For Immediate Release
Beverly, MA, May 11, 2011 -New guidelines for the management of varicose veins and associated chronic venous disease (CVD) were just published in a supplement to the Journal of Vascular Surgery® (J Vasc Surg 2011;53(5 Suppl):2S-48S). The guidelines, which focus on evaluation and treatment of varicose veins of the lower limbs and pelvis, were developed by a joint Venous Guideline Committee of the Society for Vascular Surgery® (SVS) and the American Venous Forum (AVF). The Journal of Vascular Surgery is published by the SVS.
An estimated 23 percent of the adult population of the U.S. has varicose veins, and six percent has more advanced CVD, including skin changes and healed or active venous ulcers. Long considered a cosmetic problem, varicose veins are now known to cause more serious disability, ranging from discomfort and pain that cause lost work days and decreased quality of life to, in the most serious cases of chronic venous disease and venous ulcers, loss of limb or loss of life.
"Improved technology and new surgical techniques, many of which can be done in an office setting, have led to dramatic changes in the treatment of varicose veins," said Peter Gloviczki, MD, Professor of Surgery, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, who chaired the SVS/AVF Venous Guideline Committee and is the vice- president of the SVS and past president of the AVF. "The new treatment options can significantly improve patient outcomes. They can experience less discomfort, improved quality of life and earlier return to work than was previously possible."
The guidelines feature nine key recommendations. Note that the strength of each guideline varies based on the benefits as compared to the risks, burdens and costs.
For treatment of the incompetent great saphenous vein (GSV) we recommend endovenous thermal ablation (radiofrequency or laser) over high ligation and inversion stripping of the saphenous vein to the level of the knee.
The authors assert that "under no circumstance should these guidelines be construed in practice or legal terms as defining 'standards of care' which is solely determined by the condition of the individual patient, treatment setting and other factors." They go on to note that individual patient factors may dictate a different approach that is outlines in the supplement.
Treatment Review Highlights; Meta-Analysis Points to the Need for More Research
The guidelines were based on evidence gained from prospective randomized studies, large case-series and a systematic review and meta-analysis of the treatments for varicose veins, led by M. Hassan Murad, MD, MPH, et al., from Mayo Clinic. These authors summarized the best available evidence about the benefits and harms of the different available treatments. The review compared results of liquid and foam sclerotherapy, laser, radiofrequency ablation and surgery of varicose veins.
The reviewers concluded that the available treatments for varicose veins appear to be safe with rare side effect, but they noted that the only treatment with long-term effectiveness data is still open surgery. The other less invasive treatments are associated with shorter disability and less pain, but only short and medium term effective data exists.
In addition, the reviewers noted that there is an "apparent need for randomized trials of newer and less invasive therapies, such as laser, radiofrequency ablation and foam therapy to compare their durability, efficacy and safety to that of the standard procedure of ligation, stripping and multiple phlebectomies." They also noted that additional studies should stratify patients by the severity of their symptoms in order to obtain the most useful results and that they should focus on cost and long term benefit.
To view the abstract, log on to http://www.jvascsurg.org/article/S0741-5214(11)00327-2/abstract
American Venous Forum
The American Venous Forum (AVF) is an international consortium of venous and lymphatic specialists dedicated to improving patient care. Its mission is to promote venous and lymphatic health through innovative research, education and technology.
Society for Vascular Surgery
The Society for Vascular Surgery® is a not-for-profit professional medical society, composed primarily of vascular surgeons, that seeks to advance excellence and innovation in vascular health through education, advocacy, research, and public awareness. SVS is the national advocate for 3,350 specialty-trained vascular surgeons and other medical professionals who are dedicated to the prevention and cure of vascular disease.