ESVS Publishes 2022 Guidelines on Management of Chronic Venous Disease of the Lower Limb

January 12, 2022—The European Society for Vascular Surgery (ESVS) announced the publication in press of the 2022 clinical practice guidelines on the management of chronic venous disease (CVD) of the lower limb. The document by Marianne G. De Maeseneer, MD, et al is available online ahead of print in European Journal of Vascular & Endovascular Surgery.

According to ESVS, the focus of the present guidelines is on CVD related to pathology of the superficial, perforating, and deep veins of the lower limbs, as well as to abdominal and pelvic venous pathology.

Sections of the guidelines discuss the following:

• Conservative management of patients without active venous leg ulcers
• Interventions for superficial venous incompetence
• Interventions for deep venous pathology
• Management of venous ulceration
• Management of pelvic venous disorders causing varicose veins

The document advises that compared with the 2015 version of the guidelines, the global structure of the document has been modified considerably to make it more practical and user friendly. Special subsections on management strategy with accompanying flowcharts have been added to the different chapters.

Updates include an extensive chapter entirely dedicated to superficial venous incompetence. Additionally, there are new subsections on evidence supporting endovenous nonthermal ablation, on incompetence of perforating veins, and on practical strategies for special anatomic presentations. The management of recurrent varicose veins is also discussed.

The guidelines also discuss deep venous pathology, with an emphasis on the increasing evidence in the field of managing iliofemoral and iliocaval obstruction. In addition, new topics include the combination of superficial and deep venous problems, aneurysms of the deep veins, and popliteal vein entrapment syndrome.

New chapters include:

• Management of patients with venous leg ulcers
• Management of patients with varicose veins related to underlying pelvic venous disorders
• Special patient characteristics and their potential influence on management strategy
• Gaps in evidence and future perspectives

Additionally, a lay summary of the guidelines provides information for patients. Because of the new chapters and subsections, many new recommendations have been added that are outlined in Figure 1 of the document. Figure 2 of the document lists five recommendations that have been upgraded and three that have been downgraded compared with the 2015 CVD guidelines.