Managing Varicose Veins & More Advanced Chronic Venous Diseases

It is estimated that 20% to 25% of American adults have varicose veins, and 6% have more advanced chronic venous diseases (CVDs). While varicose veins were once considered a cosmetic problem, they are associated with discomfort, pain, and poor quality of life. Severe CVDs may also lead to loss of limb or life. In response to the rapid improvement in technology and results from recent randomized clinical trials, the Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) jointly released new clinical practice guidelines for the care of patients with varicose veins. The guidelines, published in the May 2011 supplement to the Journal of Vascular Surgery, also provide recommendations for those with more advanced CVDs, including edema, skin changes, or venous ulcers. As the aging population continues to grow, so too will complications related to varicose veins and associated CVDs. Advancements in technology and surgical techniques have resulted in vast improvements in the prevention and management of varicose veins. “It is critical that surgeons are aware of the latest diagnostic strategies and the less invasive and more effective treatment techniques for treating the disease,” says Peter Gloviczki, MD, who chaired the SVS/AVF Venous Guideline Committee. New & Modified Recommendations Numerous recommendations for the management of varicose veins and more advanced CVDs are presented in the SVS/AVF guidelines (Table). The strength of each guideline varies based on the benefits as compared to the risks, burdens, and costs. A key recommendation offered by the new guidelines is duplex scanning of the deep and superficial veins to complement the standard history and physical examination in evaluation of patients with varicose veins...