Although much of the research in the field of vascular intervention has historically trended toward arterial diseases and therapies, the tide has shifted in recent years, with the wide variety of venous pathologies and procedures garnering increased attention from practitioners and industry alike. Seemingly countless new modalities are in trials or coming to market to address the spectrum of superficial and deep venous conditions.

The promise of technologic advancement beckons clinicians just as it does those at the forefront of every tech-driven field. In many cases, our inherent bias that “newer equals better” is confirmed. However, as new technologies begin to flood the venous space, our enthusiasm for emerging options that hold the possibility of improving case outcomes and patient lives must be tempered with reasonable skepticism and a demand for supporting data.

Similarly, it is essential that we recognize the dangers of overuse and other forms of inappropriate use of today’s procedures. Aside from potential regulatory and reimbursement backlash, adverse outcomes for our patients resulting from inappropriate applications could irrevocably damage the standing of vascular specialties in our local and global communities. For the benefit of our patients and our continued ability to provide them with cutting-edge techniques, we must assume the collective responsibility of ensuring their appropriate application.

The purpose of this Venous edition’s focus on appropriate care is not to strike an ominous tone at a time of great promise in our field. Rather, we aim to amplify current understandings of best practices and promote a blend of optimism and objective scrutiny in evaluating and adopting new technologies. We also endeavor to point out no-fly zones ranging from lack of data support to downright hazardous practices to avoid.

We have invited experts known not only for their abilities to illustrate meticulous techniques, but also their demonstrated concern for how and when to apply them. This month’s articles include impassioned editorials on appropriate use, practical how-I-do-it technical descriptions, pointers on pitfall avoidance, and candid discussions on the strengths and shortfalls of supporting data. You will also find an emphasis on optimal utility of each of today’s major imaging modalities, which are at least as critical to outcomes as the performance of the therapeutic technologies.

Our call to action is simple: Hold yourselves, your partners, your staff, your industry partners, your podium presenters, and your referrers to high standards for appropriate care without compromise. And, share your suboptimal outcomes as enthusiastically as your highlight-reel cases, acknowledging that our practices will always be a work in progress, but with greater abilities for vicarious learning than ever before.

We hope this edition helps to inform your decisions but also encourage your continued efforts to ensure optimal delivery of venous interventions.

Erin H. Murphy, MD, FACS
Stephen A. Black, MD, FRCS(Ed), FEBVS