Sometimes the duplex is normal and the leg is not.
A co-branded metabolic panel that sorts the swollen-leg differential duplex cannot explain — iron, cardiac, renal and thyroid — and gives you an ancillary line for the majority of your patients you manage conservatively.
Your logo, our laboratory. Your opening order — nothing.
The co-branded Vein Wellness kit — your logo on the box, our laboratory behind it. Artwork is proofed with you before any print run.
Obesity is the modifiable driver of venous disease.
The Edinburgh Vein Study followed a population cohort for thirteen years. Body weight separated who developed chronic venous insufficiency and who did not — independent of age.
Age-adjusted OR 3.58 (95% CI 1.70–7.56). Robertson 2013 · PMID 26993896.
n=12,423, with obesity as an independent determinant of it.
An independent multivariate predictor of progression to ulceration in varicose vein patients (95% CI 1.01–1.15). Robertson 2009 · PMID 19497512.
Why this matters at the point of care
Padberg studied 39 limbs with C4–C6 disease in patients with class III obesity. Twenty-four had no duplex evidence of venous insufficiency at all. The skin changes were real. The venous hypertension was not primarily valvular.
For a phlebologist that is a diagnostic problem, not a marketing one. A metabolic workup in this population can change what the patient is treated for — and it identifies the patients for whom weight, not the vein, is the lever.
Ulcers in this cohort averaged 29 cm², took seven months to heal, and 52% recurred inside three years. Padberg et al., J Vasc Surg 2003 · PMID 12514581 · n=20 patients / 39 limbs.
No panel here diagnoses venous disease, excludes DVT or PE, or predicts venous thromboembolism. We removed a D-dimer rule-out claim and an estradiol/progesterone clot-risk claim from our own earlier material rather than defend either: a D-dimer without a validated pretest-probability score and same-day turnaround is not a rule-out test, and a ‘normal’ result in a symptomatic patient could delay care. Imaging diagnoses venous disease. This tests what imaging cannot see.
Vein Wellness Test.
Every brand kit shares a CBC and CMP backbone, then adds the markers that your specialty actually acts on. The four in orange are the additions that make it a vein panel rather than a general one.
The panel
- CBC with differentialPlatelets and Hct/Hgb — hemostatic response, blood viscosity
- Comprehensive metabolic panelRenal function gates contrast; hepatic function governs coagulation
- Iron studies with TSATIron-deficient restless legs is the most common mimic sent to a vein clinic
- NT-proBNPSeparates cardiac edema from venous edema
- Urine protein:creatinineSeparates renal edema from venous edema
- TSH with reflex free T4Thyroid dysregulation presents as peripheral edema
Indications
Leg-symptom differential
Sorts edema that duplex cannot explain — cardiac, renal, thyroid, iron.
Pre-procedure safety
Renal, hepatic and hematologic clearance before ablation or contrast.
Anticoagulation baseline
Renal function, age and weight are the exact inputs DOAC dose selection and dose-reduction criteria key off.
No panel diagnoses or grades chronic venous insufficiency; imaging does that. Laboratory-developed tests performed by a CLIA-certified laboratory, not FDA-cleared for any venous indication. Results inform clinical judgement.
The patient is already in your chair.
Mallick et al. followed 144,098 newly diagnosed varicose vein patients through commercial and Medicare-supplemental claims. The profile is a metabolic-risk population that returns on a schedule.
Never an intervention. These are the patients who generate follow-up visits and almost no ancillary revenue.
Female-to-male 71:29 — and inside the USPSTF colorectal screening window.
Across 10.3–12.4 diagnoses. A polypharmacy population, which is what makes PGX land here.
Of those treated interventionally. The follow-up is already on the calendar.
Conservative-management patients generate follow-up visits and almost no ancillary revenue. They are exactly the patients a diagnostic, a weight-management protocol and a regenerative option are all built for. Mallick et al., Am Health Drug Benefits 2016 · PMID 28465773 · n=144,098 (Truven MarketScan). US burden: more than 25 million adults with varicose veins, 2–6 million with advanced CVI, roughly 500,000 with venous ulcers — Eberhardt & Raffetto, Circulation 2014 · PMID 25047584.
You buy it. You price it. You keep the difference.
You buy the co-branded kit at clinic pricing and resell at your own price, and you own the stock you buy.
| Volume per centre | Kits / month | Your monthly | Your annual |
|---|---|---|---|
| 1 kit per day | 20 | $2,000 | $24,000 |
| 2 kits per day | 40 | $4,000 | $48,000 |
| 3 kits per day | 60 | $6,000 | $72,000 |
Per centre, at 20 business days a month. Across a multi-site group the figure scales linearly with centre count — we will model your own footprint rather than quote ours. Illustrative, and not a guarantee of results.
The brand kit is the base. General Wellness ($130 margin), CGX ($155) and PGX ($75) stack onto the same collection visit, same requisition, same portal — and six of the eight catalogue panels need no draw at all. The stool panel is the easiest thing in the group to deploy: your mean-age-57 population sits squarely inside the USPSTF 45–75 colorectal window, and the box is handed over at checkout.
The metabolic line treats what the panel finds.
Obesity is a modifiable risk factor for chronic venous disease, and it predicts poorer ulcer healing. The panel identifies the patient; this line treats them — and it is the largest peptide category by volume.
| Product | Clinic | Patient (3×) | Your margin |
|---|---|---|---|
| Tirzepatide 30 mg | $195 | $585 | $390 |
| Tirzepatide 60 mg | $349 | $1,047 | $698 |
| Semaglutide 20 mg | $110 | $330 | $220 |
| AOD-9604 10 mg | $69 | $207 | $138 |
Patient price modelled at 3× clinic cost — illustrative. You set your own retail. Supplied to licensed healthcare providers only.
