Varicose Veins

Management

NICE produced guidelines in 2013.

In the NHS, treatment should be offered to patients complaining of:

Bleeding varicose veins
Symptomatic varicose veins (including aching, discomfort, swelling, heaviness and itching)
Recurrent symptomatic varicose veins
Lower limb skin changes of chronic venous insufficiency
Superficial venous thrombosis
Venous leg ulcer - active or healed

Management options should be given in the following order.

First line: Endovenous treatment
Second line: Ultrasound guided foam sclerotherapy
Third line: Open surgery

If intervention is unsuitable, offer compression hosiery.

When wouldn't you offer intervention?

If the patient has had a previous DVT
If the patient's BMI is 30
If the patient is pregnant

Please answer each row

Well done. You have scored 3 out of 3.

If the deep venous system is obstructed (e.g. from DVT), you should not obliterate the superficial system. Pregnant patients can be offered compression hosiery and followed up for treatment after delivery if necessary.

Endovenous procedures are performed under local anaesthetic and are usually quick (less than an hour), so even relatively co-morbid patients are suitable for it.