Raghu Kolluri

Following his recent appointment as president of the Society for Vascular Medicine (SVM), Raghu Kolluri (Columbus, USA) speaks to Venous News about how the venous field is being affected by the results of recent trials, his involvement with The VEINS at VIVA, and key areas of innovation to watch out for in 2020.

When did you decide to enter the field of vascular medicine?

I decided to enter the field of vascular medicine towards the end of my first year of an internal medicine residency at Riverside Methodist Hospital (Columbus, USA). I saw a patient with bilateral brachial artery fibromuscular dysplasia, which I reported along with my mentor (now my colleague and partner at work) Gary Ansel (Columbus, USA). I was fascinated by the field of vascular medicine and was able to do a month of “away-rotation” at The Cleveland Clinic’s Vascular Medicine section during my second year of residency training. I fell in love with vascular medicine during that time. Following residency training, I went to The Cleveland Clinic for advanced fellowship training in vascular medicine. We were trained to manage all aspects of vascular disorders and thrombosis, and I was exposed to the first iteration of radiofrequency ablation technology and other superficial venous therapies. Although I enjoy practicing all aspects of vascular medicine, I was particularly attracted to venous disease since it was a highly neglected field at that time. My interest in venous disease only became stronger later on in clinical practice, as I cared for many patients suffering from debilitating venous disease.

During your training, were there any vascular or venous specialists who particularly inspired you?

Of course, I have several role models and mentors. Ansel and Mitchell Silver (Columbus, USA), now my practice partners, encouraged me to get into the field of vascular medicine while in training. Spending time with Ansel on the hospital floors and in the cath lab was truly inspiring. The one individual who influenced my professional life the most is John Bartholomew (Cleveland, USA). He trained several doctors in vascular medicine and genuinely cares for his patients. His thoroughness in every aspect of patient care left a significant impact on my career, and his passion for thrombosis and venous disease has rubbed off on me.

How has the venous field changed, and do you agree that future trials must focus on “technical success”?

Venous care is still a relatively neglected field, especially when compared to peripheral arterial disease (PAD) or coronary artery disease (CAD). Nevertheless, we have come a long way, with tremendous growth in the venous space in the last couple of decades. I recall a time when deep venous interventions were offered only for palliative care, and therapies for long-term sequelae of post-thrombotic syndrome were available only in a few select centres in the USA. I hope venous patients will ultimately benefit from evolving technologies in the superficial and deep venous space, and for pulmonary embolism (PE). I agree that we must focus on technical success in deep venous interventional trials, but appropriate assessment of technical success is equally important. Also, patient-reported outcomes are as important as anatomic success; ultimately, the patient needs to feel better.

What are some of the key areas of innovation that currently interest you?

We are a large Health System in Central Ohio, with 14 hospitals and more than 20 vascular laboratories. We are interested in all aspects of innovation that improve our patients’ lives. I am very excited about some of the advances in duplex imaging. Multi-row array technology allows a lot more elements to be packed into the new ultrasound probe, leading to exceptionally high-resolution images. Visualisation of slow flow and deep structures is fascinating. 3D ultrasound imaging and ultrasound contrast may have some future vascular applications. Point-of-care ultrasound is another area of interest, and I believe this will change the way physicians practice and examine patients. I would also like to see increased utilisation of simultaneous extravascular and intravascular ultrasound in cath labs. We are also interested in thrombectomy devices for PE and deep vein thrombosis (DVT) management that hopefully will reduce bleeding risks and improve outcomes.

Before The VEINS, fellow course director John Kaufman described you as “a force of nature”; how successful was the programme this year?

That is very kind of John. He has been a great partner with the management of this highly successful meeting. We welcomed 400 attendees representing 31 countries, this year. We have a broad range of venous education at The VEINS, and will continue to listen to our attendees and provide patient-centric educational content. Stay tuned for more announcements with regard to The VEINS’ 2020 programme; we have several unique and innovative sessions planned.

You are also part of the American Venous Forum’s Annual Programme Committee; what can attendees look forward to at the AVF meeting in March?

