SCAI Unveils First Clinical Guidelines for Chronic Venous Disease Management

On June 30, 2025, the Society for Cardiovascular Angiography and Interventions (SCAI) officially released its inaugural clinical practice guidelines for managing chronic venous disease (CVD). The comprehensive document comprises nine recommendations addressing eight distinct clinical scenarios, aiming to enhance the quality of care for millions of individuals affected by this condition. Notably, the guidelines advocate for personalized, evidence-based approaches to treatment, emphasizing the importance of tailored patient care.

Chronic venous disease, which can manifest as discomfort, heaviness, and swelling in the lower extremities, can lead to severe complications such as venous ulcers, drastically affecting patients' quality of life. Dr. Robert Attaran, MD, MBBS, Chair of the SCAI guideline writing community and member of the Vascular Disease Council, highlighted the significance of these guidelines at a time when the burden of CVD is increasingly recognized by healthcare professionals.

"These are the first SCAI guidelines focused on chronic venous disease, and they come at a time of increasing recognition of the burden it places on patients and healthcare systems," Dr. Attaran stated. "Our recommendations aim to provide clinicians and patients with a roadmap for personalized, evidence-informed care."

The guidelines outline various therapeutic options for practitioners, including compression therapy, wound care, ablation, sclerotherapy, phlebectomy, and deep vein stenting. The recommendations categorize treatment options as either 'strong' or 'conditional' based on the certainty of evidence and contextual factors, thereby guiding clinicians in their decision-making processes.

The creation of the guidelines was informed by a thorough technical review conducted by SCAI, which sought to answer eight specific research questions regarding treatment modalities for symptomatic varicose veins and venous ulceration. This review involved a systematic analysis of literature, beginning with the aggregation of 3,648 titles and abstracts, ultimately filtering down to 19 pertinent studies that shaped the final recommendations.

Each recommendation not only reflects the best available evidence but also recognizes existing uncertainties. For instance, the SCAI guidelines acknowledge gaps in the existing literature regarding the efficacy of various treatments on healing rates, symptom improvement, quality of life, and disease recurrence. Specifically, the panel noted that the evidence surrounding perforator vein ablation and other treatments remains inconclusive, prompting a call for further research in these areas.

In particular, the guidelines suggest additional studies focusing on specific ablation techniques for C2-C4 disease and the management of perforator and accessory reflux. Dr. Srihari Naidu, MD, president of SCAI, emphasized the organization's commitment to establishing high-quality, evidence-based standards in a field where interventional cardiologists are increasingly involved in CVD management.

"As interventional cardiologists take a larger role in managing chronic venous disease, a common problem affecting millions of people, these recommendations will help ensure that patient care remains both consistent and personalized," Dr. Naidu remarked.

The SCAI guidelines signify a pivotal moment in the management of chronic venous disease, offering a structured framework for clinicians and paving the way for improved patient outcomes. As the medical community continues to evolve its understanding of CVD, these guidelines will serve as a crucial resource for practitioners in their efforts to deliver effective, patient-centered care.