Editor's Choice – European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs

New Perspectives in Phlebology and Lymphology

“…Varicose veins (VV) represent the most frequent chronic venous disease in the general population, reaching a 21% pooled prevalence [ 4 ], and although innovative treatments are continuously proposed, ineluctably, a 30% or higher mid/long-term recurrence rate is documented by most publications [ 1 , 2 , 4 ]. The most recent endovenous procedures, based for example on laser, radiofrequency, (catheter-)foam sclerotherapy, glue and mechanochemical ablation, are showing promising results, but a higher degree of evidence is still required as to their long-term efficacy [ 1 , 2 , 4 , 5 ]. Surgery is still considered a feasible and useful therapeutic procedure for VV, but only if practised in a mini-invasive and tailored modality in order to improve its efficacy, safety and cost-effectiveness [ 1 , 4 , 6 ].…”

“…The most recent endovenous procedures, based for example on laser, radiofrequency, (catheter-)foam sclerotherapy, glue and mechanochemical ablation, are showing promising results, but a higher degree of evidence is still required as to their long-term efficacy [ 1 , 2 , 4 , 5 ]. Surgery is still considered a feasible and useful therapeutic procedure for VV, but only if practised in a mini-invasive and tailored modality in order to improve its efficacy, safety and cost-effectiveness [ 1 , 4 , 6 ].…”

“…However, regardless of the therapeutic options, a thorough colour-duplex ultrasound (CDU)-based diagnostic approach to the varicose patient is fundamental to tailor a specific treatment and improve its technical and strategic elements. As PVI and abdominal vein obstruction may relevantly impact the treatment of VV disease and its recurrence rate [ 1 , 4 , 7 ], greater attention should be paid to this peculiar morpho-hemodynamic condition through the combination of CDU with other radiological diagnostic tools, such as computed tomography/magnetic resonance-based venography. Actually, in the presence of lower limb VV related also to abdomino-pelvic vein insufficiency, this combined approach may offer some advantages [ 8 ].…”

“…In fact, a high incidence of PVI and pelvic refluxes has been documented in varicose patients, especially in the case of non-saphenous varices and in pluriparous women [ 4 , 8 , 9 ]. In most cases, refluxes in gonadal veins are elicited and a sclero-embolization procedure may be indicated in these patients, especially when frankly symptomatic [ 1 , 4 , 8 , 9 ].…”

“…The treatment of minor varicosities, such as reticular varices and telangiectasias, relies on sclerotherapy which has undoubtedly proven its value through past and recent literature data. The need for a detailed CDU evaluation before any treatment of these C1 (CEAP clinical classification) cases has been repeatedly highlighted [ 4 ] in order to avoid those side effects, complications and poor outcomes attributable to a wrong strategy. In fact, saphenous incompetence and/or truncular vein refluxes are often associated with apparently isolated minor varicosities [ 4 ], and these major refluxes should be addressed firstly, before any treatment on spider veins.…”