Clinical Decisions in the Absence of Evidence: Expert’s Panel Recommendations for the Management of Chronic Venous Disease and Superficial Thrombophlebitis

When making decisions in routine practice venous specialists must use guidelines for the diagnosis and treatment developed by professional medical societies. Guidelines are based on scientific data that are collected from all available sources, carefully systematized, analyzed and critically assessed. A particular recommendation gets certain class and evidence level depending on the quality of studies. The highest level is based on data from multiple randomized controlled trials and/or meta-analyses. In real practice, specialists often make decisions based only on expert’s opinion and experience. Acute and chronic venous diseases are the responsibility of surgeons and vascular surgeons. Many clinical decision options, especially at the primary level, are often made by other specialists. In this regard, a detailed presentation of action algorithms at each stage in clinical recommendations is of particular importance, especially when it comes to situations where decision-making is based on practical experience. Objective. To develop the recommendations for management of patients with chronic venous disease and superficial vein thrombophlebitis in situations with absence of scientific evidence. Material and methods. A group of venous specialists developed statements for clinical situations for which there are recommendations with evidence level of 5C, as well as for other situations. The wording was accepted in case of consent of all members of the group. Results. The expert group reviewed, discussed and developed the recommendations for situations when there is no scientific evidence. Conclusions. The developed clinical decisions can be used in routine practice when managing the patients with chronic venous disease and superficial thrombophlebitis.