Recent literature in CVD reported updated classifications, new long-term FU results concerning invasive treatment in different clinical settings, new shreds of evidence about conservative treatments (compression and pharmacology) as well as updated data about Pelvic Venous Disorders, which has become a new, important Phlebology chapter in clinical practice.
According to these novelties, the European Society for Vascular Surgery (ESVS) has prepared new clinical practice guidelines for the treatment of patients with CVD, to update the 2015 ESVS edition. The focus of the guidelines is the recommendation on diagnosis and treatment of CVD of the lower limbs, related to the pathology of the superficial, perforating, and deep veins as well as to abdominal and pelvic venous pathology to support diagnosis and treatment choices of medical professionals involved in circulation and blood flow care.
New 2022 ESVS Clinical practice guidelines on the Management of Chronic Venous Disease of the Lower Limbs is based on the extensive review of the updated literature. The guidelines proposed by the group of the well-known experts focus on the modern approach.
Here, we summarize the highlights and news reported in of 2022 ESVS guidelines on CVD:
The introductive chapter reports a very practical table summary of new and updated recommendations stratified accordingly with the level of evidence through color codes. Moreover, updated CEAP classification is represented and each chapter reports clearly the new recommendations with a flag.
In the CVD conservative management chapter, several new recommendations about compression and pharmacological approach are described and reported, including elastic stocking/bandages methods and pharmacology treatment aimed to improve venous symptoms and edema with Venoactive drugs (VADs) such as ruscus extract, micronized purified flavonoid fraction, sulodexide, calcium dobesilate.
An extensive chapter is dedicated to interventions for superficial venous incompetence. Besides thermal ablation, a new subsection on evidence supporting endovenous non-thermal ablation has been included. Innovative subsections on practical strategies for special anatomical presentations as well as on perforating vein treatment have been added. The authors of the guidelines discussed also the options for the management of recurrent varicose veins.
In the deep venous pathology chapter, the increasing evidence in the field of managing iliofemoral and iliocaval obstruction is emphasized. In addition, new topics depicted the combination of superficial and deep venous incompetence.
An entirely new chapter (n. 6) has been dedicated to the management of patients with venous ulcer.
Special (new) chapter (7) has be created on the pelvic venous disorders as well as on the management of the patients with varicose vein of pelvic origin.
A new chapter describes how special patient characteristics (such as obesity, pregnancy, patients with comorbidities, and patients under anticoagulant treatment) affect the CVD management strategy. (Number 8).
Gaps in evidence and future perspectives are discussed in chapter 9.
The guideline document is written in very practical and friendly to read way. The text of the document is supported by the flowcharts, which simplified the understanding of the proposed patient management.
