TNRF2: Vascular surgery

Overview

Varicose veins are swollen and enlarged veins that usually occur on the legs and feet. They may be blue or dark purple, and are often lumpy, bulging or twisted in appearance.

Thresholds and eligibility 

Patients with symptomatic varicose veins should be offered treatment of their varicose veins. Compression hosiery is not recommended if an interventional treatment is possible.

Intervention in terms of endovenous thermal (laser ablation, and radiofrequency ablation), ultrasound guided foam sclerotherapy, open surgery (ligation and stripping) are all cost-effective treatments for managing symptomatic varicose veins compared to no treatment or the use of compression hosiery. For truncal ablation there is a treatment hierarchy based on the cost effectiveness and suitability, which is endothermal ablation then ultrasound guided foam, then conventional surgery.

Refer people to a vascular service if they have any of the following:

• Symptomatic primary or recurrent varicose veins.
  • Symptomatic means veins found in association with troublesome lower limb symptoms (typically pain, aching, discomfort, swelling, heaviness, and itching).
• Lower limb skin changes, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency.
• Superficial vein thrombophlebitis (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 two weeks).
• A healed venous leg ulcer.

For patients, whose veins are purely cosmetic and are not associated with any symptoms, do not refer for NHS treatment.

Refer people with bleeding varicose veins to a vascular service immediately.

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

Resources

Treatments not routinely published policy (TNRF2)

Additional information

Assuming patients meet the criteria for this procedure, the consultant can provide the treatment.  

However, if the patients does not meet the criteria, the consultant has the option of submitting an Individual Funding Request (IFR) application to the Effective Commissioning Initiative Team at NHS Surrey Heartlands via the Blueteq database if they consider them to be clinically exceptional.