AVF is a highly scientific organisation and I enjoy attending the AVF meeting every year. As always, the latest in basic and clinical science will be featured, in the form of abstracts and presentations. AVF has also formally partnered with C-TRACT to increase the awareness of the trial and the enrolment process. I look forward to hearing an update on this landmark study by Suresh Vedantham (St. Louis, USA).

How excited are you about your appointment as president of the Society for Vascular Medicine?

SVM is my professional home society and it is an honour to lead this society, which consists of incredible vascular specialists from all training backgrounds. Although we are not a large organisation, we certainly are mighty. In my opinion, no single specialty can provide comprehensive vascular care. Nationally and internationally, SVM has partnered with like-minded vascular societies at various levels. We routinely participate in writing Appropriateness Use Criteria (AUC) documents and other vascular guidelines. As the USA’s population ages and the prevalence of vascular disease increases, there is going to be a shortage of vascular specialists. We will explore all options to increase training programmes in vascular medicine in the next few years.

If you had to give one piece of advice to new doctors entering the venous specialty, what would you say?

Understand the disease process and the pathophysiology of venous disease. This is more important than focusing on techniques and technologies. It is also important to remember that manifestations of venous disease result from complex veno-lymphatic and cardiovascular interactions. Unless you think outside of the vascular box, you will not be able to help all patients. With a laundry list of venous therapies now available, it is quite easy to miss underlying systemic causes that may mimic symptoms consistent with venous disease. It is not uncommon for me to see patients seeking a second opinion, with persistent symptoms even though their deep veins have been stented and their superficial veins ablated. Above all, stay humble and collaborate.

During your time as a venous specialist, are there any cases which stand out?

I saw a 99-year-old lady with an extremely painful atrophy blanche venous ulcer. She was dealing with this severe pain for at least 15 years. She said: “I am going to turn 100 in six weeks. I want to blow out my birthday candles without any pain. I have been to many doctors, and they all told me that I am too old.” We had a lengthy discussion about the potential complications with superficial venous therapies. However, with thermal ablation of the great saphenous vein (GSV) and careful sub-ulcer sclerotherapy, we were able to heal the ulcer before she reached her birthday. That was very rewarding.

What are some of your hobbies and interests outside the world of medicine?

I like to exercise my right brain as much as possible. Photography is a serious hobby: I enjoy taking pictures and post-processing and printing them. What initially started as portrait photography of my three sons then blossomed into landscape and cityscape photography. I love listening to rock n’ roll and heavy metal music; I even used to play guitar, and hope to pick it up again soon. In my spare time, I try to recreate my mother’s South Indian recipes. Travelling with my family is also something I look forward to every few months.

Fact File:

Qualifications

1997 MBBS/MD, Armed Forces Medical College, Pune, India

2001 MS, Pennsylvania State University, University Park, USA

2004–2005 Fellowship in Vascular Medicine, Section of Vascular Medicine, Division of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, USA

Academic Appointments (selected)

2005–2013 Principal investigator, Prairie Educational Research Co-operative, Springfield, USA

2005–2013 Clinical assistant professor, Southern Illinois University School of Medicine, Springfield, USA

Professional Appointments (selected)

2005–2013 Director, Vascular medicine, Prairie Vascular Institute, Springfield, USA

2011–2013 Medical director of informatics, Illinois Referral Division, Hospital Sisters Health System (St John’s Hospital, Springfield; St Francis, Litchfield), Illinois, USA

2013–Present Medical director, Vascular laboratories, OhioHealth, Ohio, USA

2013–Present System medical director, Vascular medicine, OhioHealth Heart and Vascular Service, Ohio, USA

Offices (selected)

2009–2011 Chair, Research committee, American Board of Phlebology

2019–Present President, Society of Vascular Medicine

Present Board member, VIVA Physicians

Present Annual Scientific Sessions planning committee, American Venous Forum

Corrections and clarifications

This article has been amended in the factfile section.

Venous News originally erroneously reported that Dr Kolluri was chair of the American Board of Phlebology. We have updated the section to show that he was the Chair of the Research Committee of the American Board of Phlebology. The error is regretted.