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Optimizing the management of venous disease: Expert consensus from a multinational panel of phlebology specialists
Sergiu-Ciprian Matei1, Nadelin Nikolov2, Miroslava Popović3
1Abdominal Surgery and Phlebology Research Center, Victor Babeş University of Medicine and Pharmacy Timişoara, Timişoara, Romania; 1'st Surgical Department, "Pius Brînzeu" County Emergency Clinical Hospital Timişoara, Timişoara, Romania.
Insights
Expert consensus on managing chronic venous disease (CVD) and varicose veins (VV) emphasizes symptom-driven treatment. Endovenous procedures and diosmin-based drugs are supported for symptom relief, guiding individualized care.
Area of Science:
- Vascular Medicine
- Phlebology
- Medical Consensus
Background:
- Chronic venous disease (CVD) and varicose veins (VV) present significant management challenges.
- Existing guidelines for CVD and VV treatment show variability in application.
- Inconsistent approaches exist in patient stratification and conservative therapy use.
Purpose of the Study:
- To establish expert consensus on managing chronic venous disease and varicose veins.
- To address key clinical questions regarding interventional and conservative treatment strategies.
- To provide practical guidance for individualized patient care in venous disease.
Main Methods:
- A multinational Delphi-like process involving 38 phlebologists from 15 countries.
- Four thematic workshops focused on interventional and conservative approaches for CVD and VV.
- Consensus was reached on 30 out of 34 statements (88%) using a 5-point Likert scale.
Main Results:
- Treatment decisions for CVD and VV should prioritize symptoms and quality of life over anatomy alone.
- Endovenous procedures are recommended for symptomatic disease; endovenous laser ablation and radiofrequency ablation are considered equivalent for VV.
- Diosmin-based venoactive drugs, with compression, are endorsed for symptom relief across CEAP classes.
Conclusions:
- Expert consensus offers practical guidance for individualized venous disease management.
- Highlights the need for improved risk stratification, patient adherence, and long-term outcome data.
- Emphasizes symptom-driven treatment strategies for chronic venous insufficiency and varicose veins.
Abstract:
Chronic venous disease and varicose veins (VVs) are highly prevalent yet remain inconsistently managed despite existing guidelines, with variability in treatment selection, patient stratification, and use of conservative therapies. This multinational initiative sought to establish expert consensus on key clinical questions in venous disease management. A Delphi-like process involved 38 phlebologists from 15 countries across Europe, North Africa, and Central Asia. Four thematic workshops addressed interventional and conservative approaches for both chronic venous disease and VV. Twenty predefined questions were discussed, and resulting statements were rated on a 5-point Likert scale, with consensus defined as ≥75% agreement. Of 34 proposed statements, 30 (88%) achieved consensus. The panel emphasized that treatment decisions should be driven primarily by symptoms and quality of life rather than anatomy alone. Endovenous procedures were supported for symptomatic disease, with endovenous laser ablation and radiofrequency ablation considered equivalent for VV. Diosmin-based venoactive drugs, often combined with compression, were endorsed across Clinical, Etiologic, Anatomic, and Pathophysiologic classes for symptom relief, although adherence to conservative therapy remains limited. This consensus provides practical guidance for individualized care and highlights unmet needs in risk stratification, adherence, and long-term comparative outcomes.
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