In 2013, NICE produced Clinical Guidance CG168 on the management of varicose veins, including diagnosis and management. In 2016, NICE and its panel of experts reviewed and updated its guidance. The mission of The National Institute for Health and Care Excellence (NICE) is to improve health and social care through evidence-based guidance.
In its guidance CG168, NICE identified the following as priorities for implementation.
-1) Referral to a vascular service
Refer people to a vascular service* if they have any of the following. Symptomatic primary or symptomatic recurrent varicose veins. Lower-limb skin changes, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency. Superficial vein thrombosis (characterised by the appearance of hard, painful veins) and suspected venous incompetence. A venous leg ulcer (a break in the skin below the knee that has not healed within 2 weeks). A healed venous leg ulcer.
* NICE definition: A vascular service is a team of healthcare professionals who have the skills to undertake a full clinical and duplex ultrasound assessment and provide a full range of treatment.
-2) Assessment and treatment in a vascular service
Assessment Use duplex ultrasound to confirm the diagnosis of varicose veins and the extent of truncal reflux, and to plan treatment for people with suspected primary or recurrent varicose veins.
-3) Interventional treatment
For people with confirmed varicose veins and truncal reflux: Offer endothermal ablation ( Radiofrequency ablation or Endovenous laser treatment; If endothermal ablation is unsuitable, offer ultrasound-guided foam sclerotherapy; If ultrasound-guided foam sclerotherapy is unsuitable, offer surgery. If incompetent varicose tributaries are to be treated, consider treating them at the same time.
-4) Non-interventional treatment
Do not offer compression hosiery to treat varicose veins unless interventional treatment is unsuitable.
-5) Management during pregnancy
Give pregnant women presenting with varicose veins information on the effect of pregnancy on varicose veins. Do not carry out interventional treatment for varicose veins during pregnancy other than in exceptional circumstances. Consider compression hosiery for symptom relief of leg swelling associated with varicose veins during pregnancy.
You can read NICE CG168 in full belowNICE.CG168