Key priorities for implementation

Guidance

The following recommendations have been identified as priorities for implementation.

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).

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.

For people with confirmed varicose veins and truncal reflux:
Offer endothermal ablation (see the NICE interventional procedures guidance on radiofrequency ablation of varicose veins and endovenous laser treatment of the long saphenous vein).
If endothermal ablation is unsuitable, offer ultrasound‑guided foam sclerotherapy (see the NICE interventional procedures guidance on ultrasound-guided foam sclerotherapy for varicose veins).
If ultrasound‑guided foam sclerotherapy is unsuitable, offer surgery.

If incompetent varicose tributaries are to be treated, consider treating them at the same time.

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