Multi-society guideline on venous disease, varicose veins updated

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Peter Gloviczki, co-chair of the guideline writing group

The Society for Vascular Surgery (SVS) has published an update to the SVS/American Venous Forum (AVF) 2011 clinical practice guideline on the care of patients with varicose veins. This guideline update was developed in collaboration with the AVF and the American Vein and Lymphatic Society (AVLS).

The “2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities” is the first of two parts and presents evidence-based recommendations on the diagnosis of superficial venous disease and treatment of superficial truncal venous reflex. The updated guideline has also been endorsed by Society for Vascular Medicine and the International Union of Phlebology.

An SVS press release notes that superficial venous disease of the lower extremities is an extremely common disease and primarily affects people as they age, although the disease can be seen in younger patients.

The first step, according to the guideline, is accurate and consistent diagnosis of the reflux in the superficial veins. Duplex ultrasound scanning is recommended as the diagnostic test of choice. Duplex ultrasound scanning—which delivers no radiation—is considered best due to standardised protocols for sonographers and standardised definitions for abnormal reflux. The guideline also recommends using trained vascular ultrasonographers in an accredited vascular laboratory.

The guideline recommends that patients with symptomatic varicose veins and reflux are best treated with intervention rather than prolonged long-term compression stockings. Use of compression stockings, while an important mode of therapy, does not relieve the underlying cause of the venous reflux and insufficiency. The techniques to treat systematic axial vein reflux are primarily endoluminal with thermal or non-thermal ablation techniques rather than the older surgical vein stripping. Treatment of tributary varicosities can be by direct phlebectomy or ultrasound-guided foam sclerotherapy.

The guideline also addresses the role of treatment of incompetent perforator veins in patients with varicose veins, as well as the limitations of perforator vein treatment in patients with mild to moderate venous insufficiency. Lastly, the guideline recommends performing truncal ablation in the superficial veins combined with varicose vein treatment during the same session, if possible.

“The new SVS/AVF/AVLS guideline on varicose veins is the first high-quality multi-society guideline where each recommendation is based on an independent systematic review and meta-analysis,” said Peter Gloviczki (Mayo Clinic, Rochester, USA), co-chair of the guideline writing group. “The primary goal was to provide recommendations supported by the latest scientific data, with a secondary goal that adopting these guidelines will markedly decrease the number of inappropriate procedures performed in patients with chronic venous disease.”

Read the new guideline at vascular.org/JVSVL-VaricoseVeinUpdate. It will be published in an upcoming issue of the Journal of Vascular Surgery: Venous and Lymphatic Disorders.


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