A Comparison of the Revised SVS/AVF/ASVL and ESVS Clinical Practice Guidelines (CPGs) in the Management of Varicose Veins (VVs)

Clinical Practice Guidelines (CPGs) are based on a systematic review of evidence to assess the benefits and harms of clinical recommendations for diagnosis and treatment. As a result, CPGs should undergo periodic revision as new evidence is developed. Two recently published CPGs (2022) are revisions of original guidelines addressing a common problem, varicose veins (VVs). Our objective was to compare the similarities and differences between the SVS/AVF/AVLS and the ESVS CPGs for treatment of C2 VVs.

 



Methods:

The 2022 SVS/AVF/AVLS (A) guidelines for VVs were compared to the 2022 ESVS (E) CPGs on VVs for: specific methodology, evidence development [ED], strength of recommendation (SOR), level (quality) of evidence (LOE). Individual guidelines addressing the interventional treatment (ITx) by thermal ablation (TA) or Non-thermal ablation (NTA) for reflux in the Great Saphenous vein (GSV), Small saphenous vein (SSV), Anterior accessory saphenous vein (AASV), and perforating veins (PV) in CEAP C2 patients were compared between the two guidelines.



Results:

The two CPGs differed in methodology and scope of content. Format E-component of larger CPG; A-separate publication specific to C2; Sponsor E- single society; A -three societies; Systematic Review and Meta-analysis E -internal; A -Independent group: Quality of Evidence and Recommendations criteria E -European Society of Cardiology (ESC) system, LOE = 3, SOR = 4; A -GRADE LOE = 3, SOR = 2: Patient input E -Formal; A -none specified.

Table I demonstrates that the strength of recommendation was relatively similar for most guidelines on intervention between the two CPGs, but the level of evidence was rated lower in A than E for treatment of GSV, SSV, and tributary incompetence. Since both CPGs had access to the same studies, this difference in LOE may be related to the hierarchy of evidence quality for outcomes employed by A. Patient reported outcome (PRO) measures at 5 years were rated specifically as the highest factor in the A guidelines, while this criterion was not explicitly stated in E. Formal patient input on CPGs was provided in E.



Conclusions: The methods for the two CPGs differed in several elements. E formally included patient value judgments and preferences in the CPG process. Although rating of recommendation strength was relatively similar overall for both, LOE was rated lower in A due to the specific requirements for the value of PROs and long-term outcomes.