A need, a vision, a plan, and a team. That’s how the total vein care program for treatment of chronic venous insufficiency (CVI) started at Cardiovascular Associates of East Texas, a private practice of 11 cardiologists in Tyler. More than eight years and 4,000 cases later, they have myriad lessons to share with practices contemplating a new service line.

About a decade ago, cardiologist Jeff Carr, MD, recognized a vast, unmet need among a subset of his cardiac and peripheral vascular patients with persistent and painful leg problems. “After sending patient after patient off to see his or her family doctor or a vascular surgeon, and realizing patients really weren’t getting relief, I knew we should start addressing the venous side of our patients’ problems,” Carr recalls.

The need then and now is great. In the U.S., more than 30 million adults have varicose veins or CVI, yet only 1.9 million seek treatment (J Vasc Surg. 2002;35:950-957; 2000;31:642-649). Six percent have more advanced chronic venous disease (J Vasc Surg. 2003;37:1047-1053). Another 30 million Americans develop clinical sequelae from CVI, with some eventually leading to limb amputation (J Vasc Surg. 2011;5(suppl):2S-48S). Yet, very few patients—and some physicians—realize that treatment is an option covered by most insurance companies.

Carr, who like his partners is experienced in cardiac and peripheral vascular interventions, educated himself on venous therapies by attending clinical meetings and was encouraged by a fellow cardiologist with a similar mission. He and his nurse visited an experienced phlebologist to see the procedure and patient workflow in action. Thus, his team and the Vein Center of East Texas, was born.

Carr and one of his partners vowed to go “all in,” creating a long-term plan and strategy to brand his group as a progressive cardiovascular and venous practice—and his partners concurred. The program launched in 2006 with one dedicated vascular diagnostic and treatment room, with patients undergoing venous interventions two days a month. Business grew quickly, largely from their current patient base, with the practice treating about 16 patients two days a week. “There already is venous business in every practice,” Carr says. “We see patients all the time who need these types of therapies.” They use compression hose and other conservative treatments as first-line therapy. If that fails, most insurers will pay for a procedure to repair venous function.

Today, the practice performs 20 to 24 venous procedures two days a week. They perform the Venefit procedure, which is delivered via the ClosureFast radiofrequency ablation (RFA) catheter. Evidence shows that, on average, RFA produces less discomfort and bruising with a faster improvement to quality of life when compared to a 980nm endovenous laser (J Vasc Interv Radiol. 2009;20:752-759). Each procedure takes about 20 to 40 minutes, with patients spending a few hours in total at the doctor’s office, and many patients report little to no discomfort, Carr says. Patients say symptoms most often disappear within a week of treatment—and clinical studies show 93 to 97 percent of patients still have closure after 3 years. (J Vasc Surg. 2011;54:146-152.) “We don’t see many patients return for the same areas, even 5 years after starting the program. That attests to the reliability and effectiveness of venous therapy.”

Dr. Jeff Carr is a paid consultant for Covidien.