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.

Background: Stimulated by published reports of potentially inappropriate application of venous procedures, the American Venous Forum and its Ethics Task Force in collaboration with multiple other professional societies including the Society for Vascular Surgery (SVS), American Vein and Lymphatic Society (AVLS), and the Society of Interventional Radiology (SIR) developed the appropriate use criteria (AUC) for chronic lower extremity venous disease to provide clarity to the application of venous procedures, duplex ultrasound imaging, timing, and reimbursements.

Methods: The AUC were developed using the RAND/UCLA Appropriateness Method, a validated method of developing appropriateness criteria in health care. By conducting a modified Delphi exercise and incorporating best available evidence and expert opinion, AUC were developed and scored.

The 2020 update of the CEAP classification system and reporting standards.

The CEAP (Clinical-Etiology-Anatomy-Pathophysiology) classification is an internationally accepted standard for describing patients with chronic venous disorders and it has been used for reporting clinical research findings in scientific journals. Developed in 1993, updated in 1996, and revised in 2004, CEAP is a classification system based on clinical manifestations of chronic venous disorders, on current understanding of the etiology, the involved anatomy, and the underlying venous pathology. As the evidence related to these aspects of venous disorders, and specifically of chronic venous diseases (CVD, C2-C6) continue to develop, the CEAP classification needs periodic analysis and revisions.

Venous hemodynamic changes in lower limb venous disease: the UIP consensus according to scientific evidence.

There are excellent guidelines for clinicians to manage venous diseases but few reviews to assess their hemodynamic background. Hemodynamic concepts that evolved in the past have largely remained unchallenged in recent decades, perhaps due to their often complicated nature and in part due to emergence of new diagnostic techniques. Duplex ultrasound scanning and other imaging techniques which evolved in the latter part of the 20th century have dominated investigation.

Thrombophilia testing has limited usefulness in clinical decision-making and should be used selectively.

Management of venous thromboembolism (VTE) includes evaluation for hypercoagulable state, especially if the VTE occurs in young patients, is recurrent, or is associated with a positive family history. These laboratory tests are costly, and surprisingly, there is little evidence showing that testing leads to improved clinical outcomes. Evidence based on observational prospective studies suggests that optimal duration of anticoagulation should be based on clinical risks resulting in VTE, such as transient, permanent, and idiopathic or unprovoked risks, and less on abnormal thrombophilia values.

Pretreatment elevated D-dimer levels without systemic inflammatory response are associated with thrombotic complications of thermal ablation of the great saphenous vein.

Objective: To examine possible association of plasma levels of biomarkers of inflammation and hemostatic activation with the incidence of thrombotic complications after thermal ablation of the great saphenous vein (GSV).

Methods: This was a prospective cohort study of 120 patients with primary chronic venous disease and reflux limited to the GSV and its tributaries, who were to undergo treatment with radiofrequency ablation of the GSV. Plasma concentration of C-reactive protein (high-sensitivity CRP) and D-dimer were measured immediately prior to the ablation procedure, and in 64 patients, at 20 to 36 hours, 1 week, and 1 month after the treatment.

On the existence of helical flow in veins of the lower extremities.

Purpose: Helical flow has been shown to be present in the heart and arteries, but its existence in veins has not been demonstrated before. This study aimed to investigate if helical flow is present in the venous system and if the venous valves contribute to development of this flow pattern.

Methods: Color and spectral Doppler were used to calculate the true velocity vectors at five cross-sectional planes of the femoral and common femoral veins in 10 healthy individuals and eight patients with chronic venous disease.

Multicenter assessment of venous reflux by duplex ultrasound.

Objective: This prospective multicenter investigation was conducted to define the repeatability of duplex-based identification of venous reflux and the relative effect of key parameters on the reproducibility of the test.

Methods: Repeatability was studied by having the same technologist perform duplicate tests, at the same time of the day, using the same reflux-provoking maneuver and with the patient in the same position. Reproducibility was examined by having two different technologists perform the test at the same time of the day, using the same reflux-provoking maneuver and with the patient in the same position.

The controversy of managing calf vein thrombosis.

Background: Controversy persists as to whether all calf vein thrombi should be treated with anticoagulation or observed with duplex surveillance. We performed a systematic review of the literature to assess whether data could support either approach, followed by examination of its natural history by stratifying results according to early clot propagation, pulmonary emboli (PE), recurrence, and postthrombotic syndrome (PTS).

Methods: A total of 1513 articles were reviewed that were published from January 1975 to August 2010 using computerized database searches of PubMed, Cochrane Controlled Trials Register, and extensive cross-references.

