CITY, July 6, 2025
New hope for aching legs
SCAI releases its first CVD treatment guidelines.
- First guidelines from SCAI focused on chronic venous disease.
- Offers 9 recommendations for 8 clinical scenarios.
- Covers therapies from compression to deep vein stenting.
- Addresses when to use conservative vs. invasive treatments.
Do your legs often feel heavy, swollen, or just plain achy? The Society for Cardiovascular Angiography and Interventions (SCAI) released its first clinical practice guidelines on June 30, 2025, offering a roadmap for managing chronic venous disease (CVD), which can severely impact quality of life.
Personalized care for CVD
These guidelines include nine formal recommendations for eight clinical scenarios, covering various treatment options like compression therapy, wound care, ablation, sclerotherapy, phlebectomy, and deep vein stenting. They aim to help clinicians decide when conservative treatment is enough and when more invasive options are needed.
According to Robert Attaran, MD, MBBS, chair of the guideline writing community and member of the SCAI Vascular Disease Council, these guidelines come “at a time of increasing recognition of the burden it places on patients and healthcare systems.” He adds, “Our recommendations aim to provide clinicians and patients with a roadmap for personalized, evidence-informed care.”
Behind the Guidelines
SCAI’s guidelines are based on a technical review that addressed eight research questions about the safety and efficacy of different treatments for symptomatic varicose veins and venous ulceration. The review looked at existing systematic reviews and conducted new ones on ablation therapy, sclerotherapy, and phlebectomy.
Initially, 3648 titles and abstracts were reviewed, with 19 ultimately selected to inform the technical review. Recommendations were then categorized as either “strong” or “conditional,” based on the certainty of the evidence.
Treatment Algorithms
The guidelines present two treatment algorithms: one for patients with symptomatic varicose veins and another for those with venous ulcer disease. These algorithms are designed to help tailor treatment plans to individual patient needs.
Limitations and Future Research
What are some limitations of the new SCAI guidelines for chronic venous disease? The SCAI acknowledges uncertainty regarding the effects of perforator vein ablation, venoplasty, stenting for iliocaval obstruction, sclerotherapy, and phlebectomy on healing rates, symptom scores, quality of life, and disease recurrence. Data pooling was also difficult due to dissimilar studies, and evidence for some treatments, like sclerotherapy and IPV ablation, was of very low certainty.
The panel also calls for more research to address knowledge gaps, particularly regarding specific ablation modalities for C2-C4 disease and the treatment of perforator and accessory reflux.
Commitment to Quality Care
SCAI president Srihari Naidu, MD, stated that these guidelines “reflect SCAI’s commitment to bringing high-quality, evidence-based standards to areas where our members are increasingly practicing.” He emphasized the importance of consistent and personalized care as interventional cardiologists play a larger role in managing chronic venous disease.
References
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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
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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
