ANZSVS CLINICAL PRACTICE GUIDELINES ON DEEP VENOUS DISEASE. Part VENOUS OUTFLOW OBSTRUCTION OF THE FEMORO-ILIO-CAVAL VEINS.

The document addresses two key areas: patient selection and technical aspects of venous stenting. Regarding patient selection: Patients with a CEAP score 3 or above, a VCSS pain score 2 or above or both, and evidence of > 50% stenosis on venography/CTV/MRV/IVUS should be considered for venous stenting. Level of recommendation IB; Patients undergoing thrombus removal treatment for acute ilio-femoral DVT, in whom a culprit stenotic lesion has been uncovered, should be considered for venous stenting. Level of recommendation IB; Patients with chronic pelvic pain, deep dyspareunia, post-coital pain affecting quality of life, when other causes have been ruled out, should be considered for venous stenting. Level of recommendation IC. Asymptomatic patients should not be offered venous stenting. Level of recommendation IIIC CONCLUSION: Patients suffering from deep venous outflow obstruction have been underdiagnosed and undertreated for decades, but in recent years interest from physicians and industry has grown substantially. The advent of simpler and safer treatment options has revolutionized its management, but unfortunately, formal training for venous disease has not grown at the same rate. Simplifying the technology and training required can result in inconsistent outcomes. These guidelines are aimed at developing standards of care and will serve as an educational platform for future developments.