Recommendations developed for lower-extremity varicose veins

Medical Xpress / Journal of Vascular Surgery: Venous and Lymphatic Disorders ^ | Dec. 15, 2022 | Elana Gotkine / Peter Gloviczki et al

[ConservativeMind]

In clinical practice guidelines issued by the Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society, recommendations are presented for the diagnosis and treatment of lower-extremity varicose veins.

Peter Gloviczki, M.D. and colleagues conducted a systematic review and meta-analysis of diagnostic tests and treatment options for patients with lower-extremity varicose veins to develop new evidence-based recommendations on critical issues relating to care of patients.

Part I of the guidelines includes recommendations for the evaluation of patients with Clinical Class, Etiology, Anatomy, Pathology class 2 varicose veins. The authors note that duplex ultrasound scanning is recommended as the diagnostic test of choice for evaluating venous reflux in patients with chronic venous disease of the lower extremities (strong recommendation with moderate-quality evidence).

Venous intervention is recommended over long-term compression stockings for patients with symptomatic varicose veins and axial reflux in the great or small saphenous vein who are candidates for intervention (strong recommendation with moderate-quality evidence). Both thermal and nonthermal ablation from the groin to below the knee are recommended for patients with symptomatic axial reflux of the great saphenous vein, depending on the expertise of the treating physician and patient preference (strong recommendation with moderate-quality evidence).

"The primary goal was to provide recommendations supported by the latest scientific data, with a secondary goal that adopting these guidelines will markedly decrease the number of inappropriate procedures performed in patients with chronic venous disease," Gloviczki said in a statement.

[ConservativeMind]

The specific occasions to not rely on compression stockings is interesting, and there is flexibility with treatment of axial reflux.

[ConservativeMind]

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[sauropod]

Bkmk

[Reddy]

“The specific occasions to not rely on compression stockings is interesting,”

Couldn’t find that in the article, was there a link to it? (compression stocking user due to previous DVT).

[ckilmer]

the jargon made my mind go numb. I think I know what compressions stockings are. But I couldn’t figure this paragraph. Can you translate?

“Venous intervention is recommended over long-term compression stockings for patients with symptomatic varicose veins and axial reflux in the great or small saphenous vein who are candidates for intervention (strong recommendation with moderate-quality evidence)”

I didn’t understand this paragraph at all. Can you translate this one?
“Both thermal and nonthermal ablation from the groin to below the knee are recommended for patients with symptomatic axial reflux of the great saphenous vein, depending on the expertise of the treating physician and patient preference (strong recommendation with moderate-quality evidence).”

[ConservativeMind]

“Venous intervention is recommended over long-term compression stockings for patients with symptomatic varicose veins and axial reflux in the great or small saphenous vein who are candidates for intervention.”

[armydoc]

Basically, surgical intervention is recommended over compression stockings alone for reflux (backwards blood flow due to valves not working) in the saphenous veins of the legs that is causing symptomatic varicose veins. In the past, surgical intervention consisted of vein stripping, a painful procedure done in the OR. For the past 15 years or so, ablation techniques have taken over due to their minimally invasive nature that is typicallydone in an office setting. Basically, the vein is destroyed from within using a catheter. Heat via laser or radio-frequency is popular. I use injection of cyanoacralate (medical grade super glue) which is marketed as VenaSeal and have had good results. Hope this was helpful

[ConservativeMind]

Compression stockings don’t help long term versus an operation on the vein.

The two veins described are common varicose veins, with the great one being the longest vein in your body:

https://en.m.wikipedia.org/wiki/Great_saphenous_vein

The second paragraph simply says any form of removal or destruction of the vein is okay if you have had a form of deep vein issue that often occurs along with a blood clot, which would tend to be something people would know they had, and had taken care of.

[ConservativeMind]

Thank you for that!

[Some Fat Guy in L.A.]

Wife had the super glue treatment. Said it hurt like crazy and has been very slow to produce results. Her doctor says be patient, will work eventually - also told her to take horse chestnut seed extract to help the process along.

A different vein doctor has had me taking the horse chestnut for several years now - I was having lymphatic fluid build up in my lower legs, causing big ugly blisters. The horse chestnut cleared this up and have not had further issues.