- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
On January 11, 2022, the European Society of Vascular Surgery (ESVS) completed its first update in the “European Society for Vascular Surgery 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs” since 2015. Based on the existing literatures and expert consensus, the guidelines added and revised the treatment strategies, postoperative monitoring, and postoperative anticoagulation of superficial venous insufficiency of the lower extremities and pelvic venous diseases. The new and modified parts will be interpreted.
Citation: CHEN Guoxin, WU Zhoupeng. Interpretation of “European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs”. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(3): 308-314. doi: 10.7507/1007-9424.202201044 Copy
1. | De Maeseneer MG, Kakkos SK, Aherne T, et al. European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg, 2022 Jan 10. Online ahead of print. doi: 10.1016/j.ejvs.2021.12.024. |
2. | Alvarez OM, Markowitz L, Parker R, et al. Faster healing and a lower rate of recurrence of venous ulcers treated with intermittent pneumatic compression: results of a randomized controlled trial. Eplasty, 2020, 20: e6. PMCID: PMC7322110. |
3. | Ashby RL, Gabe R, Ali S, et al. Clinical and cost-effectiveness of compression hosiery versus compression bandages in treatment of venous leg ulcers (venous leg ulcer study Ⅳ, VenUS Ⅳ): a randomised controlled trial. Lancet, 2014, 383(9920): 871-879. |
4. | Azirar S, Appelen D, Prins MH, et al. Compression therapy for treating post-thrombotic syndrome. Cochrane Database Syst Rev, 2019, 9(9): CD004177. doi: 10.12968/bjcn.2020.25.4.202. |
5. | Clarke-Moloney M, Keane N, O’Connor V, et al. Randomised controlled trial comparing European standard class 1 to class 2 compression stockings for ulcer recurrence and patient compliance. Int Wound J, 2014, 11(4): 404-408. |
6. | Dolibog P, Franek A, Taradaj J, et al. A comparative clinical study on five types of compression therapy in patients with venous leg ulcers. Int J Med Sci, 2013, 11(1): 34-43. |
7. | Jünger M, Wollina U, Kohnen R, et al. Efficacy and tolerability of an ulcer compression stocking for therapy of chronic venous ulcer compared with a below-knee compression bandage: results from a prospective, randomized, multicentre trial. Curr Med Res Opin, 2004, 20(10): 1613-1623. |
8. | Milic DJ, Zivic SS, Bogdanovic DC, et al. A randomized trial of class 2 and class 3 elastic compression in the prevention of recurrence of venous ulceration. J Vasc Surg Venous Lymphat Disord, 2018, 6(6): 717-723. |
9. | Mosti G, Cavezzi A, Massimetti G, et al. Recalcitrant venous leg ulcers may heal by outpatient treatment of venous disease even in the presence of concomitant arterial occlusive disease. Eur J Vasc Endovasc Surg, 2016, 52(3): 385-391. |
10. | Mosti G, Mancini S, Bruni S, et al. Adjustable compression wrap devices are cheaper and more effective than inelastic bandages for venous leg ulcer healing. A multicentric Italian randomized clinical experience. Phlebology, 2020, 35(2): 124-133. |
11. | O’Meara S, Cullum N, Nelson EA, et al. Compression for venous leg ulcers. Cochrane Database Syst Rev, 2012, 11(11): CD000265. doi: 10.1002/14651858.CD000265.pub3. |
12. | Stansal A, Tella E, Yannoutsos A, et al. Supervised short-stretch compression therapy in mixed leg ulcers. J Med Vasc, 2018, 43(4): 225-230. |
13. | Vandongen YK, Stacey MC. Graduated compression elastic stockings reduce lipodermatosclerosis and ulcer recurrence. Phlebology, 2000, 15(1): 33-37. |
14. | Kakkos SK, Timpilis M, Patrinos P, et al. Acute effects of graduated elastic compression stockings in patients with symptomatic varicose veins: a randomised double blind placebo controlled trial. Eur J Vasc Endovasc Surg, 2018, 55(1): 118-125. |
15. | Benigni JP, Sadoun S, Allaert FA, et al. Efficacy of class 1 elastic compression stockings in the early stages of chronic venous disease. A comparative study. Int Angiol, 2003, 22(4): 383-392. |
16. | Gürdal Karakelle S, Ipek Y, Tulin O, et al. The efficiency of exercise training in patients with venous insufficiency: a double blinded, randomized controlled trial. Phlebology, 2021, 36(6): 440-449. |
