SVS/AVF/AVLS Update Clinical Practice Guideline on Venous Disease and Varicose Veins

December 1, 2022—The Society for Vascular Surgery (SVS) has published an update to the SVS/American Venous Forum (AVF) 2011 clinical practice guideline on the care of patients with varicose veins. This guideline update was developed in collaboration with the AVF and the American Vein and Lymphatic Society (AVLS). The updated guideline has also been endorsed by Society for Vascular Medicine and the International Union of Phlebology.

The “2022 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” is the first of two parts and presents evidence-based recommendations on the diagnosis of superficial venous disease and treatment of superficial truncal venous reflex, noted SVS.

The guidelines by Peter Gloviczki, MD, et al are available online ahead of print in Journal of Vascular Surgery: Venous and Lymphatic Disorders.

“The new SVS/AVF/AVLS guideline on varicose veins is the first high-quality multisociety guideline where each recommendation is based on an independent systematic review and meta-analysis,” commented Dr. Gloviczki, cochair of the guideline writing group, in the SVS press release. “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.”

According to SVS press release, the guidelines recommendations include:

• Using duplex ultrasound scanning for accurate and consistent diagnosis of the reflux in the superficial veins. Duplex ultrasound scanning is considered best because of standardized protocols for sonographers and standardized definitions for abnormal reflux.
• Using trained vascular ultrasonographers in an accredited vascular laboratory.
• Intervention—rather than prolonged long-term compression stockings—is the best treatment for patients with symptomatic varicose veins and reflux. Use of compression stockings, although an important mode of therapy, does not relieve the underlying cause of the venous reflux and insufficiency.
• Treatment of systematic axial vein reflux should be primarily endoluminal with thermal or nonthermal ablation techniques rather than the older surgical vein stripping.
• Treatment of tributary varicosities can be by direct phlebectomy or ultrasound-guided foam sclerotherapy.

The guideline also addresses the role of treatment of incompetent perforator veins in patients with varicose veins, as well as the limitations of perforator vein treatment in patients with mild to moderate venous insufficiency.

Additionally, the guideline recommends performing truncal ablation in the superficial veins combined with varicose vein treatment during the same session, if possible.