SCAI Releases First Ever Guidelines for Managing Chronic Venous Disease

On June 30, 2025, the Society for Cardiovascular Angiography and Interventions (SCAI) published its first clinical practice guidelines on the treatment of chronic venous disease (CVD).1

Composed of 9 formal recommendations for 8 clinical scenarios addressed by the guideline panel, “SCAI Clinical Practice Guidelines for the Management of Chronic Venous Disease” provides recommendations on a variety of therapeutic options, including compression therapy, wound care, ablation, sclerotherapy, phlebectomy, and deep vein stenting. The guidelines also provide practical insights on which patients may benefit from conservative therapy and when to escalate to invasive options.1

“These are the first SCAI guidelines focused on chronic venous disease, and they come at a time of increasing recognition of the burden it places on patients and healthcare systems,” said Robert Attaran, MD, MBBS, chair of the guideline writing community and member of the SCAI Vascular Disease Council. “CVD may present with discomfort, heaviness, and swelling, but it can progress to venous ulcers that are difficult to heal and severely impair quality of life. Our recommendations aim to provide clinicians and patients with a roadmap for personalized, evidence-informed care.”1

The guidelines are based on a technical review conducted by the SCAI, which aimed to answer 8 separate research questions regarding the safety and efficacy of several treatment modalities in patients with symptomatic varicose veins and/or venous ulceration. Each of these questions was based on specific clinical scenarios. Special consideration was given to varied levels of evidence relevant to venous autonomy.2

The SCAI’s technical review consisted of 2 major sections. The first involved looking for high-quality published systematic reviews relevant to the questions, and the second was 3 de novo systematic reviews on ablation therapy, sclerotherapy, and phlebectomy. An initial total of 3648 titles and abstracts were collected; after filtering for eligibility criteria, 19 were selected to inform the technical review.2

Individual recommendations were categorized as “strong” or “conditional” based on the evidence’s certainty, among other contextual considerations. The guidelines also introduce 2 algorithms of treatment: the first for patients with symptomatic varicose veins, and the second for patients with venous ulcer disease.1

Despite the in-depth analysis, the SCAI notes in the guidelines themselves the uncertainty of evidence for the effect on healing rate, symptom score, quality of life, and disease recurrence of perforator vein ablation, venoplasty, and stenting for iliocaval obstruction, sclerotherapy, and phlebectomy of symptomatic varicose veins.2

Additionally, the panel reported an inability to meaningfully pool data for questions 5, 7, and 8, as the underlying studies were deemed too dissimilar from each other. Similarly, very low certainty evidence suggests sclerotherapy of varicose veins for the reduction of symptom scores, as well as demonstrating a benefit of IPV ablation compared to conservative management for the treatment of venous ulcer disease.2

Considering these limitations, the SCAI panel also endorses further research, acknowledging knowledge gaps in the review and suggesting examination of specific ablation modalities for C2-C4 disease, treatment of perforator and accessory reflux, and other specific clinical situations.2

“These guidelines reflect SCAI’s commitment to bringing high-quality, evidence-based standards to areas where our members are increasingly practicing,” said SCAI president Srihari Naidu, MD. “As interventional cardiologists take a larger role in managing chronic venous disease, a common problem affecting millions of people, these recommendations will help ensure that patient care remains both consistent and personalized.”1

References

1. Society for Cardiovascular Angiography and Interventions. SCAI clinical document provides clinical practice guidelines for the management of chronic venous disease. Eurekalert! July 1, 2025. Accessed July 2, 2025. https://www.eurekalert.org/news-releases/1089598

2. Attaran R, Edwards M, Bunte M, et al. SCAI Technical Review on Management of Chronic Venous Disease. JSCAI. doi:10.1016/j.jscai.2025.103730