Chronic venous disease (CVD) is a common condition with major health consequences that is associated with poor long-term prognosis, significant socioeconomic impact, disabling symptoms and reduced quality of life. To provide practical guidance for diagnosis and management of CVD, a Delphi panel of 5 experts in steering committee and 28 angiologists/vascular surgeons met with the major aim of providing a supplement for established national and international guidelines. A total of 24 statements were voted upon in two rounds, of which consensus was reached on 22 statements, indicating a high level of overall agreement. Consensus was reached on 7 of 8 statements relative to diagnosis (CEAP classification, diagnostic tools, QoL assessment, diagnostic imaging) and on 15 of 16 statements on management (conservative treatments, compressive therapy, pharmacological therapy, surgical treatment). The results of the consensus reached are discussed herein from which it is clear that diagnostic and management approaches utilising personalised therapies tailored to the individual patient should be favoured. While it is clear that additional studies are needed on many aspects of diagnosis and management of CVD, the present Delphi survey provides some key recommendations for clinicians treating CVD that may be useful in daily practice.

Mesotherapy is an evidence-based, minimally invasive technique used across multiple clinical fields, including pain medicine, sports medicine, rehabilitation, vascular diseases, dermatology, and aesthetic medicine. In recent years, international consensus recommendations have been developed to guide its safe and standardized application. To identify essential criteria for good clinical practice in mesotherapy and to promote their adoption among healthcare professionals and health authorities through a secondary analysis of the current recommendations issued by the Italian Society of Mesotherapy. A multidisciplinary panel of experts reviewed existing evidence-based recommendations and related scientific literature through a structured Delphi process. The analysis aimed to identify key elements that ensure safety, efficacy, and consistency in mesotherapy practice, and to distinguish evidence-supported interventions from outdated or inappropriate procedures. The expert panel formulated 49 evidence-based recommendations covering terminology, clinical use, and ethical aspects. Recommendations reached a high level of agreement (92.6%), confirming the robustness and clinical relevance of mesotherapy. The resulting standards clearly define what should and should not be done in modern mesotherapy practice. Adherence to evidence-based recommendations promotes transparency, patient safety, and professional accountability, while supporting regulatory recognition of mesotherapy as a scientifically grounded therapeutic option. These guidelines provide a framework for standardizing clinical practice, guiding education and research, and ensuring appropriate integration of mesotherapy into individualized treatment pathways. These evidence-based recommendations support harmonization of mesotherapy practice and its recognition by health authorities.

To describe residual intima and the average media thickness persisted after the empty vein ablation (EVA) technique, endovenous laser ablation (EVLA), and foam sclerotherapy (FS) in a sheep in vivo model. Six iliofemoral and two jugular sheep vein axes were treated as follows: four with EVA (using polidocanol [POL] 0.5% or 1% with 1 or 3 minutes as contact time), two with FS (FS-1 and FS during Valsalva maneuver [FS-Val], POL1% for 10 minutes), and two with EVLA (1470 nm radial, 80 J/cm²). The average percentage of residual intima layer was 2% (interquartile range [IQR]: 1%-4%) for EVA-POL0.5%-1 minute, 1% (IQR: 0%-3.5%) for EVA-POL0.5%-3 minutes, 2% (IQR: 0%-4%) for EVA-POL1%-1 minute, 0 for EVA-POL1%-3 minutes, 13% (IQR: 13%-15.7%) for FS, 1% (IQR: 0%-3%) for FS-Val, and 1% (IQR: 0%-6%) for EVLA. The average percentage of residual media thickness was 13% (IQR: 8%-15%) for EVA-POL0.5%-1 minute, 6% (IQR: 4%-9%) for EVA-POL0.5%-3 minutes, 13% (IQR: 10%-27%) for EVA-POL1%-1 minute, 6% (IQR: 5%-12%) for EVA-POL1%-3 minutes, 51% (IQR: 40%-62%) for FS, 29% (IQR: 23%-35%) for FS-Val, and 62% (IQR: 41%-75%) for EVLA. EVA demonstrated better results in vein wall damage compared with EVLA and FS, both in intima and media layers. This study provides crucial insights into the effectiveness of different vein treatment techniques, particularly the empty vein ablation method, in minimizing residual intima and media thickness. By evaluating these outcomes in a sheep model, it highlights how empty vein ablation may lead to more vein wall damage compared with endovenous laser ablation and foam sclerotherapy. For clinicians, understanding the comparative efficacy of these treatments is vital for optimizing patient care in managing venous diseases. As the field evolves, these findings could influence clinical decision-making, encouraging the adoption of techniques that promote better long-term outcomes for patients.

Background/Objectives: Chronic venous disease is a very common disease. Recent studies suggest a potential link between this condition and cardiovascular disease or mortality. Common pathophysiological features include endothelial injury, hypercoagulability, and systemic inflammation. Conservative management of chronic venous disease includes compression therapy and pharmacological treatment. However, there is some controversy regarding the exact place of pharmacological treatment in the management of this condition. We conducted the VeinHeart Survey to gather information on the management of patients with chronic venous disease referred to vascular specialists in Italy. Methods: The present survey involved 78 Italian phlebologists, angiologists, and vascular surgeons, with data from a total of 1621 patients. Results: Drug therapies prescribed by vascular specialists participating in this survey included: glycosaminoglycans, topical phlebotonics, systemic phlebotonics, and supplements. The most commonly prescribed medications were glycosaminoglycans, both at the first visit and at follow-up. The meantime since the first visit was 56.4 days. Both symptoms and signs improved at follow-up. The most improved signs at follow-up were edema and venous ulcer healing. The prevalence of CEAP classes C3 and C4 also showed a decrease at the follow-up visit. Conclusions: The findings of this survey provide a picture of the state of the art of current pharmacological treatments prescribed by expert clinicians in the management of patients with chronic venous disease in Italy. This may offer some useful insights for the optimization of current therapeutic options, in order to improve the clinical management of this disease.

Background/Objectives: Chronic venous disease is a very common disease. Recent studies suggest a potential link between this condition and cardiovascular disease or mortality. Common pathophysiological features include endothelial injury, hypercoagulability, and systemic inflammation. Conservative management of chronic venous disease includes compression therapy and pharmacological treatment. However, there is some controversy regarding the exact place of pharmacological treatment in the management of this condition. We conducted the VeinHeart Survey to gather information on the management of patients with chronic venous disease referred to vascular specialists in Italy. Methods: The present survey involved 78 Italian phlebologists, angiologists, and vascular surgeons, with data from a total of 1,621 patients. Results: Drug therapies prescribed by vascular specialists participating in this survey included: glycosaminoglycans, topical phlebotonics, systemic phlebotonics, and supplements. The most commonly prescribed medications were glycosaminoglycans, both at the first visit and at follow-up. The meantime since the first visit was 56.4 days. Both symptoms and signs improved at follow-up. The most improved signs at follow-up were edema and venous ulcer healing. The prevalence of CEAP classes C3 and C4 also showed a decrease at the follow-up visit. Conclusions: The findings of this survey provide a picture of the state of the art of current pharmacological treatments prescribed by expert clinicians in the management of patients with chronic venous disease in Italy. This may offer some useful insights for the optimization of current therapeutic options, in order to improve the clinical management of this disease.