Varicose Veins

 

Referral and Treatment Criteria applies – see RaTC - Varicose veins - Referral criteria for specialist assessment

Referral criteria

Referral for specialist assessment of varicose veins may only be considered for patients with:

  • Refer people with bleeding varicose veins to a vascular service immediately
  • Refer people to a vascular service if they have any of the following:
    • Suspected venous incompetence with an episode of superficial vein thrombophlebitis.
    • Lower-limb skin changes ascribed to venous disease, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency.
    • Late stage venous disease, e.g. severe skin changes, active (not healing) or healed ulceration, bleeding from varicose vein

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Rationale

Local cost impact analysis indicates that referring people with symptomatic* varicose veins as recommended by NICE Clinical Guideline 168 would be unaffordable in the context of current Clinical Commissioning Groups (CCGs) resources

* Veins found in association with troublesome lower limb symptoms (typically pain, aching, discomfort, swelling, heaviness and itching)

Management and Patient Advice

If varicose veins are bleeding, offer first aid and admit to a vascular service.  (If there is doubt whether admission is required, seek immediate specialist advice from a vascular surgeon)

If varicose veins are not bleeding:

  1. Explain that varicose veins have faulty valves which allow reversed venous blood flow leading to pooling of blood and venous distension
  2. Reassure the person that complications are uncommon (if appropriate, discussion could include potential complications including deep vein thrombosis, skin changes, leg ulcers, bleeding, and thrombophlebitis)
  3. Explain to pregnant women why varicose veins are common and can appear or worsen in pregnancy. Treatment options are limited, as interventional treatments are only offered in exceptional circumstances, but compression stockings can improve symptoms. Reassure women that varicose veins often improve considerably after pregnancy
  4. Offer information on lifestyle, including advice to (if appropriate):
    1. Lose weight
    2. Engage in light to moderate physical activity
    3. Avoid factors that exacerbate symptoms such as sitting or standing for long periods of time, and to elevate the legs when possible

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Doppler studies

If a Doppler study to assess vascular flow is required, please refer to the East Kent Vascular Centre at East Kent Hospitals where it will be performed by a Vascular Nurse Specialist

Advice and Guidance is being made available for all specialties, and is being provided by consultant specialists at East Kent Hospitals.  To make a request or to check to if a query has been answered, you will need to log in via the electronic Referral System (eRS)

Click here for the "how to access" e-Referral Advice and Guidance Manual for instructions on how to make a request and check responses

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