-old male presented early satiety, anemia, and dyspepsia. EGD showed diffuse moderate erythema of the stomach sparing the antrum, and two small superficial duodenal ulcers. Biopsies showed mild chronic inflammation, duodenitis, and negative for H. pylori. The patient was started on a proton pump inhibitor (PPI).

One month later, patient reported early satiety, a 40-pound weight loss over last few months, nausea and vomiting, with minimal improvement while using the PPI. A CT scan of the abdomen and pelvis showed diffuse thickening of the stomach, but was otherwise unremarkable.

One month after that, a repeated EGD showed moderate erythema with enlarged gastric folds, cobblestone of mucosa, again all sparing the antrum. The colonoscopy results were unremarkable. Gastric biopsies showed mild chronic inflammation. Endoscopic ultrasound showed a thickened gastric wall to 14 mm (normal 5 mm) and fine needle aspiration showed normal gastric foveolar epithelium. The patient received a PEG-J tube to maintain nutrition, and then had a laparoscopic assisted full thickness gastric biopsy, which showed benign hypertrophic gastric smooth muscle tissue.

Serum protein electrophoresis and urine protein electrophoresis test results were normal, with total IgG and IgA normal, total IgM low at 31 (normal 60-265), albumin low, other proteins normal, and immunofixation negative. Prealbumin was low at 5 (normal 15-45). Albumin initially normal and over a couple of days low at 2.6 (normal 3.4-5.0). Total protein initially normal and over a couple of days was low at 6.3 (normal 6.8-8.8). Gastrin level was insignificant on the PPI, in the 400s. Zollinger Ellison gastrin not impressive, and the patient is HIV negative.

Question: With a negative biopsy and other test results, Menetrier’s, malignancy, sarcoidosis, eosinophilic gastroenteritis, and amyloidosis can be ruled out. What could the diagnosis be?
 

#1 IBD and prior hep B (July 2017)

Patient scenario: A 53-year-old male diagnosed with ulcerative colitis (UC) at outside hospital after presenting with abdominal pain, perforation of sigmoid colon. He underwent total colectomy with ileostomy, which showed he has remnant rectum, and the path of colon showed UC with sigmoid stricture. There is no malignancy or dysplasia, and the terminal ileum included in the resection was normal. He had complicated post-op course with enterocutaneous fistula.

He underwent takedown of ileostomy, small bowel resection and ileostomy revision. Path showed segmental small bowel showing viable mucosa with acute serositis and serial adhesions. Ileal mucosa was normal. Rectum has inflammation, and he has symptoms of mucus, urgency, and blood. He had rectal burning and did not tolerate CANASA^® suppository. He did not seem to improve with hydrocortisone suppository either.

In trying to decipher next treatment step, hepatitis panel was done, which showed positive hepatitis B core antibody (IgM). Hepatitis B viral load was undetectable. Hepatitis B surface antibody test (HBsAb) quantitative was 6 (not quite the range for immunity of greater than 10). Hepatitis B “e” antigen (HBeAg) negative and hepatitis B “e” antibody (HBeAb) positive. This patient’s hep B core total was positive and hep B surface antigen was negative.

Question: How would you treat this patient? Would you use Imuran?

Share your difficult patient case for the GI community to help you solve at community.gastro.org/quickpost.
 

[email protected]

AGA’s member-only online networking platform, the AGA Community, was the hub for clinical case scenarios in 2017. About 100 deidentified patient cases were submitted to the forum, generating over 475 private and public responses from your peers.

Here is a summary of the three cases that sparked the most discussion among AGA members. You can view all discussions in the forum at community.gastro.org/discussions.
 

#3 “Esophageal hyperkeratosis” (February 2017)

Patient scenario: Patient was having dysphagia. EGD showed circumferential thickening of esophageal lining in the lower half of the esophagus causing partial obstruction; lumen diameter was 7 mm (scope was able to pass with mild resistance). Human papillomavirus (HPV) stain was negative. Multiple biopsies were negative for malignancy, so the practice did not recommend esophagectomy and believed the symptoms were consistent with hyperkeratosis of esophagus. Endoscopic cryotherapy was being considered.

Question: Has anyone come across a case like this?
 

#2 Thickened stomach (May 2017)

Patient scenario: A 74-year-old male presented early satiety, anemia, and dyspepsia. EGD showed diffuse moderate erythema of the stomach sparing the antrum, and two small superficial duodenal ulcers. Biopsies showed mild chronic inflammation, duodenitis, and negative for H. pylori. The patient was started on a proton pump inhibitor (PPI).

One month later, patient reported early satiety, a 40-pound weight loss over last few months, nausea and vomiting, with minimal improvement while using the PPI. A CT scan of the abdomen and pelvis showed diffuse thickening of the stomach, but was otherwise unremarkable.

