The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on transilluminated powered phlebectomy for varicose veins in January 2004. In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.
The guidance was considered for reassessment in October 2009 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.
NICE has published a clinical guideline on varicose veins in the legs (NICE guideline CG168, 2013).
Transilluminated powered phlebectomy is used to treat varicose veins. Varicose veins are a visible surface manifestation of an underlying syndrome of venous insufficiency.
Most patients with venous insufficiency have symptoms that may include feelings of fatigue, heaviness, aching, burning, throbbing, itching and cramps in the legs.
Transilluminated powered phlebectomy is intended as an alternative to traditional phlebectomy for symptomatic varicosities of the leg and as an adjuvant to surgical removal of the saphenous vein.
Transilluminated powered phlebectomy is performed under general, regional or local anaesthesia. An endoscopic transilluminator is inserted underneath the skin illuminating the vein clusters that need to be resected. A suction device with guarded blades (resector device) is then introduced via another incision at the other end of the varicose vein and the varicosities are cut and removed by suction. Once removal of the veins is complete a second stage anaesthetic is then injected to minimise bruising, pain and haematoma formation. The incisions are then closed with sutures or tape. The resector device can also be inserted through the first incision, minimising the number of incisions made during the procedure.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.