The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on radiofrequency ablation of varicose veins.
NICE has published a clinical guideline on varicose veins in the legs (NICE guideline CG168, 2013).
Symptomatic venous insufficiency is common, affecting 1-15% of adult men and 20-25% of adult women. Saphenous vein insufficiency is the most common form of venous insufficiency in patients presenting with symptoms, which include pain, oedema, fatigue, varicose veins and venous ulcers.
Radiofrequency ablation of varicose veins involves heating the wall of the vein using a bipolar generator and catheters with sheathable electrodes
The saphenous vein is accessed above or below the knee either percutaneously via an intravenous cannula/venipuncture sheath or via a small incision. The catheter is manually withdrawn at 2.5-3cm/minute, and the vein wall temperature is maintained at 85°C.
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.