The 2023 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. Part II: Endorsed by the Society of Interventional Radiology and the Society for Vascular Medicine

Peter Gloviczki; Peter F Lawrence; Suman M Wasan; Mark H Meissner; Jose Almeida; Kellie R Brown; Ruth L Bush; Michael Di Iorio; John Fish; Eri Fukaya; Monika L Gloviczki; Anil Hingorani; Arjun Jayaraj; Raghu Kolluri; M Hassan Murad; Andrea T Obi; Kathleen J Ozsvath; Michael J Singh; Satish Vayuvegula; Harold J Welch

doi:10.1016/j.jvsv.2023.08.011

The 2023 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. Part II: Endorsed by the Society of Interventional Radiology and the Society for Vascular Medicine

J Vasc Surg Venous Lymphat Disord. 2024 Jan;12(1):101670. doi: 10.1016/j.jvsv.2023.08.011. Epub 2023 Aug 29.

Authors

Peter Gloviczki¹, Peter F Lawrence², Suman M Wasan³, Mark H Meissner⁴, Jose Almeida⁵, Kellie R Brown⁶, Ruth L Bush⁷, Michael Di Iorio⁸, John Fish⁹, Eri Fukaya¹⁰, Monika L Gloviczki¹¹, Anil Hingorani¹², Arjun Jayaraj¹³, Raghu Kolluri¹⁴, M Hassan Murad¹⁵, Andrea T Obi¹⁶, Kathleen J Ozsvath¹⁷, Michael J Singh¹⁸, Satish Vayuvegula¹⁹, Harold J Welch²⁰

Affiliations

¹ Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN. Electronic address: [email protected].
² Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Los Angeles, CA.
³ Department of Medicine, University of North Carolina, Chapel Hill, Rex Vascular Specialists, UNC Health, Raleigh, NC.
⁴ Division of Vascular Surgery, University of Washington, Seattle, WA.
⁵ Division of Vascular and Endovascular Surgery, University of Miami Miller School of Medicine, Miami, FL.
⁶ Medical College of Wisconsin, Milwaukee, WI.
⁷ John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX.
⁸ South Austin Vein Center, Austin, TX.
⁹ Department of Medicine, Jobst Vascular Institute, University of Toledo, Toledo, OH.
¹⁰ Division of Vascular Surgery, Stanford University, Stanford, CA.
¹¹ Department of Internal Medicine and Gonda Vascular Center, Rochester, MN.
¹² NYU Brooklyn Medical Center, Brooklyn, NY.
¹³ RANE Center for Venous and Lymphatic Diseases, Jackson, MS.
¹⁴ Heart and Vascular Service, OhioHealth Riverside Methodist Hospital, Columbus, OH.
¹⁵ Evidence Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
¹⁶ University of Michigan, Ann Arbor, MI.
¹⁷ Vascular Associates, St Peters Health Partners, Albany, NY.
¹⁸ University of Pittsburgh Medical Center, Pittsburgh, PA.
¹⁹ Vein Clinics of America, Plano, TX.
²⁰ Lahey Hospital and Medical Center, Burlington, MA.

Abstract

The Society for Vascular Surgery, the American Venous Forum, and the American Vein and Lymphatic Society recently published Part I of the 2022 clinical practice guidelines on varicose veins. Recommendations were based on the latest scientific evidence researched following an independent systematic review and meta-analysis of five critical issues affecting the management of patients with lower extremity varicose veins, using the patients, interventions, comparators, and outcome system to answer critical questions. Part I discussed the role of duplex ultrasound scanning in the evaluation of varicose veins and treatment of superficial truncal reflux. Part II focuses on evidence supporting the prevention and management of varicose vein patients with compression, on treatment with drugs and nutritional supplements, on evaluation and treatment of varicose tributaries, on superficial venous aneurysms, and on the management of complications of varicose veins and their treatment. All guidelines were based on systematic reviews, and they were graded according to the level of evidence and the strength of recommendations, using the GRADE method. All ungraded Consensus Statements were supported by an extensive literature review and the unanimous agreement of an expert, multidisciplinary panel. Ungraded Good Practice Statements are recommendations that are supported only by indirect evidence. The topic, however, is usually noncontroversial and agreed upon by most stakeholders. The Implementation Remarks contain technical information that supports the implementation of specific recommendations. This comprehensive document includes a list of all recommendations (Parts I-II), ungraded consensus statements, implementation remarks, and best practice statements to aid practitioners with appropriate, up-to-date management of patients with lower extremity varicose veins.

Keywords: Ablation; Chronic venous disease; Compression; Cyanoacrylate; Endovascular; Endovenous; Foam; Guidelines; Laser; Mechanochemical; Radiofrequency; Saphenous vein; Sclerotherapy; Thrombophlebitis; Thrombosis; Varicose veins; Venoactive drugs; Venous insufficiency.

Publication types

Meta-Analysis
Systematic Review
Practice Guideline
Research Support, Non-U.S. Gov't

MeSH terms

Cardiology*
Humans
Lower Extremity
Radiology, Interventional
Saphenous Vein / surgery
Sclerotherapy / methods
Treatment Outcome
United States
Varicose Veins* / diagnostic imaging
Varicose Veins* / surgery
Vascular Surgical Procedures / adverse effects
Venous Insufficiency* / diagnostic imaging
Venous Insufficiency* / etiology
Venous Insufficiency* / therapy