On tirzepatide 15 mg, vs 3.1% on placebo. SURMOUNT-1 · PMID 35658024.
On semaglutide 2.4 mg, vs 2.4% on placebo. STEP-1 · PMID 33567185.
Versus −5.5% on continued therapy. SURMOUNT-4 · PMID 38078870. This is a maintenance relationship, not a course.
No trial has tested a GLP-1 against a venous endpoint. The link runs obesity → CVI risk → weight loss, and we present it as the inference it is. We make no efficacy claim for any peptide on a venous outcome.
Baseline. Treat. Prove it worked.
The panel is not a side product — it is what makes the therapy repeatable, and it turns a conservative-management visit into a care pathway.
Baseline
The panel establishes metabolic and hematologic status before the procedure. $0 to stock, and buy ten or more and we match it.
Visit oneIntervention
Ablation or sclerotherapy as today — plus whatever the panel indicated: a GLP-1, healing peptides, or a regenerative protocol.
Your procedure90-day validation
A clinically indicated re-test shows what moved. It justifies the next cycle and adds a second billable visit per treatment episode.
Visit twoObjective before-and-after data turns a one-time procedure into a trackable care relationship — which is exactly what the 69.5% of your patients on conservative management do not currently have.
What it takes to run it across multiple sites.
Four questions, and the one honest risk.
Who orders the test?
AAP Medical’s telehealth physicians order and own the results, licensed in every state you operate. Your vascular specialists never become physician of record for findings outside their scope.
Where does the laboratory work sit?
Specimens go to our CLIA-certified partner laboratory. We hold the laboratory relationship and the result-delivery obligation, including abnormal-result escalation.
How much staff time per patient?
Roughly 25–40 minutes of clinical staff time per kit — explanation, consent, collection, packaging, dispatch. Across a multi-site group this is a workflow change, not a product drop.
How does it reach our practice-management stack?
Two paths. Run beside your stack with file-based handoff for the pilot, or one API integration that lights up every site at once. We are not rebuilding anything you own.
Staff time is the honest risk at scale — and the reason we propose a bounded pilot rather than a rollout.
What your medical director will ask
You operate in the most enforcement-active corner of the vein sector. Everything below is how we position the programme so that it does not add to that.
Does this touch our insured business at all?
No. It is cash-pay and it sits beside your insured venous care, never inside it. Nothing in the programme is billed to Medicare, Medicaid or any federal healthcare programme, and the panel is not represented as part of the covered episode.
Can we say this screens for DVT or clot risk?
No, and we removed both claims from our own material. A D-dimer without a validated pretest-probability score and same-day turnaround is not a rule-out test — a ‘normal’ result in a symptomatic patient is the largest patient-harm exposure in this catalogue. Estradiol and progesterone as a clot-risk predictor is scientifically unsupportable and we will not print it.
Do the GLP-1s have venous outcome data?
None. No trial has tested one against a venous endpoint. What exists is the obesity–CVI association and the weight-loss trial data, and we present the chain as the inference it is rather than as an indication.
What is the staff-time reality across many sites?
25 to 40 minutes per kit is our estimate and we will hold ourselves to it as a pilot gate. At scale that is a workflow change requiring central training, not a box you put on a shelf. It is the honest risk and the reason we ask for six centres and ninety days rather than a group rollout.
Can the kit carry our brand?
Yes. The co-branded kit is the model — your logo on the box, our laboratory behind it, shipped to the centre or direct to the patient’s home. We will want a high-resolution logo file and a print proof round before any run.
How does it reach our practice-management system?
File-based handoff for the pilot, an API for the rollout. Results arrive as a PDF today rather than as discrete values, so budget three to five minutes of manual entry per result until the interface is live.
Six centres. Ninety days. One number that decides it.
Pick six centres in one metro. We supply the opening order, stock an opening peptide order if you want the second line, train your staff centrally, and run it for a quarter.
Agreement and scope
Your counsel papers the terms. We confirm state licensure for the ordering physicians and set the opening order.
Your counsel, your termsCentral training
One virtual session per role — collection, consent, dispatch. No new clinical credential required at any site.
One session per roleRun and measure
Weekly attach rate, staff-minutes per kit, and 90-day re-test conversion.
Weekly reportingThe pilot gate we propose
- Attach rate clears 4%. Measured weekly across the six centres, on the patients already on your schedule.
- Staff time lands inside 25–40 minutes. Our own estimate, used as the gate. If it does not, we have mis-sold the workflow and we scale nothing.
- 90-day re-test conversion is real. The second visit is where the programme either works or does not.
What we are not asking for
- No capital. Your opening order on the diagnostic line, yours once bought.
- No group-wide commitment. Six centres, one metro, ninety days. Scale is a decision you make afterwards on your own numbers.
- No change to your clinical protocol. Ablation and sclerotherapy are unchanged. This runs beside them.
Multi-site groups
We already build purpose-designed kits per specialty — vascular, longevity, fibroid, hemorrhoid, oncology, pain and prostate all have a panel designed around what imaging cannot see at that site. If you run several brands, ask for the group model rather than the single-practice one.
- One kit per practice, co-branded
- Central training, one session per role
- File-based handoff for the pilot, API for the rollout
- Phased rollout gated on the pilot numbers
Panels are laboratory-developed tests, are not FDA-cleared for any venous indication, and do not diagnose venous disease. Peptide and regenerative products are supplied to licensed healthcare providers only. Economics shown are illustrative and not a guarantee of results.