New Guidelines Address Chronic Venous Disease
SCAI releases recommendations for personalized treatment approaches.
The Society for Cardiovascular Angiography and Interventions (SCAI) has recently released its inaugural clinical practice guidelines focused on the treatment of chronic venous disease (CVD), offering a roadmap for clinicians and patients alike.
Key Development
These guidelines, comprised of nine formal recommendations addressing eight clinical scenarios, provide recommendations on options such as compression therapy, wound care, ablation, sclerotherapy, phlebectomy, and deep vein stenting. According to Robert Attaran, MD, MBBS, chair of the guideline writing committee, the recommendations aim to offer clinicians and patients a “roadmap for personalized, evidence-informed care.”
The guidelines help determine which patients might initially benefit from conservative treatments versus when to consider more invasive procedures.
In-Depth Analysis
The SCAI’s technical review involved an extensive search for published systematic reviews and included three de novo systematic reviews focusing on ablation therapy, sclerotherapy, and phlebectomy.
Initial screening of 3648 titles and abstracts resulted in 19 being selected to inform the technical review. Individual recommendations were classified as either “strong” or “conditional,” taking into account the certainty of the evidence and other contextual factors.
The guidelines introduce treatment algorithms for symptomatic varicose veins and for venous ulcer disease.
Limitations and Future Research
The SCAI acknowledges the uncertainty of evidence for certain treatments including perforator vein ablation, venoplasty, and stenting for iliocaval obstruction. Similarly, pooling data was challenging due to dissimilar underlying studies.
According to the National Institutes of Health, CVD affects as many as 40% of adults in the United States (NIH, 2022).
Acknowledging these limitations, the SCAI panel advocates for further research, particularly regarding specific ablation modalities for C2-C4 disease and treatment of perforator and accessory reflux.
SCAI’s Commitment
“These guidelines reflect SCAI’s commitment to bringing high-quality, evidence-based standards to areas where our members are increasingly practicing,”
said SCAI president Srihari Naidu, MD. As interventional cardiologists become more involved in managing CVD, these recommendations seek to standardize and personalize patient care.
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