The Importance of Data-Driven Decisions in Superficial Venous Pathology to Achieve Optimal Outcomes

S uperficial venous pathology describes a spectrum of disease related to an underlying dysfunction of the venous system due to either reflux or obstruction. Although rarely life threatening, chronic venous disease (CVD) presents a significant burden both to those affected and to society. It is highly prevalent, with spider veins, varicose veins, and chronic venous ulceration (CVU) affecting up to 80%, 40%, and 2% of the population, respectively.1 Despite the low prevalence of ulceration, CVU costs up to 2% of the national health budget of Western societies due to its chronic nature and laborintensive management.2 Furthermore, the quality of life of those with different stages of CVD is significantly affected,3 and a higher prevalence of depression is present in this population.4 Importantly, the burden of CVD is expected to rise in function of the aging and increasingly obese population5; as such, measures and techniques to improve its prevention and management are essential. Over the last 2 decades, the treatment of CVD has been revolutionized, moving from open surgical high ligation and stripping to minimally invasive, day surgery procedures. These procedures have the advantage of a shorter treatment time and allow a quicker return to daily activities.6 In particular, the endothermal techniques, radiofrequency ablation, and endovenous laser ablation have become commonplace in the management of CVD. Despite having been shown to have as good, if not better, ablation success rates and quality of life outcomes compared to surgery,6,7 these endothermal techniques can still present specific risks relating to thermal injury.8 This is reduced by the administration of tumescent anesthesia which, although effective, can be cumbersome for patients. In light of this, novel techniques have recently been developed by industry, representing the next generation of endovenous therapy.9 The nonthermal nontumescent (NTNT) techniques, including mechanochemical ablation and glue, do not employ thermal energy, thereby avoiding the risk of thermal injury and the administration of tumescent anesthesia.10-12 These are currently the subject of ongoing studies to assess their longer-term efficacy. The importance of these studies, their design, and their findings cannot be underestimated. Gone are the days when decision making was the remit of a single expert. We now live in the era of big data, evidencebased medicine, and peer review, with the means, technology, and skills to extract high-quality data and generate important, evidence-based conclusions regarding health care. The Importance of Data-Driven Decisions in Superficial Venous Pathology to Achieve Optimal Outcomes