Pioneering Guidelines for Chronic Venous Disease

On June 30, 2025, the Society for Cardiovascular Angiography and Interventions (SCAI) made history by releasing its groundbreaking clinical practice guidelines dedicated to managing chronic venous disease (CVD). This unprecedented document features nine formal recommendations tailored to eight distinct clinical scenarios, providing a comprehensive roadmap for healthcare professionals.

A Holistic Treatment Approach

The "SCAI Clinical Practice Guidelines for the Management of Chronic Venous Disease" encompass a spectrum of treatment strategies, from compression therapy and wound care to advanced procedures like ablation, sclerotherapy, phlebectomy, and deep vein stenting. These guidelines not only suggest when to opt for conservative methods but also when to escalate treatment to more invasive options. Dr. Robert Attaran, chair of the guideline committee, emphasizes the importance of addressing CVD, which can lead to debilitating symptoms and venous ulcers that severely affect patients' quality of life.

Evidence-Based Insights and Recommendations

The guidelines are founded on an extensive technical review by SCAI, which posed eight essential research questions about the safety and effectiveness of various treatment methods for patients dealing with symptomatic varicose veins and venous ulceration. This rigorous process involved sifting through 3,648 titles and abstracts to identify high-quality studies, ultimately distilling them down to 19 key pieces of research.

Navigating Treatment Options

Recommendations are categorized as either "strong" or "conditional" based on the certainty of evidence available. Additionally, the guidelines introduce two treatment algorithms: one tailored for symptomatic varicose veins and another for managing venous ulcer disease.

Challenges and Future Research Needs

Despite their thorough analysis, the SCAI acknowledges the limitations in the existing evidence related to healing rates, symptom relief, quality of life, and recurrence of disease following various procedures. Many of the studies reviewed were too inconsistent to draw clear, definitive conclusions.

A Call for Continued Exploration

Recognizing these gaps, the SCAI panel advocates for further research, specifically into ablation techniques for varying stages of CVD, and the treatment approaches for complex cases like perforator and accessory reflux.

Commitment to Excellence in Patient Care

Dr. Srihari Naidu, SCAI president, highlights the organization’s dedication to creating high-quality, evidence-driven standards in managing chronic venous disease. With interventional cardiologists increasingly involved in treating this widespread issue, these newly established guidelines aim to ensure consistent and personalized care for millions of affected patients.