Varicose Veins

Policy

Referral for varicose vein surgery should be considered only if the following criteria are met:

If they are bleeding from a varicosity that has eroded the skin
If there is acute thrombophlebitis progressing up to the groin
If they have bled from a varicosity and are at risk of bleeding again
If they have an ulcer which is progressive and/or painful despite treatment
If there is recurrent superficial thrombophlebitis.
Progressive skin changes
If the patient has venous skin problems and significant arterial insufficiency (ankle- brachial pressure index less
than 0.8)

Patients who do not meet these criteria should be offered conservative therapy in primary care, which includes:

Compression stockings

Exercise

Daily elevation several times a day

Background

Varicose veins (ICD-10 Code:183) are dilated superficial veins in the leg caused by incompetent venous valves. In
the UK varicose veins occur in around 1520% of adults. Although treatment for varicose veins is generally effective
recurrence is estimated at around 50% within five years. An evidence based classification of varicose veins (CEAP,
2004) is given below to assist clinicians in assessing the severity of varicose veins. There is mixed evidence as to
the relative effectiveness of sclerotherapy or surgery, therefore specific surgical options for individual patients
should be left to clinical decision.

C0
C1
C2
C3

C4

C5
C6

No visible or palpable signs of venous disease

Telangiectasies or reticular veins
Varicose veins; diameter >3mm
Oedema
Changes in skin and subcutaneous tissue: pigmentation, eczema,
lipodermatosclerosis or atrophie blanche
Healed venous ulcer
Active venous ulcer

NHS NW London Planned Procedures with a Threshold Policy. Version 2.1 (April 2012)
Is this the latest version? Check here: http://www.northwestlondon.nhs.uk

References

Patient information leaflet

http://www.cks.nhs.uk/patient_information_leaflet/Varicose_Veins

References

Simpson, S. & Roderick, P. in Stevens, A., Raftery, J., Mant, J. & Simpson, S. (eds) Health Care Needs
Assessment First Series, Volume 1, Second Edition Varicose Veins & Venous Ulcers (2004)

N.I.C.E. Referral Advice: a guide to appropriate referral from general practice to specialist services 2001

N.I.C.E. Interventional Procedures guidance IPG8 (September 2003)

N.I.C.E. Interventional Procedures guidance IPG52 (March 2004)

Campbell B. Clinical Review - Varicose veins and their management. BMJ 2006;333:287-292

Bradbury A, Evans C, Allan P et al. What are the symptoms of varicose veins? Edinburgh vein study cross
sectional population survey. BMJ 1999;318:353-356 (6 February) http://www.cks.nhs.uk/varicose_veins#341091 Date accessed = 6/7/10

Rigby KA, Palfreyman SSJ, BeverleyC,Michaels JA. Surgery versus sclerotherapy for the treatment of
varicose veins. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD004980. DOI:
10.1002/14651858.CD004980.

Eklof B, Rutherfors RB, Bergan JJ et al. Revision of the CEAP Classification for chronic venous disorders:
Consensus Statement. J Vas Surg 2004; 40; 1248 52

NHS ONEL PoLCE Policy Document. April 2010.

NHS NW London Planned Procedures with a Threshold Policy. Version 2.1 (April 2012)
Is this the latest version? Check here: http://www.northwestlondon.nhs.uk