Refer to Guideline A-0171, Sclerotherapy Plus Ligation, Saphenofemoral Junction, for additional information.

Refer to Guideline A-0172, Saphenous Vein Stripping, for additional information.

Refer to Guideline A-0174, Saphenous Vein Ablation, Radiofrequency, for additional information.

Refer to Guideline A-0425, Saphenous Vein Ablation, Laser, for additional information.

Refer to Guideline A-0735, Stab Phlebectomy, for additional information.

Refer to Guideline A-1024, Saphenous Vein Ablation, Adhesive Injection, for additional information.

Refer to Guideline A-1025, Saphenous Vein Ablation, Mechanical Occlusion Chemical Ablation (MOCA), for additional information.

Refer to Medical Policy S-551, Echosclerotherapy, for additional information.

Refer to Medical Policy S-552, Sclerotherapy (Liquid or Microfoam), for additional information.

Refer to Medical Policy S-553, Subfascial endoscopic perforator surgery (SEPS), for additional information.

Refer to Medical Policy S-554, Endovenous Cryoablation, for additional information.

Refer to Medical Policy S-555, Laser Treatment, Non-Invasive, for additional information.

Refer to Medical Policy S-556, Ligation or Ablation, Incompetent Perforator Veins, for additional information.

Refer to Medical Policy S-557, Spider Veins, Treatment, for additional information.

Refer to Medical Policy S-558, Ligation, Division, and/or Excision of Varicose Vein Cluster(s), for additional information.

Refer to Medical Policy E-9, Non-Custom/Custom-Made Gradient Compression Garments/Stockings, for additional information.

Refer to Medical Policy S-100, Multiple Surgical Procedures, for additional information.

Refer to Medical Policy S-133, Endovascular/Endoluminal Stent Grafts, for additional information.

Refer to Medical Policy S-16, Assistant Surgery Eligibility Criteria, for additional information.

Refer to Medical Policy S-28, Cosmetic Surgery vs. Reconstructive Surgery, for additional information.

Refer to Provider Reimbursement Policy RP-014, Bilateral and Multiple Surgical Procedures, for additional information.

American Vein and Lymphatic Society

In 2015, the AVLS (previously named the American College of Phlebology) published guidelines on the treatment of superficial vein disease.

AVLS gave a Grade 1 recommendation based on high quality evidence that compression is an effective method for the management of symptoms, but when patients have a correctable source of reflux, definitive treatment should be offered unless contraindicated. AVLS recommends against a requirement for compression therapy when a definitive treatment is available. AVLS gave a strong recommendation based on moderate quality evidence that endovenous thermal ablation is the preferred treatment for saphenous and accessory saphenous vein incompetence, and gave a weak recommendation based on moderate quality evidence that mechanochemical ablation may also be used to treat venous reflux.

In 2017, AVLS published guidelines on the treatment of refluxing accessory saphenous veins. The College gave a Grade 1 recommendation based on level C evidence that patients with symptomatic incompetence of the accessory saphenous veins be treated with endovenous thermal ablation or sclerotherapy to reduce symptomatology. The guidelines noted that although accessory saphenous veins may drain into the great saphenous vein before it drains into the common femoral vein, they can also empty directly into the common femoral vein.

National Institute for Health and Care Excellence

In 2013, the NICE updated its guidance on ultrasound-guided foam sclerotherapy for varicose veins. NICE stated that:

"1.1 Current evidence on the efficacy of ultrasound-guided foam sclerotherapy for varicose veins is adequate. The evidence on safety is adequate, and provided that patients are warned of the small but significant risks of foam embolization (see section 1.2), this procedure may be used with normal arrangements for clinical governance, consent and audit.

1.2 During the consent process, clinicians should inform patients that there are reports of temporary chest tightness, dry cough, headaches and visual disturbance, and rare but significant complications including myocardial infarction, seizures, transient ischaemic attacks and stroke."

In 2015, NICE published a technology assessment on the clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation, and surgery for varicose veins.

In 2016, NICE revised its guidance on endovenous mechanochemical ablation, concluding that "Current evidence on the safety and efficacy of endovenous mechanochemical ablation for varicose veins appears adequate to support the use of this procedure...."