17. | Araujo DN, Ribeiro CT, Maciel AC, et al. Physical exercise for the treatment of non-ulcerated chronic venous insufficiency. Cochrane Database Syst Rev, 2016, 12(12): CD010637. doi: 10.1002/14651858.CD010637.pub2. |
18. | Shaalan W, El Emam A, Lotfy H, et al. Clinical and hemodynamic outcome of morbidly obese patients with severe chronic venous insufficiency with and without bariatric surgery. J Vasc Surg Venous Lymphat Disord, 2021, 9(5): 1248-1256. |
19. | Kakkos SK, Papageorgopoulou CP, Nikolakopoulos KM, et al. Validation of the 3D SYM VEIN symptom assessment tool. Eur J Vasc Endovasc Surg, 2020, 60(4): 587-593. |
20. | Carradice D, Wallace T, Gohil R, et al. A comparison of the effectiveness of treating those with and without the complications of superficial venous insufficiency. Ann Surg, 2014, 260(2): 396-401. |
21. | Kahn SR, Shrier I, Shapiro S, et al. Six-month exercise training program to treat post-thrombotic syndrome: a randomized controlled two-centre trial. CMAJ, 2011, 183(1): 37-44. |
22. | San Norberto García EM, Merino B, Taylor JH, et al. Low-molecular-weight heparin for prevention of venous thromboembolism after varicose vein surgery in moderate-risk patients: a randomized, controlled trial. Ann Vasc Surg, 2013, 27(7): 940-946. |
23. | Wang H, Sun Z, Jiang W, et al. Postoperative prophylaxis of venous thromboembolism (VTE) in patients undergoing high ligation and stripping of the great saphenous vein (GSV). Vasc Med, 2015, 20(2): 117-121. |
24. | Masuda E, Ozsvath K, Vossler J, et al. The 2020 appropriate use criteria for chronic lower extremity venous disease of the American Venous Forum, the Society for Vascular Surgery, the American Vein and Lymphatic Society, and the Society of Interventional Radiology. J Vasc Surg Venous Lymphat Disord, 2020, 8(4): 505-525. |
25. | Knipp BS, Blackburn SA, Bloom JR, et al. Endovenous laser ablation: venous outcomes and thrombotic complications are independent of the presence of deep venous insufficiency. J Vasc Surg, 2008, 48(6): 1538-1545. |
26. | Marston WA, Brabham VW, Mendes R, et al. The importance of deep venous reflux velocity as a determinant of outcome in patients with combined superficial and deep venous reflux treated with endovenous saphenous ablation. J Vasc Surg, 2008, 48(2): 400-406 . |
27. | Gauw SA, Lawson JA, van Vlijmen-van Keulen CJ, et al. Five-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg, 2016, 63(2): 420-428. |
28. | Rasmussen LH, Lawaetz M, Bjoern L, et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg, 2011, 98(8): 1079-1087. |
29. | Rass K, Frings N, Glowacki P, et al. Same site recurrence is more frequent after endovenous laser ablation compared with high ligation and stripping of the great saphenous vein: 5 year results of a randomized clinical trial (RELACS study). Eur J Vasc Endovasc Surg, 2015, 50(5): 648-656. |
30. | De Hert S, De Baerdemaeker L, De Maeseneer M. What the phlebologist should know about local anesthetics. Phlebology, 2014, 29(7): 428-441. |
31. | Nandhra S, Wallace T, El-Sheikha J, et al. A randomised clinical trial of buffered tumescent local anaesthesia during endothermal ablation for superficial venous incompetence. Eur J Vasc Endovasc Surg, 2018, 56(5): 699-708. |
32. | Huang TW, Chen SL, Bai CH, et al. The optimal duration of compression therapy following varicose vein surgery: a meta-analysis of randomized controlled trials. Eur J Vasc Endovasc Surg, 2013, 45(4): 397-402. |
33. | Chou JH, Chen SY, Chen YT, et al. Optimal duration of compression stocking therapy following endovenous thermal ablation for great saphenous vein insufficiency: a meta-analysis. Int J Surg, 2019, 65: 113-119. |
34. | Dabbs EB, Mainsiouw LE, Holdstock JM, et al. A description of the ‘smile sign’ and multi-pass technique for endovenous laser ablation of large diameter great saphenous veins. Phlebology, 2018, 33(8): 534-539. |
35. | Woo HY, Kim SM, Kim D, et al. Outcome of ClosureFAST radiofrequency ablation for large-diameter incompetent great saphenous vein. Ann Surg Treat Res, 2019, 96(6): 313-318. |
