SCAI Releases First-Ever Guidelines for Chronic Venous Disease Treatment

Washington D.C.- in a landmark move set to reshape the landscape of vascular care, The Society For Cardiovascular Angiography And Interventions (SCAI) unveiled its inaugural clinical practice guidelines for the treatment of chronic venous disease (CVD) on June 30, 2025.

This comprehensive document, featuring nine formal recommendations addressing eight distinct clinical scenarios, promises to provide clinicians and patients with a clear roadmap for personalized, evidence-informed care.

New hope For Millions Suffering from Chronic Venous disease

Chronic Venous Disease (CVD), a condition affecting millions worldwide, is characterized by discomfort, heaviness, and swelling in the legs. In severe cases, it can progress to debilitating venous ulcers. These new guidelines offer a beacon of hope, providing clarity on when conservative therapies are sufficient and when more invasive options become necessary.

Dr. robert Attaran, chair of the guideline writing community and member of the SCAI Vascular Disease Council, emphasized the timeliness of these guidelines. “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,” Dr. Attaran stated.

Inside The SCAI Guidelines: A Rigorous Review Process

The recommendations are rooted in a meticulous technical review conducted by the SCAI,designed to answer eight specific research questions concerning the safety and efficacy of various treatment modalities for patients experiencing symptomatic varicose veins and/or venous ulceration. The review heavily considered the varied levels of evidence relevant to venous autonomy.

The SCAI’s review involved two primary phases: a search for high-quality, published systematic reviews and three *de novo* systematic reviews focusing on ablation therapy, sclerotherapy, and phlebectomy. From an initial pool of 3,648 titles and abstracts, 19 were ultimately selected to inform the technical review.

Key Recommendations And Treatment Algorithms

Individual recommendations were categorized as either “strong” or “conditional,” reflecting the certainty of the evidence and other contextual factors. The guidelines also introduce two distinct treatment algorithms: one for patients with symptomatic varicose veins and another for those with venous ulcer disease.

Did You Know? Varicose veins affect approximately 23% of adults in the United States. Early diagnosis and management are crucial to prevent progression to more severe CVD.

limitations And Future Research

Despite the in-depth analysis, the SCAI acknowledges uncertainties in the evidence regarding the effect of several procedures on healing rates, symptom scores, quality of life, and disease recurrence. These include perforator vein ablation, venoplasty, stenting for iliocaval obstruction, sclerotherapy, and phlebectomy of symptomatic varicose veins.

The panel also noted an inability to meaningfully pool data for certain questions due to the heterogeneity of the underlying studies.Moreover, evidence supporting the benefits of sclerotherapy for reducing symptom scores in varicose veins and IPV ablation compared to conservative management for venous ulcer disease was deemed to have very low certainty.

Recognizing these limitations, the SCAI panel advocates for further research, pinpointing knowledge gaps and suggesting investigations into specific ablation modalities for C2-C4 disease, treatment of perforator and accessory reflux, and other specific clinical situations.

Srihari Naidu, MD, president of the SCAI, affirmed the organization’s commitment to evidence-based standards. “these guidelines reflect SCAI’s commitment to bringing high-quality, evidence-based standards to areas where our members are increasingly practicing,” said dr. Naidu. “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.”

Understanding Chronic Venous Disease: A Rapid Guide

Chronic Venous Disease (CVD) encompasses a range of conditions affecting the veins, most commonly in the legs. It occurs when valves inside the veins that keep blood flowing toward the heart become damaged or weakened. This can cause blood to pool in the veins, leading to various symptoms.

Common Symptoms Of CVD

• Leg pain or aching
• Heaviness or fatigue in the legs
• Swelling in the legs and ankles
• Skin changes, such as discoloration or thickening
• Varicose veins (enlarged, twisted veins visible under the skin)
• Venous ulcers (open sores that develop on the skin)

Risk Factors For CVD

• Age: The risk of CVD increases with age.
• Gender: Women are more likely to develop CVD than men.
• Family history: A family history of CVD increases yoru risk.
• Obesity: Excess weight can put extra pressure on your veins.
• Pregnancy: Pregnancy increases blood volume and pressure on the veins in the legs.
• Prolonged standing or sitting: Jobs that require long periods of standing or sitting can increase the risk of CVD.