The European Society for Vascular Surgery (ESVS) have published 2022 guidelines for the management of Chronic Venous Disease (CVD) of the lower limbs.
What’s new?
The diagnosis and categorization of PeVD have changed. Gone are the older terms of “Pelvic Congestion”, “May-Thurner” and “Nutcracker” syndromes. They were unhelpful in linking the pelvic symptoms with a patients pathology. The American Vein and Lymphatic Society have developed a new classification system for PeVD which has been included in the 2022 ESVS guidelines. It is called the SVP classification: Symptoms (S), Varices (V) and Pathophysiology (P). These occur in four anatomical zones of the abdomen and pelvis:
For patients with varicose veins and related symptoms of pelvic origin, this new SVP classification will be used in future research, in conjunction with Clinical Etiological Anatomical Pathophysiological (CEAP) classification.
For the first time, diagnosis and treatment have been recognized in the 2022 ESVS Guidelines. Below is a summary of section 7 -“The management of Pelvic Venous Disorders (PeVD) causing varicose veins.”
It is worth noting that these guidelines are written from the perspective of vascular surgeons and interventionalists. Their starting point is the presence of varicosities. From the point of view of a referrer (e.g. a gynaecologist), the starting point is the presence of pelvic symptoms. This is an important consideration when referring patients for treatment by vascular surgeons or interventionalists.
