Consensus statement on the symptom‐based treatment of chronic venous diseases

Abstract

SummaryBackground: Chronic venous diseases are very common. Early symptoms such as a sensation of swelling and heaviness may occur without objectifiable findings, but are nevertheless perceived as bothersome. Progressive disease -marked by varicose veins and symptoms of chronic venous insufficiency -is associated with considerable impairment in quality of life. Methods: The present consensus recommendations are based on publications in Pubmed-listed journals as well as relevant international therapeutic guidelines on chronic venous diseases. Only conclusive randomized controlled trials (RCTs) and review articles/meta-analyses were included. Results: Symptom-based treatment of chronic venous diseases is based on three therapeutic pillars with proven efficacy: invasive therapy, compression therapy, and oral pharmacological treatment. According to current therapeutic guidelines, invasive procedures aimed at restoring unimpaired venous blood flow as well as improving or eliminating pathological changes should be the first-line approach. If an invasive approach is infeasible or undesirable, or if symptoms persist following a therapeutic intervention, optimal use of symptom-based treatment options is recommended. Compression and pharmacological therapy may each be used as sole treatment or in combination. To guarantee maximum therapeutic success, individual treatment decisions should be made on a case-by-case basis. Conclusions: Chronic venous diseases should be treated on the basis of individual pathophysiological disturbances. Symptom-based treatment of chronic venous disorders encompasses invasive therapy, compression therapy, and oral pharmacological therapy. Considerations in choosing the appropriate treatment option should include both objective signs as well as subjective symptoms.

Refining diagnosis and management of chronic venous disease: Outcomes of a modified Delphi consensus process

“…Moreover, in line with the objectives of the steering committee on individualised treatment, treatment decisions should be made on a case-by-case basis. These concepts are also in full agreement with another recent consensus statement advocating the greater need for symptom-based treatment of CVD [56]. Similarly, the experts wholly agreed on the need for continuous treatment of CVI (statement 11).…”

“…Agreement was reached for the statement (#13) that the best medical treatment in symptomatic C0-C1 patients is venoactive drugs + elastic compression + lifestyle modification (weight control, physical activity, dietary intervention). These interventions are fully supported by clinical evidence [56]. In symptomatic CVD, the experts agreed that choice of therapy should be based on individual factors.…”

“…Indeed, patients may often prefer less invasive over more aggressive management strategies. Given that combination therapy has been shown to have additive effects, combining various methods is thus a valid therapeutic strategy [56].…”

Chronic venous insufficiency – a review of pathophysiology, diagnosis, and treatment

“…Flavonoids in particular may also help reduce the tendency for edema. Thus, phlebotonics can be prescribed for symptom relief but they have no effects on the underlying disease .…”

Die chronische venöse Insuffizienz – Eine Zusammenfassung der Pathophysiologie, Diagnostik und Therapie

“…Speziell Flavonoide können auch zu einer Minderung der Ödemneigung beitragen. Phlebotonika können daher zur Symptomlinderung verschrieben werden, haben jedoch keinen Einfluss auf die Grunderkrankung .…”