Negotiations with health insurers can lead to positive changes in policies toward venous disease.

Many health insurance plan (HIP) policies toward the treatment of chronic venous insufficiency (CVI) are outdated, formulated by administrators with the advice of physicians unfamiliar with CVI, and are not evidence-based. Denial of appropriate care by the HIP is frustrating to both the patient and provider, leading to delays in care and much time and effort in the appeals process. This led to meeting with the HIPs outlining the problems with their CVI policies.

Ultrasound-guided angioplasty of autogenous arteriovenous fistulas in the office setting.

Objective: There has been an increasing awareness of the superiority of native arteriovenous fistulas (AVFs) over prosthetic grafts for dialysis access. Many AVFs fail to mature, however, and others develop stenosis while in use. There is growing experience in treating these patients in the interventional suite with percutaneous balloon angioplasty.