One month after that, a repeated EGD showed moderate erythema with enlarged gastric folds, cobblestone of mucosa, again all sparing the antrum. The colonoscopy results were unremarkable. Gastric biopsies showed mild chronic inflammation. Endoscopic ultrasound showed a thickened gastric wall to 14 mm (normal 5 mm) and fine needle aspiration showed normal gastric foveolar epithelium. The patient received a PEG-J tube to maintain nutrition, and then had a laparoscopic assisted full thickness gastric biopsy, which showed benign hypertrophic gastric smooth muscle tissue.

Serum protein electrophoresis and urine protein electrophoresis test results were normal, with total IgG and IgA normal, total IgM low at 31 (normal 60-265), albumin low, other proteins normal, and immunofixation negative. Prealbumin was low at 5 (normal 15-45). Albumin initially normal and over a couple of days low at 2.6 (normal 3.4-5.0). Total protein initially normal and over a couple of days was low at 6.3 (normal 6.8-8.8). Gastrin level was insignificant on the PPI, in the 400s. Zollinger Ellison gastrin not impressive, and the patient is HIV negative.

Question: With a negative biopsy and other test results, Menetrier’s, malignancy, sarcoidosis, eosinophilic gastroenteritis, and amyloidosis can be ruled out. What could the diagnosis be?
 

#1 IBD and prior hep B (July 2017)

Patient scenario: A 53-year-old male diagnosed with ulcerative colitis (UC) at outside hospital after presenting with abdominal pain, perforation of sigmoid colon. He underwent total colectomy with ileostomy, which showed he has remnant rectum, and the path of colon showed UC with sigmoid stricture. There is no malignancy or dysplasia, and the terminal ileum included in the resection was normal. He had complicated post-op course with enterocutaneous fistula.

He underwent takedown of ileostomy, small bowel resection and ileostomy revision. Path showed segmental small bowel showing viable mucosa with acute serositis and serial adhesions. Ileal mucosa was normal. Rectum has inflammation, and he has symptoms of mucus, urgency, and blood. He had rectal burning and did not tolerate CANASA^® suppository. He did not seem to improve with hydrocortisone suppository either.

In trying to decipher next treatment step, hepatitis panel was done, which showed positive hepatitis B core antibody (IgM). Hepatitis B viral load was undetectable. Hepatitis B surface antibody test (HBsAb) quantitative was 6 (not quite the range for immunity of greater than 10). Hepatitis B “e” antigen (HBeAg) negative and hepatitis B “e” antibody (HBeAb) positive. This patient’s hep B core total was positive and hep B surface antigen was negative.

Question: How would you treat this patient? Would you use Imuran?

Share your difficult patient case for the GI community to help you solve at community.gastro.org/quickpost.
 

[email protected]

As part of Crohn’s and Colitis Awareness Week 2017 (Dec. 1-7), AGA participated in a congressional briefing sponsored by Takeda and the California Life Sciences Association highlighting advances in inflammatory bowel disease (IBD) therapies, as well as the barriers that patients face in receiving proper treatment for managing their disease.

Physician perspective

Michael Weinstein, MD, representing AGA and the Digestive Health Physicians Association, discussed how treatment options have changed considerably since he began practicing in the 1980s when the only treatment options were immunosuppressive drugs or high-dose steroids that led to dangerous side effects. He highlighted the burden that physicians face with prior authorization practices, especially step therapy in which a patient is required to fail several therapies before being granted coverage to the preferred, physician-prescribed therapy. These insurance protocols can have dire effects on patient care and can be very disruptive to patients who may be so ill that they cannot work or go to school. Dr. Weinstein stated that the burden step therapy places on his practice requires him to have a full-time employee just to navigate the various insurance policies. Many small practices do not have the resources to handle these burdens. Read more from Dr. Weinstein in his op-ed from The Hill.

Patient perspective

Members of Congress and congressional staff heard compelling testimony from Kate Detwiler, an IBD patient who spoke of her family history of IBD, her experience with the disease, and how disruptive it has been to find the best provider and treatments to manage her disease. She and Dr. Weinstein both stressed the financial burdens that the disease puts on families and how limiting it can be to patients who are starting out in their careers or school.

Legislator perspective

Rep. Brad Weinstrup, R-OH, and Rep. Raul Ruiz, D-CA, addressed the briefing as the lead sponsors of HR 2077, the Restoring Patient’s Voice Act, which would provide patients and providers with a clear, equitable, and transparent appeals process when subject to step therapy protocols. Both Rep. Wenstrup and Rep. Ruiz are physicians and have seen the real-life consequences of these policies and their impact on patient care. Both representatives stressed that this is a bipartisan, commonsense solution to ensuring that patients have access to the care that they need when they need it.

