American Insurance Coverage of Endovenous Ablation for Greater and Lesser Saphenous Varicose Veins.

GOALS/PURPOSE: Severe cases of varicose veins can cause psychological distress as well as physical symptoms including skin discoloration, wounds and burning sensations. One intervention, endovenous laser/radiofrequency ablation, is variably covered by insurance. Insurance coverage for this procedure was assessed for all indications of endovenous laser/radiofrequency ablation as medically necessity criteria. METHODS: A cross-sectional analysis was conducted of 57 insurance policies for endovenous laser/radiofrequency ablation. The insurance companies were selected based on the greatest state enrollment and market share. A web-based search and telephone interviews were utilized to identify the policies. Medically necessary criteria were then extracted from the publicly available policies. RESULTS: Fifty-seven (57) insurance policies were assessed, with 36 (63.2%) of these policies providing coverage for endovenous radiofrequency or laser ablation. Six indications existed for coverage, with the most common indication being the demonstration of valvular reflux (n=29, 80.6%). Of the 29 companies that indicated coverage for valvular reflux, 19 (52.8%) specifically required saphenous reflux. Significantly more companies required saphenous reflux vs other specified types of valvular reflux (52.8% vs 8.3%, p<0.001 for saphenous vs junctional reflux and 52.8% vs 16.7%, p <0.003 for saphenous vs nonspecific). Prior to proceeding with endovenous laser or radiofrequency ablation, up to 33% of insurance companies required a trial of conservative management as medically necessary. CONCLUSION: There is a great discrepancy in insurance policy criteria for coverage of endovenous laser/radiofrequency ablation for the treatment of varicose veins, particularly regarding the requirements for valvular reflux and a trial of conservative therapy.

Synergistic influence of rivaroxaban on inflammation and coagulation biomarkers in patients with coronary artery disease and peripheral artery disease on aspirin therapy.

COMPASS study demonstrated efficacy of dual pathway inhibition with 2.5 mg twice daily rivaroxaban and aspirin in patients with polyvascular disease (coronary artery disease, peripheral arterial disease or both), the underlying mechanism of which is not clearly understood. In this Phase IV, prospective, open-label and randomized study, we hypothesize that treatment with rivaroxaban is associated with a reduction in platelet activation and aggregation, inflammation and coagulation markers. 30 patients will be randomly treated with aspirin (81 mg q.d.) or aspirin plus rivaroxaban (2.5 mg b.i.d.) for 12 weeks. Platelet aggregation, platelet activation and inflammation markers, thrombin generation kinetics and tissue factor-induced platelet-fibrin clot strength will be measured at baseline, and 4 and 12 weeks after randomization. Trial registration number: NCT04059679.

Celiac artery aneurysm diagnosis and repair in the postpartum female.

A postpartum female presented with aching abdominal pain as well as persistently elevated blood pressure poorly controlled by medication. Computed tomography angiography was performed and identified an aneursym of the celiac artery proximal to its branching points. Due to symptomatic presentation of the patient and plans of future pregnancy, surgical repair of the aneursym was planned and performed 2 months following initial diagnosis. Celiac artery aneurysms are rare types of visceral artery aneursyms (VAAs) and comprise ~4% of all VAAs.

Plasma levels of the beta chemokine regulated upon activation, normal T cell expressed, and secreted (RANTES) correlate with severe brain injury.

BACKGROUND: The expression of the beta chemokine RANTES (regulated upon activation, normal T cell expressed, and secreted) has previously been shown to be elevated after traumatic brain injury (TBI) in animal models, but it was unknown whether the plasma level of RANTES was predictive of TBI in critically injured trauma patients. METHODS: A prospective study was conducted on 108 critically ill trauma patients. Patients were stratified by radiologic diagnosis of TBI. Severe TBI was classified as the presence of diffuse axonal injury, midline shift, or herniation based on admission head computed tomography findings. Serum levels were evaluated at admission and hospital day 7. RANTES was measured using Luminex multiplex assays. RESULTS: Fifty-four patients with and without TBI were compared. Severe TBI was diagnosed in 23 of the 54 TBI patients (43%) and mild/moderate TBI was found in 31 (57%) patients. The mean age of the study population was 43 +/- 20 years with a mean Injury Severity Score of 29 +/- 14. There was no significant difference between groups in age, sex, and Injury Severity Score. At admission, RANTES was significantly higher in patients with severe brain injury than in non-TBI patients (mean 1,339 pg/mL vs. 708 pg/mL, p = 0.046), and there was a trend toward significance when comparing patients with severe versus mild/moderate brain injury (mean 1,339 pg/mL vs. 752 pg/mL, p = 0.069). There was no statistically significant difference on day 7. CONCLUSIONS: RANTES was a significant early marker of severe TBI in critically injured trauma patients, consistent with animal models. Future research on the role of RANTES in the pathogenesis of human TBI is warranted.