The Society for Cardiovascular Angiography & Interventions (SCAI) has released new, evidence-based clinical practice guidelines to support the treatment of chronic venous disease (CVD).
Published in JSCAI with an accompanying technical review, the document offers recommendations on a range of therapeutic options—from compression therapy and wound care to ablation, sclerotherapy, phlebectomy, and deep vein stenting. The Society for Vascular Medicine has endorsed the guidelines.
“These are the first SCAI guidelines focused on chronic venous disease, and they come at a time of increasing recognition of the burden it places on patients and healthcare systems,” said Robert Attaran (Yale School of Medicine, New Haven, USA), chair of the guideline writing committee and member of the SCAI Vascular Disease Council. “CVD may present with discomfort, heaviness, and swelling, but it can progress to venous ulcers that are difficult to heal and severely impair quality of life. Our recommendations aim to provide clinicians and patients with a roadmap for personalised, evidence-informed care.”
The guideline panel addressed eight clinical scenarios, culminating in nine formal recommendations and multiple identified knowledge gaps. The guidelines provide practical insights on which patients may benefit most from conservative therapy alone and when to consider escalating to more invasive options.
The recommendations were categorised as either ‘strong’ or ‘conditional,’ depending on the certainty of the evidence and other contextual considerations, including patient values and preferences. Among the key recommendations:
- Compression therapy is suggested for patients with symptomatic varicose veins (conditional recommendation) and strongly recommended for patients with venous ulcers (strong recommendation).
- Ablation therapy in combination with conservative management, is suggested for patients with symptomatic reflux in the great or small saphenous veins and ulcer-associated perforator vein reflux (conditional recommendations) in combination with conservative management.
- Foam sclerotherapy and phlebectomy, when applied in patients without truncal vein reflux or with persistent symptoms after treatment of truncal veins, may be considered in combination with conservative therapy (conditional recommendations).
- Venoplasty or stenting may offer improved quality of life and symptom relief for patients with iliocaval venous obstruction, though with low certainty of evidence (conditional recommendation).
In addition to formal recommendations, the guidelines introduce two treatment algorithms, one for patients with symptomatic varicose veins and another for those with venous ulcer disease, to help guide clinical decision-making in real-world settings. The document pays close attention to patient-centred care, shared decision-making, and the potential trade-offs associated with each treatment modality, particularly in the context of comorbid conditions such as peripheral arterial disease (PAD) or prior surgical history.
“These guidelines reflect SCAI’s commitment to bringing high-quality, evidence-based standards to areas where our members are increasingly practicing,” said SCAI President Srihari S Naidu (New York Medical College, New York, USA). “As interventional cardiologists take a larger role in managing chronic venous disease, a common problem affecting millions of people, these recommendations will help ensure that patient care remains both consistent and personalised. SCAI is proud to support this milestone publication and its vision of advancing patient outcomes through collaboration across disciplines, which ultimately increases the quality and quantity of patient access to much-needed treatment options.”
