National Institute for Health and Clinical Excellence (NICE)
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Offer less invasive treatments before surgery for varicose veins

Surgery should only be offered to treat varicose veins if other less invasive treatments are unsuitable for patients, according to latest guidance from NICE.

Varicose veins develop when blood vessels become enlarged, preventing blood flowing back to the heart efficiently and resulting in blood flowing in the wrong direction. They normally occur in the legs, and are more likely to occur among older people and those who are pregnant.

The severity of varicose veins can increase over time, and can lead to complications such as changes in skin pigmentation, bleeding or venous ulceration.

Many with varicose veins have no symptoms, but for some they can cause pain, aching or itching. They can also develop into leg ulcers, which can be difficult to heal and can have a significant effect on their quality of life.

Currently, there is wide regional variation treatment of varicose veins in the UK, as there is no definitive system for determining which people would benefit most from interventional treatment. There is also currently no established framework within the NHS for the diagnosis and management of the condition.

To help standardise the kind of treatment patients with this treatment can receive, NICE has published a new clinical guideline on varicose veins.

NICE says that people should be referred to a vascular service if they have symptomatic primary or recurrent varicose veins; lower limb skin changes such as pigmentation or eczema, hard painful veins (superficial vein thrombosis), or leg ulcers below the knee.

Duplex ultrasound, which is a test to see how blood moves through the arteries and veins, should be used to confirm the diagnosis of varicose veins and plan the course of treatment.

For confirmed cases of varicose veins, NICE recommends that endothermal ablation, which is radiofrequency or laser treatment, should be offered.

If endothermal treatment is not suitable, then ultrasound-guided foam scleropathyshould be offered.

If these treatments are not suitable, then surgery should be considered. Compression hosiery such as tights and stockings should only be offered if none of the interventional treatments are suitable.

In addition, interventional treatments for varicose veins should not be carried out during pregnancy.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: "Although varicose veins are a common health complaint, there was no established framework for diagnosis and treatment in the NHS until now.

"For some people they present few problems, while others can suffer painful and distressing symptoms.

"This guidance sets out the options for patients and their physicians to treat the individual symptoms of each patient so that no matter where they live, they have access to the therapy that's right for them."

Professor Alun Davies, Professor of Vascular Surgery and Honorary Consultant Surgeon, Imperial College and Imperial College NHS Trust, Charing Cross and St Mary's Hospitals, London, and chair of the group which developed the guideline added: "This guideline shows quite clearly that interventional treatment for some patients who are suffering from symptomatic varicose veins is a better alternative to surgery, and is both clinically and cost effective. It will help standardise care for all those with this condition."

To view all that NICE has recommended on this topic, visit the NICE Pathway on varicose veins, which also contains links to range of support tools to help implement the recommendations.

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