Prevention in Phlebology – Results of PREVENT2

Introduction, Objectives, and/or Purpose: Products and recommendations to prevent vein disease are plentiful, however, evidence-based data on primary and secondary prevention are scarce. At the same time, there are recent pilot studies indicating new mechanisms of initial stages of vein damage, a promising basis for prevention. Which data are reliable for daily practice, education and further research?

Methods: Together with the prevention working group of the German Society of Phlebology and help from international experts involved in the annual meetings 2020 - 2021, 335 relevant original publications and 37 guidelines were reviewed with the aim of an updated reassessment of the prevention topic (PREVENT2 study).

Results: An excellent data situation was found for anticoagulant therapy, apart from prevention of thrombosis during Covid-19 infection, which has only been relevant since 2020. The use of medical compression stockings is well proven to reduce edema and congestion-related symptoms, but there is no proof for preventing vein insufficiency. Similarly, for so-called venotonic pharmaceuticals, there is evidence of partial symptomatic relief, but no proof of any preventive benefit. The greatest scientific and educational deficit was found for the prevention of primary venous insufficiency. Early stages of the disease, the main target for prevention, are still not defined or considered in all common classifications and recommendations. One exception is the EPS classification suggested by a German institution, showing options of cause-related prevention.

Conclusion(s): While in the past a lot of professional attention has been devoted to the prophylaxis of acute and serious phlebological issues, such as thrombosis and venous embolism, this is not the case for the socio-economically far more relevant "chronic" disease of primary venous insufficiency. There is a lot of catching up to do to with a focus on establishing adequate research and professional education.