Clinical Summary: SCAI 2025 Guidelines for Chronic Venous Disease (CVD)
Clinical Summary: SCAI 2025 Guidelines for Chronic Venous Disease (CVD)
Published: July 1, 2025 | Source: SCAI – Society for Cardiovascular Angiography and Interventions
1. Presidential Context
• Former U.S. President Donald Trump (age 79) was recently diagnosed with chronic venous insufficiency (CVI) after presenting with leg swelling.
• Bilateral Doppler ultrasound confirmed CVI; no signs of DVT or arterial disease.
• Echocardiography showed normal cardiac function, with no evidence of heart failure.
• The case highlighted CVI as a common but generally benign condition, especially in older adults.
2. Disease Overview
• CVD results from failure of leg veins to efficiently return blood to the heart.
• Over 25 million adults in the U.S. are affected, with prevalence increasing significantly after age 70.
• Symptoms include leg heaviness, ankle swelling, skin discoloration, and in advanced cases, venous ulcers.
3. SCAI 2025: General Guideline Framework
• Developed using the GRADE methodology.
• Endorsed by the Society for Vascular Medicine.
• Includes 8 key clinical recommendations based on randomized trials and expert consensus.
• Emphasizes a patient-centered approach and shared decision-making.
• Future updates expected between 2–5 years post-publication.
4. Treatment Recommendations by Modality
4.1 Compression Therapy
• Strongly recommended for patients with venous ulcers.
• Conditionally recommended for patients with symptomatic varicose veins.
• Benefits include reduced edema, pain, and improved ulcer healing.
• Limitations: adherence may be low due to discomfort or difficulty donning stockings.
4.2 Ablation Therapy
• Conditionally recommended for patients with reflux in the great saphenous vein (GSV), small saphenous vein (SSV), or accessory GSV.
• Especially useful when conservative therapy fails or ulcers are present.
• Improves symptom control and ulcer healing.
• Nonthermal techniques are preferred below the knee to reduce nerve injury.
4.3 Foam Sclerotherapy
• Conditionally recommended for:
• Symptomatic varicose veins without truncal reflux.
• Nonhealing ulcers resistant to compression therapy.
• Benefits include symptom relief and cosmetic improvement.
• Small risks: DVT, skin pigmentation, and phlebitis.
4.4 Phlebectomy
• Conditionally recommended for symptomatic varicose veins without truncal reflux or after failed ablation.
• Associated with faster symptom resolution and lower recurrence rates.
• No recommendation for venous ulcers due to insufficient evidence.
4.5 Iliocaval Stenting
• Conditionally recommended in patients with severe iliac vein obstruction (e.g., May-Thurner syndrome) and persistent symptoms despite compression.
• Improves quality of life and wound healing.
• Requires intravascular ultrasound (IVUS) for accurate sizing.
• Risk of stent migration or restenosis if improperly placed.
4.6 Femoral or Common Femoral Vein Stenting
• No recommendation given due to lack of adequate evidence.
• Identified as a knowledge gap in the field.
• Future research needed for post-thrombotic patients with isolated femoral disease.
5. Summary of Clinical Approach
• Start with compression therapy in nearly all patients.
• Add ablation when there is saphenous reflux or poor response.
• Use sclerotherapy or phlebectomy in selected cases based on anatomy and patient preference.
• Reserve iliocaval stenting for advanced, obstructive disease.
• Avoid deep venous interventions unless supported by strong imaging and clinical need.
6. Final Note
These are the first comprehensive venous guidelines from SCAI, offering interventional cardiologists and vascular specialists a structured, evidence-informed roadmap for treating chronic venous disorders. As venous procedures continue to increase globally, standardized guidance is essential to improve outcomes and access to care.
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