36. | Malskat WSJ, Engels LK, Hollestein LM, et al. Commonly used endovenous laser ablation (EVLA) parameters do not influence efficacy: results of a systematic review and meta-analysis. Eur J Vasc Endovasc Surg, 2019, 58(2): 230-242. |
37. | Paravastu SC, Horne M, Dodd PD. Endovenous ablation therapy (laser or radiofrequency) or foam sclerotherapy versus conventional surgical repair for short saphenous varicose veins. Cochrane Database Syst Rev, 2016, 11(11): CD010878. doi: 10.1002/14651858.CD010878.pub2. |
38. | Doganci S, Yildirim V, Demirkilic U. Does puncture site affect the rate of nerve injuries following endovenous laser ablation of the small saphenous veins? Eur J Vasc Endovasc Surg, 2011, 41(3): 400-405. |
39. | Brittenden J, Cotton SC, Elders A, et al. A randomized trial comparing treatments for varicose veins. N Engl J Med, 2014, 371(13): 1218-1227. |
40. | Nandhra S, El-sheikha J, Carradice D, et al. A randomized clinical trial of endovenous laser ablation versus conventional surgery for small saphenous varicose veins. J Vasc Surg, 2015, 61(3): 741-746. |
41. | Roopram AD, Lind MY, Van Brussel JP, et al. Endovenous laser ablation versus conventional surgery in the treatment of small saphenous vein incompetence. J Vasc Surg Venous Lymphat Disord, 2013, 1(4): 357-363. |
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44. | Eroglu E, Yasim A. A randomised clinical trial comparing N-Butyl cyanoacrylate, radiofrequency ablation and endovenous laser ablation for the treatment of superficial venous incompetence: two year follow up results. Eur J Vasc Endovasc Surg, 2018, 56(4): 553-560. |
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46. | Venermo M, Saarinen J, Eskelinen E, et al. Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy for the treatment of great saphenous varicose veins. Br J Surg, 2016, 103(11): 1438-1444. |
47. | Shadid N, Nelemans P, Lawson J, et al. Predictors of recurrence of great saphenous vein reflux following treatment with ultrasound-guided foamsclerotherapy. Phlebology, 2015, 30(3): 194-199. |
48. | Morrison N, Gibson K, Vasquez M, et al. Five-year extension study of patients from a randomized clinical trial (VeClose) comparing cyanoacrylate closure versus radiofrequency ablation for the treatment of incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord, 2020, 8(6): 978-989. |
49. | Vos CG, Ünlü Ç, Bosma J, et al. A systematic review and meta-analysis of two novel techniques of nonthermal endovenous ablation of the great saphenous vein. J Vasc Surg Venous Lymphat Disord, 2017, 5(6): 880-896. |
50. | Myers KA, Jolley D, Clough A, et al. Outcome of ultrasound-guided sclerotherapy for varicose veins: medium-term results assessed by ultrasound surveillance. Eur J Vasc Endovasc Surg, 2007, 33(1): 116-121. |
51. | Zhang J, Jing Z, Schliephake DE, et al. Efficacy and safety of Aethoxysklerol® (polidocanol) 0.5%, 1% and 3% in comparison with placebo solution for the treatment of varicose veins of the lower extremities in Chinese patients (ESA-China Study). Phlebology, 2012, 27(4): 184-190. |
52. | Michaels JA, Campbell WB, Brazier JE, et al. Randomised clinical trial, observational study and assessment of cost-effectiveness of the treatment of varicose veins (REACTIV trial). Health Technol Assess, 2006, 10(13): 1-196. |
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54. | Vasquez M, Gasparis AP. A multicenter, randomized, placebo-controlled trial of endovenous thermal ablation with or without polidocanol endovenous microfoam treatment in patients with great saphenous vein incompetence and visible varicosities. Phlebology, 2017, 32(4): 272-281. |
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57. | Richards T, Anwar M, Beshr M, et al. Systematic review of ambulatory selective variceal ablation under local anesthetic technique for the treatment of symptomatic varicose veins. J Vasc Surg Venous Lymphat Disord, 2021, 9(2): 525-535. |
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- 1. De Maeseneer MG, Kakkos SK, Aherne T, et al. European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg, 2022 Jan 10. Online ahead of print. doi: 10.1016/j.ejvs.2021.12.024.
