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Varicose veins: diagnosis and management [CG168]

Measuring the use of this guidance

Recommendation: 1.2.2

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.

What was measured: Proportion of people diagnosed with varicose veins who were referred to a specialist.
Data collection end: June 2015
28%
Number that met the criteria: 3457 / 12466
Area covered: England and Wales
Source: Davies Huw O. B, Popplewell Matthew, Bate Gareth, Ryan Ronan P, Marshall Tom P, and Bradbury Andrew W. (2018). Analysis of Effect of National Institute for Health and Care Excellence Clinical Guideline CG168 on Management of Varicose Veins in Primary Care Using the Health Improvement Network Database, European Journal of Vascular and Endovascular Surgery (2018), https://doi.org/10.1016/j.ejvs.2018.07.023

What was measured: People with a leg ulcer who were referred to a specialist.
Data collection end: June 2015
31.2%
Number that met the criteria: 2329 / 7462
Area covered: UK
Source: Davies Huw Ob, Popplewell Matthew, Bate Gareth, Ryan Ronan P, Marshall Tom P, and Bradbury Andrew W. (2018). Publication of UK NICE Clinical Guidelines 168 has not significantly changed the management of leg ulcers in primary care: An analysis of The Health Improvement Network database. Phlebology, , pp.268355518805658. DOI: 10.1177/0268355518805658


Recommendation: 1.3.2

For people with confirmed varicose veins and truncal reflux: - Offer endothermal ablation (see radiofrequency ablation of varicose veins [NICE interventional procedures guidance 8] and endovenous laser treatment of the long saphenous vein [NICE interventional procedures guidance 52]). - If endothermal ablation is unsuitable, offer ultrasound‑guided foam sclerotherapy (see ultrasound-guided foam sclerotherapy for varicose veins [NICE interventional procedures guidance 440]). - If ultrasound‑guided foam sclerotherapy is unsuitable, offer surgery. If incompetent varicose tributaries are to be treated, consider treating them at the same time.

What was measured: Proportion of people diagnosed with varicose veins who received any superficial venous intervention (conventional surgery, endothermal ablation, or ultrasound-guided foam sclerotherapy).
Data collection end: June 2015
4.2%
Number that met the criteria: 526 / 12466
Area covered: England and Wales
Source: Davies Huw O. B, Popplewell Matthew, Bate Gareth, Ryan Ronan P, Marshall Tom P, and Bradbury Andrew W. (2018). Analysis of Effect of National Institute for Health and Care Excellence Clinical Guideline CG168 on Management of Varicose Veins in Primary Care Using the Health Improvement Network Database, European Journal of Vascular and Endovascular Surgery (2018), https://doi.org/10.1016/j.ejvs.2018.07.023

What was measured: Proportion of people diagnosed with varicose veins and receiving any superficial venous intervention who were recorded as having endothermal ablation.
Data collection end: June 2015
29.3%
Number that met the criteria: 154 / 526
Area covered: England and Wales
Source: Davies Huw O. B, Popplewell Matthew, Bate Gareth, Ryan Ronan P, Marshall Tom P, and Bradbury Andrew W. (2018). Analysis of Effect of National Institute for Health and Care Excellence Clinical Guideline CG168 on Management of Varicose Veins in Primary Care Using the Health Improvement Network Database, European Journal of Vascular and Endovascular Surgery (2018), https://doi.org/10.1016/j.ejvs.2018.07.023


Recommendation: 1.3.4

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

What was measured: Proportion of people diagnosed with varicose veins who were prescribed compression hosiery.
Data collection end: June 2015
18%
Number that met the criteria: 2292 / 12466
Area covered: England and Wales
Source: Davies Huw O. B, Popplewell Matthew, Bate Gareth, Ryan Ronan P, Marshall Tom P, and Bradbury Andrew W. (2018). Analysis of Effect of National Institute for Health and Care Excellence Clinical Guideline CG168 on Management of Varicose Veins in Primary Care Using the Health Improvement Network Database, European Journal of Vascular and Endovascular Surgery (2018), https://doi.org/10.1016/j.ejvs.2018.07.023



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