Optimising the management of venous disease: Expert consensus from a multinational panel of phlebology specialists

Chronic venous disease and varicose veins (VVs) are highly prevalent yet remain inconsistently managed despite existing guidelines, with variability in treatment selection, patient stratification, and use of conservative therapies. This multinational initiative sought to establish expert consensus on key clinical questions in venous disease management. A Delphi-like process involved 38 phlebologists from 15 countries across Europe, North Africa, and Central Asia. Four thematic workshops addressed interventional and conservative approaches for both chronic venous disease and VV. Twenty predefined questions were discussed, and resulting statements were rated on a 5-point Likert scale, with consensus defined as ≥75% agreement. Of 34 proposed statements, 30 (88%) achieved consensus. The panel emphasized that treatment decisions should be driven primarily by symptoms and quality of life rather than anatomy alone. Endovenous procedures were supported for symptomatic disease, with endovenous laser ablation and radiofrequency ablation considered equivalent for VV. Diosmin-based venoactive drugs, often combined with compression, were endorsed across Clinical, Etiologic, Anatomic, and Pathophysiologic classes for symptom relief, although adherence to conservative therapy remains limited. This consensus provides practical guidance for individualized care and highlights unmet needs in risk stratification, adherence, and long-term comparative outcomes.