Management of Varicose Veins of the Lower Extremities. Part II
Diagnosis
1. Evaluation of Patients With Varicose Veins
1.1. Classification and grading of clinical severity of chronic venous disorders
Good Practice Statements
1.1.1.
1.1.2.
1.2.–1.5. Doppler ultrasound scanning (DUS)
Recommendation
1.2.1.
Implementation Remarks
1.3.1.
1.3.2.
1.3.3.
Good Practice Statements
1.4.1.
1.4.2.
1.4.3.
1.4.4.
1.4.5.
Consensus Statements
1.5.1.
1.5.2.
1.5.3.
1.5.4.
1.5.5.
Treatment
2. Compression Therapy
2.1. Compression therapy vs. intervention
Recommendations
2.1.1.
2.1.2.
2.1.3.
2.1.4.
2.2. Compression therapy after intervention
2.2.1.
3. Pharmacological Treatment
Recommendations
3.1.
3.2.
4. Interventions for Superficial Truncal Reflux
4.1. Endovenous ablation vs. high ligation and stripping (HL&S)
Recommendations
4.1.1.
4.1.2.
4.1.3.
4.1.4.
4.1.5.
4.1.6.
4.1.7.
4.1.8.
4.2. Thermal vs. non-thermal ablation of superficial truncal veins
Recommendations
4.2.1.
4.2.2.
4.2.3.
5. Factors Affecting Choice of Superficial Truncal Ablation and Outcome
Recommendation
5.1.1.
Consensus Statements
5.2.1.
5.2.2.
5.2.3.
5.2.4.
5.2.5.
5.2.6.
5.2.7.
5.2.8.
5.2.9.
6. Interventions to Preserve the GSV
Recommendations
6.1.1.
6.1.2.
7. Treatment of Venous Tributaries
7.1. Telangiectasias and reticular veins
Recommendations
7.1.1.
7.1.2.
7.2. Varicose tributaries
Recommendations
7.2.1.
7.2.2.
Consensus Statements
7.2.3.
7.2.4.
7.2.5.
8. Treatment of Varicose Tributaries Concomittant or Staged With Superficial Truncal Ablation
Recommendations
8.1.1.
8.1.2.
8.1.3.
8.1.4.
Good Clinical Practice Statement
8.2.
9. Management of Recurrent Varicosities
Consensus Statements
9.1.1.
9.1.2.
9.1.3.
For patients with symptomatic recurrent varicosities due to persistent or recurrent reflux at the groin, either EVLA or RFA can be used if there is a straight GSV stump, long enough for thermal ablation. Sclerotherapy or phlebectomy should be performed for recurrence due to neovascularization.
(CS, )9.1.4.
9.1.5.
10. Ablation of Incompetent Perforating Veins
Recommendations
10.1.1.
10.1.2.
Consensus Statement
10.2.
11. Management of Ablation-related Thrombus Extension (ARTE) And Deep Vein Thrombosis (DVT) After Endovenous Ablations
11.1. Post-procedure DUS
Recommendation
11.1.1.
Consensus Statements
11.1.2.
11.1.3.
Recommendation
11.1.4.
11.2. Pharmacological thromboprophylaxis
Recommendation
11.2.1.
Consensus Statement
11.2.2.
11.3. Treatment of varicose vein procedure related DVT and ARTE
Recommendationsb
11.3.1.
11.3.2.
11.3.3.
11.3.4.
Consensus Statements
11.4.1.
11.4.2.
12. Management of Superficial Vein Thrombosis (SVT)
Recommendation
12.1.1.
Consensus Statement
12.1.2
Recommendations
12.1.3.
12.1.4.
Consensus Statement
12.1.5.
13. Management of Bleeding Varicose Veins
Consensus Statements
13.1.
13.2.
13.3.
13.4.
14. Management of Superficial Vein Aneurysms
Consensus Statements
14.1.
14.2.
14.3.
Recommendation Grading
Disclaimer
Overview
Title
Management of Varicose Veins of the Lower Extremities. Part II
Authoring Organizations
American Vein & Lymphatic Society
American Venous Forum
Society for Vascular Surgery
Publication Month/Year
August 27, 2023
Last Updated Month/Year
May 21, 2024
Supplemental Implementation Tools
Document Type
Guideline
Country of Publication
US
Document Objectives
The Society for Vascular Surgery (SVS), the American Venous Forum (AVF), and the American Vein and Lymphatic Society (AVLS) 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 PICO (patients, interventions, comparators, and outcome) system to answer critical questions. Part I discussed the role of duplex ultrasound scanning (DUS) 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 non-controversial 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 (Part 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.
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory, Outpatient, Operating and recovery room
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Assessment and screening, Treatment, Management
Diseases/Conditions (MeSH)
D014648 - Varicose Veins
Keywords
varicose veins, Venous insufficiency
Source Citation
Gloviczki P, Lawrence PF, Wasan SM, Meissner MH, Almeida J, Brown KR, Bush RL, Di Iorio M, Fish J, Fukaya E, Gloviczki ML, Hingorani A, Jayaraj A, Kolluri R, Murad MH, Obi AT, Ozsvath KJ, Singh MJ, Vayuvegula S, Welch HJ. 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. J Vasc Surg Venous Lymphat Disord. 2023 Aug 29:S2213-333X(23)00322-0. doi: 10.1016/j.jvsv.2023.08.011. Epub ahead of print. PMID: 37652254.