Management of Varicose Veins of the Lower Extremities. Part II

Authoring Organizations

Publication Month/Year

August 29, 2023

Supplemental Implementation Tools

Document Type


Country of Publication


Document Objectives

The Society for Vascular Surgery (SVS), the American Venous Forum (AVF), and the American Vein and Lymphatic Society (AVLS) recently published Part I of the 2022 clinical practice guidelines on varicose veins. Recommendations were based on the latest scientific evidence researched following an independent systematic review and meta-analysis of five critical issues affecting the management of patients with lower extremity varicose veins, using the PICO (patients, interventions, comparators, and outcome) system to answer critical questions. Part I discussed the role of duplex ultrasound scanning (DUS) in the evaluation of varicose veins and treatment of superficial truncal reflux. Part II focuses on evidence supporting the prevention and management of varicose vein patients with compression, on treatment with drugs and nutritional supplements, on evaluation and treatment of varicose tributaries, on superficial venous aneurysms, and on the management of complications of varicose veins and their treatment. All Guidelines were based on systematic reviews, and they were graded according to the level of evidence and the strength of recommendations, using the GRADE method. All ungraded Consensus Statements were supported by an extensive literature review and the unanimous agreement of an expert, multidisciplinary panel. Ungraded Good Practice Statements are recommendations that are supported only by indirect evidence. The topic, however, is usually non-controversial and agreed upon by most stakeholders. The Implementation Remarks contain technical information that supports the implementation of specific recommendations. This comprehensive document includes a list of all recommendations (Part I-II), ungraded consensus statements, implementation remarks, and best practice statements to aid practitioners with appropriate, up-to-date management of patients with lower extremity varicose veins.

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Diagnosis, Assessment and screening, Treatment, Management

Diseases/Conditions (MeSH)

D014648 - Varicose Veins


varicose veins, Venous insufficiency

Source Citation

Gloviczki P, Lawrence PF, Wasan SM, Meissner MH, Almeida J, Brown KR, Bush RL, Di Iorio M, Fish J, Fukaya E, Gloviczki ML, Hingorani A, Jayaraj A, Kolluri R, Murad MH, Obi AT, Ozsvath KJ, Singh MJ, Vayuvegula S, Welch HJ. The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society Clinical Practice Guidelines for the Management of Varicose Veins of the Lower Extremities. Part II. J Vasc Surg Venous Lymphat Disord. 2023 Aug 29:S2213-333X(23)00322-0. doi: 10.1016/j.jvsv.2023.08.011. Epub ahead of print. PMID: 37652254.


Number of Source Documents
Literature Search Start Date
December 7, 2020
Literature Search End Date
January 31, 2023