The Treatment of Venous Disease in North America

Abstract

During the past 15 years treatment of chronic venous insufficiency (CVI) has dramatically changed in North America. In the US, approximately 13 % of men and 22 % of women have venous insufficiency as determined by the San Diego Population Study (Robertson et al., Phlebology 23:103–111, 2008). The advent of minimally invasive vein procedures combined with reimbursement charges have created a paradigm shift in the treatment of CVI. Since 2008, there has been a significant increase in the number of office based procedures and now these represent the standard of care. The increase of office procedures is presumed to be due to an expanding number of non-surgical specialists performing vein procedures, changes in office based reimbursement patterns, industry sponsored advertising and the advancement of technology. The Society for Vascular Surgery (SVS), American Venous Forum (AVF) and American College of Phlebology (ACP) have published guidelines for the treatment of CVI, emphasizing the importance of initial conservative therapy followed by minimally invasive endovascular interventions for patients that have failed to respond favorably (Gloviczki et al., J Vasc Surg 53:2S–48S, 2011; Eklof et al., J Vasc Surg 40:1248–1252, 2004). Technology advancements appear to have increased patient satisfaction and improved the morbidity associated with vein procedures. It’s apparent that therapeutic treatment options should cater to the individual all the while establishing realistic expectations for each patient. Recently, the US Food and Drug Administration approved several new venous treatment methods that may complement or replace current vein treatments. Guidance for future treatment of CVI will require updated societal guidelines, site accreditation, physician certification and large-scale randomized control trials.