- 2. Alvarez OM, Markowitz L, Parker R, et al. Faster healing and a lower rate of recurrence of venous ulcers treated with intermittent pneumatic compression: results of a randomized controlled trial. Eplasty, 2020, 20: e6. PMCID: PMC7322110.
- 3. Ashby RL, Gabe R, Ali S, et al. Clinical and cost-effectiveness of compression hosiery versus compression bandages in treatment of venous leg ulcers (venous leg ulcer study Ⅳ, VenUS Ⅳ): a randomised controlled trial. Lancet, 2014, 383(9920): 871-879.
- 4. Azirar S, Appelen D, Prins MH, et al. Compression therapy for treating post-thrombotic syndrome. Cochrane Database Syst Rev, 2019, 9(9): CD004177. doi: 10.12968/bjcn.2020.25.4.202.
- 5. Clarke-Moloney M, Keane N, O’Connor V, et al. Randomised controlled trial comparing European standard class 1 to class 2 compression stockings for ulcer recurrence and patient compliance. Int Wound J, 2014, 11(4): 404-408.
- 6. Dolibog P, Franek A, Taradaj J, et al. A comparative clinical study on five types of compression therapy in patients with venous leg ulcers. Int J Med Sci, 2013, 11(1): 34-43.
- 7. Jünger M, Wollina U, Kohnen R, et al. Efficacy and tolerability of an ulcer compression stocking for therapy of chronic venous ulcer compared with a below-knee compression bandage: results from a prospective, randomized, multicentre trial. Curr Med Res Opin, 2004, 20(10): 1613-1623.
- 8. Milic DJ, Zivic SS, Bogdanovic DC, et al. A randomized trial of class 2 and class 3 elastic compression in the prevention of recurrence of venous ulceration. J Vasc Surg Venous Lymphat Disord, 2018, 6(6): 717-723.
- 9. Mosti G, Cavezzi A, Massimetti G, et al. Recalcitrant venous leg ulcers may heal by outpatient treatment of venous disease even in the presence of concomitant arterial occlusive disease. Eur J Vasc Endovasc Surg, 2016, 52(3): 385-391.
- 10. Mosti G, Mancini S, Bruni S, et al. Adjustable compression wrap devices are cheaper and more effective than inelastic bandages for venous leg ulcer healing. A multicentric Italian randomized clinical experience. Phlebology, 2020, 35(2): 124-133.
- 11. O’Meara S, Cullum N, Nelson EA, et al. Compression for venous leg ulcers. Cochrane Database Syst Rev, 2012, 11(11): CD000265. doi: 10.1002/14651858.CD000265.pub3.
- 12. Stansal A, Tella E, Yannoutsos A, et al. Supervised short-stretch compression therapy in mixed leg ulcers. J Med Vasc, 2018, 43(4): 225-230.
- 13. Vandongen YK, Stacey MC. Graduated compression elastic stockings reduce lipodermatosclerosis and ulcer recurrence. Phlebology, 2000, 15(1): 33-37.
- 14. Kakkos SK, Timpilis M, Patrinos P, et al. Acute effects of graduated elastic compression stockings in patients with symptomatic varicose veins: a randomised double blind placebo controlled trial. Eur J Vasc Endovasc Surg, 2018, 55(1): 118-125.
- 15. Benigni JP, Sadoun S, Allaert FA, et al. Efficacy of class 1 elastic compression stockings in the early stages of chronic venous disease. A comparative study. Int Angiol, 2003, 22(4): 383-392.
- 16. Gürdal Karakelle S, Ipek Y, Tulin O, et al. The efficiency of exercise training in patients with venous insufficiency: a double blinded, randomized controlled trial. Phlebology, 2021, 36(6): 440-449.
- 17. Araujo DN, Ribeiro CT, Maciel AC, et al. Physical exercise for the treatment of non-ulcerated chronic venous insufficiency. Cochrane Database Syst Rev, 2016, 12(12): CD010637. doi: 10.1002/14651858.CD010637.pub2.
- 18. Shaalan W, El Emam A, Lotfy H, et al. Clinical and hemodynamic outcome of morbidly obese patients with severe chronic venous insufficiency with and without bariatric surgery. J Vasc Surg Venous Lymphat Disord, 2021, 9(5): 1248-1256.
