Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

Referral to a vascular service

  • 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.

    A vascular service is a team of healthcare professionals who have the skills to undertake a full clinical and duplex ultrasound assessment and provide a full range of treatment. Symptomatic veins are veins found in association with troublesome lower limb symptoms (typically pain, aching, discomfort, swelling, heaviness and itching).

Assessment and treatment in a vascular service


  • 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

Non-interventional treatment

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