Recommendations developed for lower-extremity varicose veins

Lifestyle

In clinical practice guidelines issued by the Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society, and published online Oct. 11 in the Journal of Vascular Surgery: Venous and Lymphatic Disorders, recommendations are presented for the diagnosis and treatment of lower-extremity varicose veins.

Peter Gloviczki, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues conducted a systematic review and meta-analysis of diagnostic tests and treatment options for patients with lower-extremity varicose veins to develop new evidence-based recommendations on critical issues relating to care of patients.

Part I of the guidelines includes recommendations for the evaluation of patients with Clinical Class, Etiology, Anatomy, Pathology class 2 varicose veins. The authors note that duplex ultrasound scanning is recommended as the diagnostic test of choice for evaluating venous reflux in patients with chronic venous disease of the lower extremities (strong recommendation with moderate-quality evidence).

Venous intervention is recommended over long-term compression stockings for patients with symptomatic varicose veins and axial reflux in the great or small saphenous vein who are candidates for intervention (strong recommendation with moderate-quality evidence). Both thermal and nonthermal ablation from the groin to below the knee are recommended for patients with symptomatic axial reflux of the great saphenous vein, depending on the expertise of the treating physician and patient preference (strong recommendation with moderate-quality evidence).

“The primary goal was to provide recommendations supported by the latest scientific data, with a secondary goal that adopting these guidelines will markedly decrease the number of inappropriate procedures performed in patients with chronic venous disease,” Gloviczki said in a statement.

Several authors disclosed financial ties to the pharmaceutical and medical device industries.