SCAI Technical Review on Management of Chronic Venous Disease

Background

Chronic venous disease (CVD) impacts more than 25 million adults in the United States and is associated with a host of symptoms that can adversely affect quality of life (QoL), such as leg discomfort, edema, and ulceration. Treatments for CVD range from conservative therapy centered around use of compression to more invasive approaches, such as ablation, sclerotherapy, phlebectomy, venoplasty, and stenting.

Methods

A systematic review was conducted to address 8 questions on the management of CVD that were formulated by the Society for Cardiovascular Angiography & Interventions (SCAI) Guideline Panel using the patient, intervention, comparator, outcome (PICO) format. Medical literature from January 1, 2008, through May 15, 2023, was searched using PubMed, Embase, and the Cochrane Central Register of Controlled Trials, except where an existing systematic review on compression therapy versus no intervention was updated with evidence from May 1, 2020, to May 15, 2023. Study selection was performed in duplicate; data extraction and risk of bias assessment were performed by 1 reviewer and reviewed by a second reviewer. Pooled effect estimates were calculated when applicable, and overall certainty in the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results

Our combined searches identified 3648 titles and abstracts, of which 19 met eligibility criteria and informed the technical review. Studies reported on healing rate and time to healing, disease recurrence, symptom severity, and QoL among patients who were treated with compression therapy, ablation, sclerotherapy, phlebectomy, and venoplasty or stenting. Compression therapy probably results in slightly faster and more complete venous ulcer healing compared with no compression. Ablation of the great saphenous vein ± small saphenous vein may improve healing rate and symptoms over conservative therapy alone, particularly for ulcer disease. Evidence is very uncertain for any effect on healing rate, symptom score, QoL, and disease recurrence associated with perforator vein ablation, venoplasty, and stenting for iliocaval obstruction, sclerotherapy, and phlebectomy of symptomatic varicose veins.

Conclusions

Data from this technical review will inform the Society for Cardiovascular Angiography and Interventions Guideline on Management of Chronic Venous Disease. The panel also identified research priorities based on areas where evidence to guide clinical practice is lacking or very uncertain.