Guidance
Key priorities for implementation
Key priorities for implementation
The following recommendations have been identified as priorities for implementation.
Referral to a vascular service
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Refer people to a vascular service[1] if they have any of the following.
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Symptomatic[2] primary or symptomatic recurrent varicose veins.
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Lower‑limb skin changes, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency.
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Superficial vein thrombosis (characterised by the appearance of hard, painful veins) and suspected venous incompetence.
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A venous leg ulcer (a break in the skin below the knee that has not healed within 2 weeks).
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A healed venous leg ulcer.
Assessment and treatment in a vascular service
Assessment
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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
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For people with confirmed varicose veins and truncal reflux:
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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]).
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If endothermal ablation is unsuitable, offer ultrasound‑guided foam sclerotherapy (see ultrasound-guided foam sclerotherapy for varicose veins [NICE interventional procedures guidance 440]).
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If ultrasound‑guided foam sclerotherapy is unsuitable, offer surgery.
If incompetent varicose tributaries are to be treated, consider treating them at the same time.