American College of Radiology
ACR Appropriateness Criteria®

Radiologic Management of Lower-Extremity Venous Insufficiency

Variant 1: Asymptomatic bilateral great saphenous venous insufficiency with visible varicose veins. Patient desires treatment for cosmesis.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Endoluminal laser therapy Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Endoluminal radiofrequency therapy Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Surgical vein stripping May be appropriate N/A N/A 4 n/a 0 0 0 0 0 0 0 0 0
Injection sclerotherapy May be appropriate N/A N/A 4 n/a 0 0 0 0 0 0 0 0 0
Compression stocking therapy only Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
No therapy Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Variant 2: Left small saphenous venous insufficiency resulting in intermittent pain and swelling without skin discoloration or ulceration.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Endoluminal radiofrequency therapy Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Compression stocking therapy only Usually appropriate N/A N/A 7 n/a 0 0 0 0 0 0 0 0 0
Endoluminal laser therapy Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Surgical vein stripping May be appropriate N/A N/A 5 n/a 0 0 0 0 0 0 0 0 0
Injection sclerotherapy May be appropriate N/A N/A 4 n/a 0 0 0 0 0 0 0 0 0
No therapy Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Variant 3: Left great saphenous venous insufficiency with associated lower leg skin ulceration.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Endoluminal laser therapy Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Endoluminal radiofrequency therapy Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Surgical vein stripping May be appropriate N/A N/A 5 n/a 0 0 0 0 0 0 0 0 0
Injection sclerotherapy May be appropriate N/A N/A 4 n/a 0 0 0 0 0 0 0 0 0
Compression stocking therapy only Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
No therapy Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Variant 4: Symptomatic bilateral great saphenous venous insufficiency and large visible varicose veins during pregnancy.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Compression stocking therapy only Usually appropriate N/A N/A 9 n/a 0 0 0 0 0 0 0 0 0
No therapy May be appropriate N/A N/A 4 n/a 0 0 0 0 0 0 0 0 0
Surgical vein stripping Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Endoluminal laser therapy Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Endoluminal radiofrequency therapy Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Injection sclerotherapy Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Variant 5: Chronic left femoral venous thrombosis with left great saphenous venous insufficiency and lower-extremity swelling.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Compression stocking therapy only Usually appropriate N/A N/A 9 n/a 0 0 0 0 0 0 0 0 0
Venous recanalization May be appropriate N/A N/A 6 n/a 0 0 0 0 0 0 0 0 0
Anticoagulation May be appropriate N/A N/A 6 n/a 0 0 0 0 0 0 0 0 0
Surgical vein stripping Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Endoluminal laser therapy Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Endoluminal radiofrequency therapy Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Injection sclerotherapy Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
No therapy Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Variant 6: Symptomatic bilateral great saphenous venous insufficiency with remote history of deep venous thrombosis with no residual thrombus present.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Compression stocking therapy only Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Endoluminal laser therapy Usually appropriate N/A N/A 7 n/a 0 0 0 0 0 0 0 0 0
Endoluminal radiofrequency therapy Usually appropriate N/A N/A 7 n/a 0 0 0 0 0 0 0 0 0
Surgical vein stripping May be appropriate N/A N/A 5 n/a 0 0 0 0 0 0 0 0 0
Injection sclerotherapy May be appropriate N/A N/A 4 n/a 0 0 0 0 0 0 0 0 0
No therapy Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Variant 7: Right great saphenous venous insufficiency status post vein stripping 1 year ago with persistent lower-extremity swelling. Reflux is noted in the below-knee greater saphenous vein measuring up to 5 mm.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Compression stocking therapy only May be appropriate N/A N/A 5 n/a 0 0 0 0 0 0 0 0 0
Endoluminal laser therapy Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Endoluminal radiofrequency therapy Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Repeat surgical vein stripping May be appropriate N/A N/A 4 n/a 0 0 0 0 0 0 0 0 0
Injection sclerotherapy May be appropriate N/A N/A 4 n/a 0 0 0 0 0 0 0 0 0
No therapy Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.