Report of the Society for Vascular Surgery and the American Venous Forum on the July 20, 2016 meeting of the Medicare Evidence Development and Coverage Advisory Committee panel on lower extremity chronic venous disease

This report summarizes the presented evidence to support recommendations of the Society for Vascular Surgery/American Venous Forum coalition and the presentations on selected discussion topics. These included important venous disease evidence gaps that have not been sufficiently addressed, venous disease treatment disparities and how they may affect the health outcomes of Medicare beneficiaries, and mechanisms that might be supported by the Centers for Medicare & Medicaid Services to improve the evidence base to optimize the care of patients with lower extremity CVD.Key questionsOutcome in patients with and without symptomsLevel of confidenceMEDCACSVS/AVF1. For adults with varicose veins and/or other clinical symptoms or signs of chronic venous insufficiency, how confident are you that there is sufficient evidence for an intervention that improves:a. Immediate/near-term health outcomes in patients presenting with symptoms?3.34.0In patients presenting without symptoms but with physical signs?2.01.0b. Long-term health outcomes in patients presenting with symptoms?2.564.0In patients presenting without symptoms but with signs?1.3322. For adults with chronic venous thrombosis and venous obstruction (including individuals with post-thrombotic syndrome), how confident are you that there is sufficient evidence for an intervention that improves:a. Immediate/near-term health outcomes in patients presenting with symptoms?2.113.00In patients presenting without symptoms but with signs?1.442.00b. Long-term health outcomes in patients presenting with symptoms?1.563.00In patients presenting without symptoms but with signs?1.222.00AVF, American Venous Forum; MEDCAC, Medicare Evidence Development and Coverage Advisory Committee; SVS, Society for Vascular Surgery.Level of confidence: 1, low; 3, intermediate; 5, high.