AGA continues to advocate for support and passage of HR 2077 and thanks those members who have contacted their members of Congress to request their support. If you haven’t already, please call on your legislator to support this legislation. We will continue to work to garner additional support for the bill in this Congress.
 

[email protected]

As part of Crohn’s and Colitis Awareness Week 2017 (Dec. 1-7), AGA participated in a congressional briefing sponsored by Takeda and the California Life Sciences Association highlighting advances in inflammatory bowel disease (IBD) therapies, as well as the barriers that patients face in receiving proper treatment for managing their disease.

Physician perspective

Michael Weinstein, MD, representing AGA and the Digestive Health Physicians Association, discussed how treatment options have changed considerably since he began practicing in the 1980s when the only treatment options were immunosuppressive drugs or high-dose steroids that led to dangerous side effects. He highlighted the burden that physicians face with prior authorization practices, especially step therapy in which a patient is required to fail several therapies before being granted coverage to the preferred, physician-prescribed therapy. These insurance protocols can have dire effects on patient care and can be very disruptive to patients who may be so ill that they cannot work or go to school. Dr. Weinstein stated that the burden step therapy places on his practice requires him to have a full-time employee just to navigate the various insurance policies. Many small practices do not have the resources to handle these burdens. Read more from Dr. Weinstein in his op-ed from The Hill.

Patient perspective

Members of Congress and congressional staff heard compelling testimony from Kate Detwiler, an IBD patient who spoke of her family history of IBD, her experience with the disease, and how disruptive it has been to find the best provider and treatments to manage her disease. She and Dr. Weinstein both stressed the financial burdens that the disease puts on families and how limiting it can be to patients who are starting out in their careers or school.

Legislator perspective

Rep. Brad Weinstrup, R-OH, and Rep. Raul Ruiz, D-CA, addressed the briefing as the lead sponsors of HR 2077, the Restoring Patient’s Voice Act, which would provide patients and providers with a clear, equitable, and transparent appeals process when subject to step therapy protocols. Both Rep. Wenstrup and Rep. Ruiz are physicians and have seen the real-life consequences of these policies and their impact on patient care. Both representatives stressed that this is a bipartisan, commonsense solution to ensuring that patients have access to the care that they need when they need it.

AGA continues to advocate for support and passage of HR 2077 and thanks those members who have contacted their members of Congress to request their support. If you haven’t already, please call on your legislator to support this legislation. We will continue to work to garner additional support for the bill in this Congress.
 

[email protected]

As part of Crohn’s and Colitis Awareness Week 2017 (Dec. 1-7), AGA participated in a congressional briefing sponsored by Takeda and the California Life Sciences Association highlighting advances in inflammatory bowel disease (IBD) therapies, as well as the barriers that patients face in receiving proper treatment for managing their disease.

Physician perspective

Michael Weinstein, MD, representing AGA and the Digestive Health Physicians Association, discussed how treatment options have changed considerably since he began practicing in the 1980s when the only treatment options were immunosuppressive drugs or high-dose steroids that led to dangerous side effects. He highlighted the burden that physicians face with prior authorization practices, especially step therapy in which a patient is required to fail several therapies before being granted coverage to the preferred, physician-prescribed therapy. These insurance protocols can have dire effects on patient care and can be very disruptive to patients who may be so ill that they cannot work or go to school. Dr. Weinstein stated that the burden step therapy places on his practice requires him to have a full-time employee just to navigate the various insurance policies. Many small practices do not have the resources to handle these burdens. Read more from Dr. Weinstein in his op-ed from The Hill.

Patient perspective

Members of Congress and congressional staff heard compelling testimony from Kate Detwiler, an IBD patient who spoke of her family history of IBD, her experience with the disease, and how disruptive it has been to find the best provider and treatments to manage her disease. She and Dr. Weinstein both stressed the financial burdens that the disease puts on families and how limiting it can be to patients who are starting out in their careers or school.

Legislator perspective

Rep. Brad Weinstrup, R-OH, and Rep. Raul Ruiz, D-CA, addressed the briefing as the lead sponsors of HR 2077, the Restoring Patient’s Voice Act, which would provide patients and providers with a clear, equitable, and transparent appeals process when subject to step therapy protocols. Both Rep. Wenstrup and Rep. Ruiz are physicians and have seen the real-life consequences of these policies and their impact on patient care. Both representatives stressed that this is a bipartisan, commonsense solution to ensuring that patients have access to the care that they need when they need it.

AGA continues to advocate for support and passage of HR 2077 and thanks those members who have contacted their members of Congress to request their support. If you haven’t already, please call on your legislator to support this legislation. We will continue to work to garner additional support for the bill in this Congress.
 

[email protected]