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Varicose veins: diagnosis and management

This Guidelines for Nurses summary is deliberately concise—covering recommendations 1–2, and 4. For the complete list of recommendations, please refer to the full guideline. All recommendations relate to adults aged 18 years and over

Information for people with varicose veins

  • Give people who present with varicose veins information that includes:
    • an explanation of what varicose veins are
    • possible causes of varicose veins
    • the likelihood of progression and possible complications, including deep vein thrombosis, skin changes, leg ulcers, bleeding, and thrombophlebitis. Address any misconceptions the person may have about the risks of developing complications
    • treatment options, including symptom relief, an overview of interventional treatments, and the role of compression
    • advice on:
      • weight loss (for guidance on weight management see NICE's guideline on obesity)
      • light to moderate physical activity
      • avoiding factors that are known to make their symptoms worse if possible
      • when and where to seek further medical help
  • When discussing treatment for varicose veins at the vascular service* tell the person:
    • what treatment options are available
    • the expected benefits and risks of each treatment option
    • that new varicose veins may develop after treatment
    • that they may need more than one session of treatment
    • that the chance of recurrence after treatment for recurrent varicose veins is higher than for primary varicose veins

Referral to a vascular service

  • Refer people with bleeding varicose veins to a vascular service* immediately
  • 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

Management during pregnancy

  • Give pregnant women presenting with varicose veins information on the effect of pregnancy on varicose veins
  • Do not carry out interventional treatment for varicose veins during pregnancy other than in exceptional circumstances
  • Consider compression hosiery for symptom relief of leg swelling associated with varicose veins during pregnancy

* 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

Veins found in association with troublesome lower limb symptoms (typically pain, aching, discomfort, swelling, heaviness, and itching)

full guideline available from…
National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BT
www.nice.org.uk/guidance/CG168

National Institute for Health and Care Excellence. Varicose veins: diagnosis and management.
First included: March 2016.