The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum

Abstract

The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) have developed clinical practice guidelines for the care of patients with varicose veins of the lower limbs and pelvis. The document also includes recommendations on the management of superficial and perforating vein incompetence in patients with associated, more advanced chronic venous diseases (CVDs), including edema, skin changes, or venous ulcers. Recommendations of the Venous Guideline Committee are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system as strong (GRADE 1) if the benefits clearly outweigh the risks, burden, and costs. The suggestions are weak (GRADE 2) if the benefits are closely balanced with risks and burden. The level of available evidence to support the evaluation or treatment can be of high (A), medium (B), or low or very low (C) quality. The key recommendations of these guidelines are: We recommend that in patients with varicose veins or more severe CVD, a complete history and detailed physical examination are complemented by duplex ultrasound scanning of the deep and superficial veins (GRADE 1A). We recommend that the CEAP classification is used for patients with CVD (GRADE 1A) and that the revised Venous Clinical Severity Score is used to assess treatment outcome (GRADE 1B). We suggest compression therapy for patients with symptomatic varicose veins (GRADE 2C) but recommend against compression therapy as the primary treatment if the patient is a candidate for saphenous vein ablation (GRADE 1B). We recommend compression therapy as the primary treatment to aid healing of venous ulceration (GRADE 1B). To decrease the recurrence of venous ulcers, we recommend ablation of the incompetent superficial veins in addition to compression therapy (GRADE 1A). For treatment of the incompetent great saphenous vein (GSV), we recommend endovenous thermal ablation (radiofrequency or laser) rather than high ligation and inversion stripping of the saphenous vein to the level of the knee (GRADE 1B). We recommend phlebectomy or sclerotherapy to treat varicose tributaries (GRADE 1B) and suggest foam sclerotherapy as an option for the treatment of the incompetent saphenous vein (GRADE 2C). We recommend against selective treatment of perforating vein incompetence in patients with simple varicose veins (CEAP class C(2); GRADE 1B), but we suggest treatment of pathologic perforating veins (outward flow duration ≥500 ms, vein diameter ≥3.5 mm) located underneath healed or active ulcers (CEAP class C(5)-C(6); GRADE 2B). We suggest treatment of pelvic congestion syndrome and pelvic varices with coil embolization, plugs, or transcatheter sclerotherapy, used alone or together (GRADE 2B).

Pulmonary embolism and stroke associated with mechanical thrombectomy

“…2,3 When thrombolytics are used, complete thrombi removal occurs in up to 45% of cases, compared to just 4% of cases when treatment is with anticoagulation alone. 3,4 When compared with thrombolysis alone, mechanical thrombectomy devices offer more rapid and complete thrombus removal.…”

“…The syndrome occurs in 20 to 59% of cases and is characterized by disorders caused by chronic venous hypertension, such as stasis dermatitis, dermatosclerosis and venous ulcers. 1,2 Removal of the acute thrombi, thrombectomy, can be accomplished using conventional surgery or with percutaneous methods using catheters with a range of different mechanisms of action.…”

Clinical and duplex ultrasound evaluation of lower extremities varicose veins – a practical guideline

“…From a medical point of view, a diagnostic work-up of varicose veins is recommended and invasive treatment possibilities should be considered in the following situations [16]: The diagnostic workup includes a clinical assessment complemented by a duplex ultrasound investigation [17] as described in detail below. Other modalities such as conventional venography, magnetic resonance venography, computerized tomography venography or intravascular ultrasound (IVUS) are usually reserved for special cases [18][19][20][21] and will not further be elucidated in this review.…”

“…Moreover, it is a helpful tool for decision-making regarding the diff erent treatment options. The advantages of this method are its safety, non-invasiveness, diagnostic reliability, cost eff ectiveness, and reproducibility, if compared with other imaging modalities [17]. The additional assessment of the perivascular structures is also helpful to distinguish further diff erential diagnoses.…”

Outpatient Phlebosurgery — a Vector of the Effective Development of Medical Assistance for the Patients Presenting with Primary Varicosie veins?

“…Так, в США в 1981 г. количество амбулаторных вмешательств при ХЗВ составляло всего 20% от всех выполненных операций, через 20 лет в 2001 г. их бы-ло более 60%, а к 2008 г. удельный вес таких вме-шательств приближался к 80% [9,10]. В тот же период в Европе амбулаторная флебохирургия внедря -лась медленнее.…”