6

Phlebology and the RPhSBy Jeannie White, RPhS, RVT, and CCI Phlebology Registry Examination Chair

Editor’s Note: CCI’s newest registry level credential, the Registered Phlebol-ogy Sonographer (RPhS), has a generated a lot of interest within the cardiovascular community. I have asked Phlebology Registry Examination Chair, Jeannie White, to give a brief overview of what phlebology is and what kind of work an RPhS would perform. For more information about the RPhS exam, visit www.cci-online.org.

Phlebology is the medical specialty devoted to the diagnosis and treatment of patients with venous disorders. The most serious venous disorder is deep venous thrombosis (a blood clot in a deep vein): it may be fatal if the thrombus travels to the lung or heart. The majority of venous disorders are not life threatening; however, they may be limb threatening and/ or debilitating. Patients who suffer from the diseases are affected for life and often endure chronic discomfort. Patients with venous disorders present with physical signs including spider veins, reticular veins, varicose veins, limb edema, discoloration or darkening of the lower leg between the ankle and the mid-calf, ulcerations, and vascu-lar malformations. Some patients are asymptomatic, but many complain of leg cramps, tightness, heavy legs, aching (especially after long periods of standing or sitting), or pain in one or both extremities. Many of the patients who present with signs and symptoms of venous disorders have superficial venous insufficiency (the failure of the blood in the superficial veins to return to the heart).

It is estimated that 1 in 22 (4.5%) of people in the USA, or 12.2 mil-lion people, in the USA are affected by varicose veins. The incidence of chronic venous disease increases with age and is more common in women. More than 40% of women over the age of 50 suffer from some sort of venous disorder. Although women are most likely to have the dis-order, all ages and genders are affected, with 60% of Americans suffering from venous disease and its sequelae.

Over the last two decades, the treat-ments options for venous disease have blossomed. There are many treatment op-tions for superficial venous insufficiency, and the majority of procedures that are performed are done so under the guid-ance of ultrasound. These include thermal ablation, chemical ablation, and ablation of per-forators. In the past, these veins would have been surgically ligated or stripped from the limbs. As the current treatments have evolved, so has CCI. CCI partnered with the American College of Phlebology to lead this specialized field by offering a new board examination, the registered phlebology sonographer (RPhS). A person with the RPhS credential possesses the skills and knowledge to understand all of the information that is on the venous portions of the RVS or RVT examinations, but also has the specialized knowledge that is required to assist the physician in treatments and procedures.

What is my role as an RVS/RVT, RPhS? Before treatment, I perform a complete venous insufficiency duplex examination. This more compre-hensive ultrasound includes not only the complete assessment of the deep system and major superficial system but also all superficial veins and perforating veins with the ultimate goal of defining the source of re-flux. During treatments, I set up the surgical tray, perform pre-procedure mapping; image the vessel that the doctor will access; confirm that the needle, wire, sheath, laser, or catheter is intraluminal; confirm proper placement of the sheath and laser or catheter; confirm a “cocoon” of peri-venous anesthesia around vein; confirm ablation of the vein; and assist in the treatment of tributaries. After treatment, the patient returns for an ultrasound on the limb treated to confirm the vein is occluded as well as confirming that no complications such as DVT, SVT, or heat induced thrombosis have arisen.

Why should the person holding the transducer have the most applicable credential? Being credentialed is the nationally accepted standard for excellence. It is the mark of a professional, and our patients will be better served! ♥

Jeannie White and John Mauriello, MD during a phlebectomy procedure.

Jeannie White prepping a patient for ablation.