Methodological Quality and Reporting of Clinical Practice Guidelines and Consensus Statements for Nonthrombotic Iliac Vein Lesions: A Systematic Appraisal Using AGREE II, AGREE-S, AGREE-REX, and RIGHT Tools

BACKGROUND: Several recent documents have addressed the management of nonthrombotic iliac vein lesions (NIVLs), including formal evidence-based guidelines and consensus or position statements. Differences in development methodology may influence their structure, transparency, and reporting quality. METHODS: We systematically appraised 6 recent NIVL documents using AGREE II, AGREE-REX, AGREE-S, and RIGHT. Nonparametric analyses were performed to compare scores across documents and document classes. RESULTS: Two evidence-based guidelines (European Society for Vascular Surgery 2022 and Society for Cardiovascular Angiography & Interventions 2025) demonstrated higher scores in domains related to rigor of development and reporting transparency, reflecting structured evidence synthesis, and formal grading frameworks. Consensus and position statements showed lower methodological scores in certain domains, particularly applicability and values and preferences, but provided pragmatic clinical guidance in areas where high-level evidence remains limited. Differences in appraisal scores largely corresponded to document type and development process rather than clinical validity. CONCLUSIONS: Methodological quality varied across NIVL documents and was closely associated with development framework. While evidence-based guidelines demonstrated greater methodological transparency, consensus-based documents continue to play an important role in clinical decision-making in this evolving field. Future efforts should focus on strengthening evidence generation and enhancing methodological clarity across document types.Clinical ImpactThis study helps clinicians interpret NIVL guidance more appropriately by showing that differences across documents mainly reflect development methodology rather than true disagreement in core clinical principles.For practice, it supports continued use of symptom-driven intervention, first-line duplex ultrasound, IVUS-guided lesion assessment, avoidance of prophylactic stenting in asymptomatic patients, and structured post-stenting surveillance.The innovation of this study is the first comprehensive appraisal of NIVL clinical practice guidelines and consensus statements using AGREE II, AGREE-S, AGREE-REX, and RIGHT, providing clinicians with a framework to judge both methodological rigor and practical applicability when applying recommendations in daily care.