'Informed consent' needed for varicose vein treatment
Up to a third of adults are affected by varicose veins - an annoying and sometimes painful condition. Foam sclerotherapy works in more than 80% of cases, at least in the short term. But new NICE guidance says doctors must fully explain the possible (if rare) side effects - as well as the benefits.
Above all, patients have to give their ‘informed consent' before being given the treatment.
Usually varicose veins are treated using liquid sclerotherapy. This involves injecting a liquid chemical into the problem vein to block it and ultrasound to guide the process. However, some surgeons believe foam sclerotherapy - in which the chemical is mixed with air or another gas - is more effective.
Previous NICE guidance, ‘Ultrasound-guided foam sclerotherapy for varicose veins' (interventional procedures guidance 217, 2007) found it had more than an 80% success rate, at least in the short term.
Since then, however, various reports have uncovered a range of possible side effects.
For example, in a survey of 70 UK surgeons, one patient was reported to have had a stroke and two had a transient ischaemic attack. In the latter two cases, the blood supply to the brain was temporarily cut off, which can be a warning of a stroke. Out of nearly 10,000 patients, 47 developed deep vein thrombosis (DVT).
Although rare - and not necessarily related to the procedure - the side effects led to this review of our previous guidance on the treatment.
The latest guidance advises doctors to offer patients a copy of ‘Understanding NICE guidance: treating varicose veins with foam injections using ultrasound' and other information to ensure they are fully informed. They should also be closely monitored for side effects, it says. In addition, more information is needed about whether the procedure works in the longer term.
Read more details on ‘Ultrasound-guided foam sclerotherapy for varicose veins'.
Issued: 9 November 2009
This page was last updated: 20 April 2010