Trends in patient reported outcomes of conservative and surgical treatment of primary chronic venous disease contradict current practices.

Objective: To analyze patient-reported quality of life (QOL) and symptoms in a prospective cohort of CVD patients who was managed within the framework of existing policies.

Study Design: Prospective cohort study of 150 patients with C2-C4 clinical class of primary chronic venous disease (CVD). Management consisted of initial conservative measures, following which, the patients were given a choice of continuing conservative therapy, or surgical treatment.

In prospective study using Specific Quality of Life & Outcomes Response-Venous (SQOR-V) questionnaire the recall bias had the same magnitude as the minimally important difference.

Objective: To assess whether the measurement error, and recall bias can reach magnitudes comparable to minimally important difference (MID) in symptoms scores used in chronic venous disease-specific quality of life QOL instruments, such as Specific Quality of Life & Outcomes Response-Venous (SQOR-V) questionnaire.

Methods: Prospective non-randomized study of 150 patients with primary chronic venous disease. SQOR-V questionnaire was administered prior to clinical visit (in 32 patients twice), and 1 month post-treatment.

Emerging treatment options for venous ulceration in today's wound care practice.

Unlabelled: Lower-extremity ulcers represent the largest group of ulcers presenting to an outpatient wound care clinic and, of those, ulcers due to venous insufficiency and venous hypertension make up the largest subgroup of these ulcers. Interventions for chronic venous ulcers have evolved to painless, minimally invasive, office-based procedures performed under local anesthesia. Recent advances in the endovascular management of lower-extremity superficial venous insufficiency have the potential to significantly enhance initial and long-term management of these patients, as minimally invasive procedures provide faster recoveries and fewer procedural risks.

On the mechanism of action of pneumatic compression devices: Combined magnetic resonance imaging and duplex ultrasound investigation.

Objective: This study investigated the relationships between the interface pressure produced by intermittent pneumatic compression (IPC) devices, the deformation of extremity tissues produced by this pressure, and changes in venous blood flow associated with this deformation by use of magnetic resonance imaging (MRI) and duplex ultrasound (DUS) imaging in addition to the pressure measurement.

Methods: The calf garments of two IPC devices (WizAir, Medical Compression Systems, Inc, Ltd, Or-Akiva, Israel; VenaFlow, AirCast Inc, Summit, NJ) were tested in five healthy volunteers. The interface pressure was measured with Tactilus Human Body Interface sensor system (Sensor Products Inc, Madison, NJ).

Primary chronic venous disorders.

Primary chronic venous disorders, which according to the CEAP classification are those not associated with an identifiable mechanism of venous dysfunction, are among the most common in Western populations. Varicose veins without skin changes are present in about 20% of the population while active ulcers may be present in as many as 0.5%.

Prevention of air travel-related deep venous thrombosis with mechanical devices: active foot movements produce similar hemodynamic effects.

Objective: We compared the hemodynamic effects of different mechanical devices aimed for prevention of travel-related deep venous thrombosis with active foot movements.

Methods: Two battery-operated intermittent pneumatic compression (IPC) devices and three foot and calf muscle pump facilitating devices (PFD) that claimed to prevent travel-related deep venous thrombosis were tested in 17 healthy volunteers on the ground and in 8 of same volunteers during flight. Flow changes during active foot movements were compared with the effects of each of the tested devices.

The effect of ultrasound-guided sclerotherapy of incompetent perforator veins on venous clinical severity and disability scores.

Purpose: Current techniques to treat venous ulcerations and patients with severe lipodermatosclerosis include the elimination of incompetent perforator veins by open surgical ligation and division or by subfascial endoscopic perforator surgery. An alternative and less invasive means to obliterate perforator veins is ultrasound-guided sclerotherapy (UGS). We hypothesize that UGS is a clinically effective means of eliminating perforator veins and results in improvement of the clinical state (scores) without the complications associated with other more invasive methods.

Revision of the CEAP classification for chronic venous disorders: consensus statement.

The CEAP classification for chronic venous disorders (CVD) was developed in 1994 by an international ad hoc committee of the American Venous Forum, endorsed by the Society for Vascular Surgery, and incorporated into "Reporting Standards in Venous Disease" in 1995. Today most published clinical papers on CVD use all or portions of CEAP. Rather than have it stand as a static classification system, an ad hoc committee of the American Venous Forum, working with an international liaison committee, has recommended a number of practical changes, detailed in this consensus report.