- 19. Kakkos SK, Papageorgopoulou CP, Nikolakopoulos KM, et al. Validation of the 3D SYM VEIN symptom assessment tool. Eur J Vasc Endovasc Surg, 2020, 60(4): 587-593.
- 20. Carradice D, Wallace T, Gohil R, et al. A comparison of the effectiveness of treating those with and without the complications of superficial venous insufficiency. Ann Surg, 2014, 260(2): 396-401.
- 21. Kahn SR, Shrier I, Shapiro S, et al. Six-month exercise training program to treat post-thrombotic syndrome: a randomized controlled two-centre trial. CMAJ, 2011, 183(1): 37-44.
- 22. San Norberto García EM, Merino B, Taylor JH, et al. Low-molecular-weight heparin for prevention of venous thromboembolism after varicose vein surgery in moderate-risk patients: a randomized, controlled trial. Ann Vasc Surg, 2013, 27(7): 940-946.
- 23. Wang H, Sun Z, Jiang W, et al. Postoperative prophylaxis of venous thromboembolism (VTE) in patients undergoing high ligation and stripping of the great saphenous vein (GSV). Vasc Med, 2015, 20(2): 117-121.
- 24. Masuda E, Ozsvath K, Vossler J, et al. The 2020 appropriate use criteria for chronic lower extremity venous disease of the American Venous Forum, the Society for Vascular Surgery, the American Vein and Lymphatic Society, and the Society of Interventional Radiology. J Vasc Surg Venous Lymphat Disord, 2020, 8(4): 505-525.
- 25. Knipp BS, Blackburn SA, Bloom JR, et al. Endovenous laser ablation: venous outcomes and thrombotic complications are independent of the presence of deep venous insufficiency. J Vasc Surg, 2008, 48(6): 1538-1545.
- 26. Marston WA, Brabham VW, Mendes R, et al. The importance of deep venous reflux velocity as a determinant of outcome in patients with combined superficial and deep venous reflux treated with endovenous saphenous ablation. J Vasc Surg, 2008, 48(2): 400-406 .
- 27. Gauw SA, Lawson JA, van Vlijmen-van Keulen CJ, et al. Five-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg, 2016, 63(2): 420-428.
- 28. Rasmussen LH, Lawaetz M, Bjoern L, et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg, 2011, 98(8): 1079-1087.
- 29. Rass K, Frings N, Glowacki P, et al. Same site recurrence is more frequent after endovenous laser ablation compared with high ligation and stripping of the great saphenous vein: 5 year results of a randomized clinical trial (RELACS study). Eur J Vasc Endovasc Surg, 2015, 50(5): 648-656.
- 30. De Hert S, De Baerdemaeker L, De Maeseneer M. What the phlebologist should know about local anesthetics. Phlebology, 2014, 29(7): 428-441.
- 31. Nandhra S, Wallace T, El-Sheikha J, et al. A randomised clinical trial of buffered tumescent local anaesthesia during endothermal ablation for superficial venous incompetence. Eur J Vasc Endovasc Surg, 2018, 56(5): 699-708.
- 32. Huang TW, Chen SL, Bai CH, et al. The optimal duration of compression therapy following varicose vein surgery: a meta-analysis of randomized controlled trials. Eur J Vasc Endovasc Surg, 2013, 45(4): 397-402.
- 33. Chou JH, Chen SY, Chen YT, et al. Optimal duration of compression stocking therapy following endovenous thermal ablation for great saphenous vein insufficiency: a meta-analysis. Int J Surg, 2019, 65: 113-119.
- 34. Dabbs EB, Mainsiouw LE, Holdstock JM, et al. A description of the ‘smile sign’ and multi-pass technique for endovenous laser ablation of large diameter great saphenous veins. Phlebology, 2018, 33(8): 534-539.
- 35. Woo HY, Kim SM, Kim D, et al. Outcome of ClosureFAST radiofrequency ablation for large-diameter incompetent great saphenous vein. Ann Surg Treat Res, 2019, 96(6): 313-318.
- 36. Malskat WSJ, Engels LK, Hollestein LM, et al. Commonly used endovenous laser ablation (EVLA) parameters do not influence efficacy: results of a systematic review and meta-analysis. Eur J Vasc Endovasc Surg, 2019, 58(2): 230-242.
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