Varicose veins in the legs: The diagnosis and management of varicose veins

NICE guidelines [CG168] Published date:

1 Recommendations

The following guidance is based on the best available evidence. The full guideline gives details of the methods and the evidence used to develop the guidance.

The wording used in the recommendations in this guideline (for example words such as 'offer' and 'consider') denotes the certainty with which the recommendation is made (the strength of the recommendation). See About this guideline for details.

All recommendations relate to adults aged 18 years and over.

1.1 Information for people with varicose veins

1.1.1 Give people who present with varicose veins information that includes:

  • An explanation of what varicose veins are.

  • Possible causes of varicose veins.

  • The likelihood of progression and possible complications, including deep vein thrombosis, skin changes, leg ulcers, bleeding and thrombophlebitis. Address any misconceptions the person may have about the risks of developing complications.

  • Treatment options, including symptom relief, an overview of interventional treatments and the role of compression.

  • Advice on:

    • weight loss (for guidance on weight management see Obesity [NICE clinical guideline 43])

    • light to moderate physical activity

    • avoiding factors that are known to make their symptoms worse if possible

    • when and where to seek further medical help.

1.1.2 When discussing treatment for varicose veins at the vascular service[3] tell the person:

  • What treatment options are available.

  • The expected benefits and risks of each treatment option.

  • That new varicose veins may develop after treatment.

  • That they may need more than 1 session of treatment.

  • That the chance of recurrence after treatment for recurrent varicose veins is higher than for primary varicose veins.

1.2 Referral to a vascular service

1.2.1 Refer people with bleeding varicose veins to a vascular service[3] immediately.

1.2.2 Refer people to a vascular service if they have any of the following.

  • Symptomatic[4] 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.

1.3 Assessment and treatment in a vascular service

Assessment

1.3.1 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.

Interventional treatment

1.3.2 For people with confirmed varicose veins and truncal reflux:

1.3.3 If offering compression bandaging or hosiery for use after interventional treatment, do not use for more than 7 days.

Non-interventional treatment

1.3.4 Do not offer compression hosiery to treat varicose veins unless interventional treatment is unsuitable.

1.4 Management during pregnancy

1.4.1 Give pregnant women presenting with varicose veins information on the effect of pregnancy on varicose veins.

1.4.2 Do not carry out interventional treatment for varicose veins during pregnancy other than in exceptional circumstances.

1.4.3 Consider compression hosiery for symptom relief of leg swelling associated with varicose veins during pregnancy.



[3] 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

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

NICE has accredited the process used by the Centre for Clinical Practice at NICE to produce guidelines. Accreditation is valid for 5 years from September 2009 and applies to guidelines produced since April 2007 using the processes described in NICE's 'The guidelines manual' (2007, updated 2009). More information on accreditation can be viewed at www.nice.org.uk/accreditation
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