TY - JOUR
T1 - Editor's Choice – Management of Lower Extremity Venous Outflow Obstruction
T2 - Results of an International Delphi Consensus
AU - International Venous Delphi Consensus Study Group
AU - Black, Stephen A.
AU - Gohel, Manjit
AU - de Graaf, Rick
AU - Gagne, Paul
AU - Silver, Mitchell
AU - Fleck, Bruce
AU - Hofmann, Lawrence V.
AU - Abramowitz, Steve
AU - Al-Hakim, Ramsey
AU - Almeida, Jose
AU - Avgerinos, Efthymios
AU - Bashir, Riyaz
AU - Binkert, Cristoph
AU - Bismuth, Jean
AU - Bjarnason, Haroldur
AU - Black, Stephen
AU - Chaer, Rabih
AU - Comerota, Tony
AU - Davies, Alun
AU - DeRubertis, Brian
AU - Desai, Kush
AU - Dexter, David
AU - Dillavou, Ellen
AU - Dumantepe, Mert
AU - Elias, Steve
AU - Fastabend, Carl
AU - Garcia, Mark
AU - Gasparis, Tony
AU - George, Jon
AU - Gibson, Kathy
AU - Gillespie, David
AU - Guimaraes, Marcelo
AU - Henke, Peter
AU - Hernandez, Diego
AU - Hofmann, Lawrence
AU - Hsu, Wan hsien
AU - Jalaie, Houman
AU - Jolly, Michael
AU - Kabnick, Lowell
AU - Karunanithy, Narayan
AU - Kaufmann, John
AU - Khaja, Minhaj
AU - Kokkosis, Angela
AU - Kolli, Kanti
AU - Kolluri, Raghu
AU - Kuo, Will
AU - Labropoulos, Nicos
AU - Lessne, Mark
AU - Leung, Daniel
AU - Lichtenberg, Michael
N1 - Publisher Copyright:
© 2023 European Society for Vascular Surgery
PY - 2024/2
Y1 - 2024/2
N2 - Objective: The endovascular treatment of venous obstruction has expanded significantly in recent years. Best practices for optimal patient outcomes are not well established and the evidence base is poor. The purpose of this study was to obtain consensus on management criteria for patients with lower extremity venous outflow obstruction. Methods: The study was conducted as a two round Delphi consensus. Statements addressed imaging, symptoms and other baseline measures, differential diagnosis, treatment algorithm, indications for stenting, inflow and outflow assessment, successful procedural outcomes, post-procedure therapies and stent surveillance, and clinical success factors. Statements were prepared by six expert physicians (round 1, 40 statements) and an expanded panel of 24 physicians (round 2, 80 statements) and sent to a pre-identified group of venous experts who met qualifying criteria. A 9 point Likert scale was used and consensus was defined as ≥ 70% of respondents rating a statement between 7 and 9 (agreement) or between 1 and 3 (disagreement). Round 1 results were used to guide rewording and splitting compound statements for greater clarity in round 2. Results: In round 1, 75 of 110 (68%) experts responded, and 91 of 121 (75%) experts responded in round 2. Round 1 achieved consensus in 32/40 (80%) statements. Consensus was not reached in the treatment algorithm section. Round 2 achieved consensus in 50/80 (62.5%). Statements reaching consensus were imaging (2/3, 66%), symptoms and other baseline measures (12/24, 50%), differential diagnosis (2/8, 25%), treatment algorithm (10/17, 59%), indications for stenting (10/10, 100%), inflow and outflow assessment (2/2, 100%), procedural outcomes (2/2, 100%), post-procedure therapies and stent surveillance, (5/7, 71%), and clinical success factors (5/7, 71%). Conclusion: This study demonstrated that considerable consensus was achieved between venous experts on the optimal management of lower extremity venous outflow obstruction. There were multiple domains where consensus is lacking, highlighting important areas for further investigation and research.
AB - Objective: The endovascular treatment of venous obstruction has expanded significantly in recent years. Best practices for optimal patient outcomes are not well established and the evidence base is poor. The purpose of this study was to obtain consensus on management criteria for patients with lower extremity venous outflow obstruction. Methods: The study was conducted as a two round Delphi consensus. Statements addressed imaging, symptoms and other baseline measures, differential diagnosis, treatment algorithm, indications for stenting, inflow and outflow assessment, successful procedural outcomes, post-procedure therapies and stent surveillance, and clinical success factors. Statements were prepared by six expert physicians (round 1, 40 statements) and an expanded panel of 24 physicians (round 2, 80 statements) and sent to a pre-identified group of venous experts who met qualifying criteria. A 9 point Likert scale was used and consensus was defined as ≥ 70% of respondents rating a statement between 7 and 9 (agreement) or between 1 and 3 (disagreement). Round 1 results were used to guide rewording and splitting compound statements for greater clarity in round 2. Results: In round 1, 75 of 110 (68%) experts responded, and 91 of 121 (75%) experts responded in round 2. Round 1 achieved consensus in 32/40 (80%) statements. Consensus was not reached in the treatment algorithm section. Round 2 achieved consensus in 50/80 (62.5%). Statements reaching consensus were imaging (2/3, 66%), symptoms and other baseline measures (12/24, 50%), differential diagnosis (2/8, 25%), treatment algorithm (10/17, 59%), indications for stenting (10/10, 100%), inflow and outflow assessment (2/2, 100%), procedural outcomes (2/2, 100%), post-procedure therapies and stent surveillance, (5/7, 71%), and clinical success factors (5/7, 71%). Conclusion: This study demonstrated that considerable consensus was achieved between venous experts on the optimal management of lower extremity venous outflow obstruction. There were multiple domains where consensus is lacking, highlighting important areas for further investigation and research.
KW - Delphi technique
KW - Endovascular procedures
KW - Post-thrombotic syndrome
KW - Veins
KW - Venous obstruction
KW - Venous stent
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U2 - 10.1016/j.ejvs.2023.09.044
DO - 10.1016/j.ejvs.2023.09.044
M3 - Article
C2 - 37797931
AN - SCOPUS:85178366640
SN - 1078-5884
VL - 67
SP - 341
EP - 350
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
IS - 2
ER -