• In the United States, an estimated 23% of adults have varicose veins, and 6% have more advanced chronic venous disease (CVD), including skin changes and healed or active venous ulcers. Varicose veins have long been considered a cosmetic problem that only affected emotional well-being but were not the source of disability. Varicosities, however, are frequently the cause of discomfort, pain, loss of working days, disability, and deterioration of health-related quality of life (QOL). Severe CVD may also lead to loss of limb or loss of life.
• Evaluation of varicose veins has greatly progressed in the past 2 decades with the widespread availability of duplex ultrasonography. The treatment of varicose veins has also undergone dramatic changes with the introduction of percutaneous endovenous ablation techniques, including endovenous laser therapy (EVLA), radiofrequency ablation (RFA), and liquid or foam sclerotherapy. Open surgical treatment with stripping of the varicose veins performed under general anesthesia, with the associated pain, potential for wound complications, and loss of working days, has been largely replaced by percutaneous office-based procedures that can be performed under local or tumescent anesthesia with similar early and midterm results but with less discomfort to the patient, improved early QOL, and earlier return to work.
• The purpose of this document is to report recently formulated current recommendations for the evaluation and treatment of patients with varicose veins of the lower limbs and pelvis. These Guidelines also include recommendations for management of superficial and perforating vein incompetence in patients with associated, more advanced CVDs, such as venous edema, skin changes, or ulcerations. To accomplish this task, a joint Venous Guideline Committee of the Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) was established.
• Under no circumstance should these Guidelines be construed in practice or legal terms as defining the “standard of care,” which is solely determined by the condition of the individual patient, treatment setting, and other factors. Individual factors in a given patient, such as symptom variance or combinations, comorbidities, work, and socioeconomic factors may dictate a different approach than that described in the Guidelines. Because technology and disease knowledge is rapidly expanding, new approaches may supersede these recommendations. As important new information on management of varicose veins and related CVD becomes available, these recommendations will be revised without delay.