Chronic Venous Disease Management Guidelines Published by SCAI

June 30, 2025—The Society for Cardiovascular Angiography & Interventions (SCAI) announced the publication of new, evidence-based clinical practice guidelines to support the treatment of chronic venous disease.

According to SCAI, the guidelines were developed through a multidisciplinary and methodologically rigorous process to offer clear, patient-centered recommendations on a range of therapeutic options—from compression therapy and wound care to ablation, sclerotherapy, phlebectomy, and deep vein stenting. The press release noted that the Society for Vascular Medicine endorsed the guidelines.

“SCAI Clinical Practice Guidelines for the Management of Chronic Venous Disease” by Robert R. Attaran, MD, et al is available online in JSCAI with an accompanying technical review by Dr. Attaran, et al. Dr. Attaran served as chair of the guideline writing committee and is member of the SCAI Vascular Disease Council.

Additionally, Irfan Ullah, MD, et al provided editorial commentary titled, “Charting the Course and Uncharted Territories: SCAI 2025 Guidelines for Chronic Venous Disease.”

As summarized by SCAI, the guideline panel addressed eight clinical scenarios, culminating in nine formal recommendations and multiple identified knowledge gaps. The guidelines provide practical insights on which patients may benefit most from conservative therapy alone and when to consider escalating to more invasive options.

The recommendations were categorized as either “strong” or “conditional,” depending on the certainty of the evidence and other contextual considerations, including patient values and preferences, noted the press release.

SCAI outlined the key recommendations as follows:

• Compression therapy is suggested for patients with symptomatic varicose veins (conditional recommendation) and strongly recommended for patients with venous ulcers (strong recommendation).
• Ablation therapy in combination with conservative management is suggested for patients with symptomatic reflux in the great or small saphenous veins and ulcer-associated perforator vein reflux (conditional recommendations) in combination with conservative management.
• Foam sclerotherapy and phlebectomy, when applied in patients without truncal vein reflux or with persistent symptoms after treatment of truncal veins, may be considered in combination with conservative therapy (conditional recommendations).
• Venoplasty or stenting may offer improved quality of life and symptom relief for patients with iliocaval venous obstruction though with low certainty of evidence (conditional recommendation).

In addition to formal recommendations, the guidelines introduce two treatment algorithms—one for patients with symptomatic varicose veins and the other for patients with venous ulcer disease—to help guide clinical decision-making in real-world settings.

Finally, the document focuses on patient-centered care, shared decision-making, and the potential trade-offs associated with each treatment modality, particularly in the context of comorbid conditions such as peripheral artery disease or previous surgical history, stated SCAI.