The American Venous Forum joins international panel to prioritize venous care in crisis

The COVID-19 crisis has affected all health care providers who care for patients with venous and lymphatic disease in many ways. New diseases, such as inflammatory deep venous thrombosis in previously healthy patients with COVID-19,¹ and the need for venous access in prone ventilated patients² have provided great challenges for venous specialists. Delay in treatment for some acute venous problems has also caused patients to receive suboptimal therapy.³

This document,⁴ which was initiated by Parsi and authors in Asia and Oceania, where the COVID-19 crisis began but which has since spread throughout the world, provides expert opinion on the prioritization of care for patients with acute and chronic venous and lymphatic diseases, venous trauma, and vascular malformations. Previously, articles from individual institutions and countries provided their own prioritization scheme, but it was often based on the impact of the coronavirus on their own hospital or region of their country and did not apply throughout the world. Sometimes these recommendations conflicted with those of other hospital systems that were more or less affected by the COVID-19 crisis.

What makes this document unique is that it has incorporated the recommendations of venous experts from throughout the world, and the American Venous Forum joined the international panel. They used an iterative process to come to consensus on the most common venous diseases, whether acute or chronic, upper extremity, lower extremity, or cavitary, in the superficial or deep venous systems.

This easy to understand guide should be used as an advisory template, modified by individual institutional circumstances. For example, some urgent and semiurgent venous diseases might be more aggressively treated at hospitals that have had little COVID-19 impact, with intensive care unit beds, operating rooms, and angiography suites available, whereas institutions overwhelmed with COVID-19 patients may need to limit treatment to approaches that do not take resources away from infected patients. Weighing the relative importance of patients with acute and chronic venous disease care vs COVID-19 patients is a challenge, but it is made much more systematic by using this document for guidance.

Congratulations to Drs Parsi, van Rij, and Meissner, the original authors of the recommendations, as well as the co-editors and co-authors who reviewed the recommendations, provided feedback, and suggested modifications. They have produced a document that the whole world can use in prioritizing the treatment of acute and chronic venous diseases while this COVID-19 crisis is still present. Even after the COVID-19 crisis has subsided, this document will remain useful in prioritizing venous and lymphatic care in any crisis, whether from flood or hurricane, war or terrorism—whenever resources are limited. Because unique manifestations of acute venous disease have been identified during the COVID-19 crisis, the authors are encouraged to update the document as new information on the prevention and management of venous diseases related to the coronavirus are reported.