Review Synopsis of Guidelines for Patients with Chronic Venous Disease of the Legs

Goodman EA, Alexander JT, Babrowski TA. Care of Patients with Chronic Venous Disease of the Legs. JAMA. 2025; in press.

This easily readable article presented a summary of updated clinical practice guidelines for care of patients with chronic venous disease of the lower extremity. The guidelines were promulgated by the Society for Vascular Surgery, the American Venous Forum, and the American Vein and Lymphatic Society.

Clinical stages of venous disease include telangiectasias/reticular veins and varicose veins. Complications of varicose veins and deep vein thrombosis include leg edema, skin discoloration, and ulceration.

Important recommendations include omission of duplex ultrasound for patients with asymptomatic telangiectasia/reticular veins. Ultrasound is indicated for any patient with varicose veins and/or symptoms of chronic venous disease.

Treatments for mild disease include compression stockings and dietary supplements such as ruscus extract and micronized purified flavonoid fraction. Symptomatic telangiectasia/reticular veins are treated with sclerotherapy. Varicose vein treatments include ligation and stripping or endovenous ablation. Both treatments are supported by strong data.

The advantages of endovenous interventions are performance under local anesthesia and as an outpatient procedure. Guidelines for treatment of chronic venous disease-related edema and ulceration (other than compression stockings) were not included in the summary but can be found on the societies’ websites.