SCAI Releases New Guidelines to Help Interventional Cardiologists Manage Chronic Venous Disease (CVD)
SCAI Releases New Guidelines to Help Interventional Cardiologists Manage Chronic Venous Disease (CVD)
Highlighted in the July 1, 2025
1. Background and Burden of Disease
• Chronic venous disease (CVD) is increasingly prevalent and manifests with symptoms like leg heaviness, swelling (edema), skin discoloration, and venous ulcers.
• Venous leg ulcers affect about 2.2% of Medicare beneficiaries and cost the U.S. healthcare system nearly $15 billion annually, based on outdated estimates.
2. New SCAI Guidelines Overview
• The Society for Cardiovascular Angiography & Interventions (SCAI), in collaboration with vascular surgeons, has published its first-ever clinical guidelines for the management of CVD, especially tailored for interventional cardiologists.
• The full guidelines were published in the Journal of the Society for Cardiovascular Angiography & Interventions (JSCAI).
3. Treatment Modalities Covered
• The document provides detailed recommendations on various treatments including:
• Compression therapy
• Wound care
• Ablation therapy
• Sclerotherapy
• Phlebectomy
• Venoplasty and stenting
4. What is Vein Ablation? (in context of therapy options)
• Vein ablation is a minimally invasive procedure used to close malfunctioning veins and reroute blood through healthy vessels.
• Types include:
• Radiofrequency Ablation (RFA): uses heat via radio waves
• Endovenous Laser Therapy (EVLT): uses laser energy
• Foam Sclerotherapy: uses a chemical agent to collapse the vein
• This approach is highly effective in relieving symptoms and preventing complications like venous ulcers.
5. Lifestyle Modification Remains Critical
• The guidelines stress the importance of addressing obesity and inactivity, which are major contributors to venous hypertension.
6. Two Evidence-Based Treatment Algorithms Introduced
• The guidelines include two structured algorithms to support real-world decision-making:
A. Symptomatic Varicose Veins :
• Start with conservative therapy: compression stockings, leg elevation, lifestyle changes.
• If axial reflux is confirmed on ultrasound (e.g., in the great saphenous vein – GSV), proceed with ablation therapy.
• For accessory vein reflux (e.g., anterior accessory saphenous vein), consider sclerotherapy or phlebectomy.
• Persistent symptoms after treatment may suggest iliocaval obstruction, which could warrant venoplasty or stenting.
Understanding Axial vs. Accessory Reflux:
• Axial reflux involves backward blood flow in major veins like GSV or SSV due to valve failure, contributing significantly to disease progression.
• Accessory reflux occurs in smaller branch veins and can still produce symptoms and skin changes.
• Both are diagnosed by duplex ultrasound, with reflux defined as retrograde flow >0.5 seconds.
B. Venous Ulcer Disease (C5–C6):
• Begin with compression therapy and wound care.
• If reflux in axial or accessory veins is present, use foam sclerotherapy or ablation as appropriate.
• If obstruction is suspected in deeper veins (e.g., iliac veins), venoplasty ± stenting may be required.
7. Multidisciplinary Collaboration and Endorsements
• The Society for Vascular Medicine formally endorsed the guidelines.
• SCAI emphasized collaboration across specialties to improve access to care and deliver personalized, evidence-based interventions.
