Preface: Acute and chronic venous disease. Current status and future directions

Acute and chronic venous disorders are being increasingly recognized as a healthcare priority in the Western world. The age- and sex-adjusted incidence of venous thromboembolism in the United States has been estimated to be 77.6 per 100,000, corresponding to over 275,000 new cases per year.1 Varicose veins are the most common clinical manifestation of chronic venous disease, occurring in one-quarter to one-third of Western adult populations,2, 3 and severe chronic venous insufficiency, with skin changes and ulceration, may be present in 2% to 5% of Western populations.4

There has been a corresponding increase in awareness and interest in venous disease that crosses the boundaries of many medical specialties. This has been associated with increasingly sophisticated inquiry into the epidemiology and pathophysiology of venous disease and the development of new pharmaceutical agents, devices, and procedures to treat venous disease. Significant progress has been made in some areas, such as the development of evidence-based consensus guidelines for the prophylaxis5 and treatment6 of acute deep venous thrombosis. However, to a large extent, the investigation, treatment and reporting of venous disease remains fragmented among a number of medical specialties, often narrowly focused on specific aspects of venous disease. As a result, the quality and content of the medical literature may differ between specialties, many clinical practices lack rigorous evidence to support them, research initiatives are frequently poorly coordinated, and there is a general lack of dialogue between clinicians, investigators, epidemiologists, and methodologists both within and between medical specialties.

In an effort to rectify these deficiencies and provide direction for the future, the 5th Pacific Vascular Symposium, under the auspices of the American Venous Forum, was charged with reviewing the current state of knowledge with respect to acute and chronic venous disease and developing a roadmap for advancing the field over the next decade. Accordingly, an international group of recognized experts (Appendix I) in venous disease from the fields of dermatology, epidemiology and clinical trials, interventional radiology, hematology, phlebology, and vascular medicine and surgery, as well as representatives from industry and the National Institutes of Health, was convened for a 5-day summit from January 20 to 24, 2006. A mission statement, “To promote venous health through innovative research, education, and technology” was adopted as a guide to subsequent discussions.

The process of establishing the current state of knowledge, identifying priorities, and developing a practical, working plan for the future was accomplished with the assistance of professional facilitators using a process of appreciative inquiry.7 The fundamentals of this approach are designing a plan for the future from a collaborative, strength-based perspective based on a shared vision of that future. Recognized experts first established the current state of knowledge through a 1-day series of intensive didactic lectures. The remainder of the meeting was devoted to the process of identifying areas of deficient knowledge and establishing priorities with respect to necessary research, improved collaboration between clinicians and investigators from different medical specialties, and increased professional and patient awareness of venous disease. This process was accomplished through the interaction of four groups focusing on acute venous disease, the hemodynamic and diagnostic evaluation of venous disease, primary chronic venous disease, and secondary chronic venous disease.

The template followed by each group was similar – first identifying deficiencies and defining what would constitute ideal progress 10 years from now, then broadly defining the priorities for advancing the field of venous disease; narrowing these priorities into goals that could be achieved within the next 10 years; and developing specific plans for initiating these projects. At each stage of the process, the preliminary deliberations of the groups were discussed in larger plenary sessions with input from all participants prior to proceeding to the next phase.

The didactic proceedings of the symposium, establishing the state of current knowledge, are reviewed in the following manuscripts addressing acute venous disease, the hemodynamics and diagnosis of chronic venous disease, primary chronic venous insufficiency, and secondary chronic venous insufficiency. The proceedings of a break-out group, the International Compression Club, addressing the role of compression in venous disorders (Appendix II) is included in the primary venous disease section. The last manuscript of this supplement, “The Future of Venous Disease,” represents the final work product of the symposium and includes both overall priorities and specific initiatives for advancing the field of venous disease.