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Published on: December 9, 2022
Toward the Development of an Integrated Anatomic and Hemodynamic Classification for Primary Superficial Venous
Joel Sousa1, Armando Mansilha1
1Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de S. João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine of the University of Porto, Porto, Portugal.
Background:
This study aimed to develop a validated set of expert consensus statements that may serve as the foundation for a new integrated anatomic and hemodynamic classification for primary superficial venous insufficiency (PSVI).
Methods:
A modified Delphi process was conducted among an international panel of 36 high-volume venous specialists. Experts were selected based on procedural experience (≥ 100 procedures per year) and prior participation in a global survey on the conceptual framework of an integrated anatomic-hemodynamic classification for PSVI. Over 2 iterative rounds, 17 initial statements-grouped into anatomic and hemodynamic domains-were evaluated using a 5-point Likert scale. Consensus was defined as ≥ 75% agreement, with interquartile range (IQR) of ≤ 1.0 used to assess consistency. Iterative qualitative feedback informed statement refinement between rounds.
Results:
Sixteen of 17 initial statements reached consensus in Round 1. Based on expert commentary, 3 statements were removed, 3 substantially revised, and 9 linguistically refined for Round 2. In Round 2, all 16 statements reached consensus (agreement 75.1-100%), with IQR ≤ 1.0 for all but one item (IQR = 1.5). Given the robust agreement and consistent feedback, a third round was deemed unnecessary.
Conclusions:
This international Delphi study establishes a foundational set of expert-derived statements on the key anatomic and hemodynamic components to be considered for a new integrated anatomic and hemodynamic classification for PSVI. These findings represent a critical step toward a novel, clinically actionable classification system, with potential to improve disease stratification, therapeutic planning, and outcome evaluation in primary superficial venous disease.
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