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NICE recommends cost-saving newer treatments for severe varicose veins instead of surgery

Patients with severe varicose veins should be offered newer and cheaper alternatives to surgery, according to new NICE guidance released today on the diagnosis and management of the condition.

The health regulator has ruled that endothermal ablation - either radiofrequency ablation of varicose veins or endovenous laser treatment of the long saphenous vein - and ultrasound-guided foam sclerotherapy are clinically effective and cost effective alternatives to surgery.

Patients should now only be considered for surgery if neither of these treatments are suitable, while only those patients unsuitable for any of these interventions should receive treatment with compression hosiery.

NICE says the new guidance – the first of its kind – should save the NHS both time and money, and lead to more standardised care of people with varicose veins across the UK.

Up to now there has been no clear guidance on which treatment is the best choice for patients requiring intervention. The new guidance aims to offer treatment options according to the severity of symptoms.

Professor Alun Davies, professor of vascular surgery and honorary consultant surgeon at Imperial College NHS Trust, London, who chaired the guidelines development group, said: ‘Varicose veins are a common problem, with around 35% of the UK population being affected. Treatment offered, however, varies on where you live.

‘This guideline shows quite clearly that interventional treatment for some patients who are suffering from symptomatic varicose veins is a better alternative to surgery and is both clinically and cost-effective. It will help standardise care for all those with this condition.’

NICE clinical guideline 168 - Varicose veins in the legs

Readers' comments (6)

  • I must admit that I thought compression hosiery was all about preventing skin chnage and later ulceration and I am unsure of the evidence that sclerotherapy etc will actually do that ? does anyone know ?

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  • Does anybody know if these guidlines include haemorrhoids?

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  • Pelvic venous incompetence including treatment for recurrent varicose veins, vulval varices and haemorrhoids was discussed by the Guidelines committee at length but was regarded as outside the scope of the guidelines for varicose veins. It also fell just outside the recommended areas for further research. This was disappointing for me (sitting on the committee as an Interventional radiologist, who introduced laser (EVLT) to the UK in March 2001, and who actively treats pelvic vein incompetence including for haemorrhoids.
    I was very pleased that it was part of the formal discussion process however, confirming a major step forward in mainstream conceptual thinking about venous disease over the past 10 years.
    When I first spoke about EVLT at meetings 12 years ago, there was a lot of harrumphing about stripping and "crossectomy" as "Gold Standards" and now, laser treatment is confirmed as the new Gold Standard by NICE.
    These new guidelines are therefore a bit of an historic moment, and the haemorrhoids will have to wait a bit longer. One step at a time!

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  • Regarding ulcers; EVLT of all the incompetent venous pathways (skilled duplex scanning) including, if necessary passing under the ulcer, as well as closing down all the incompetent (varicose) trunks will allow swift healing of most varicose ulcers even if present for months or years. This technique was developed by J-L Gerrard in France in 2003 and is widely confirmed.
    Compression bandaging and hosiery is a poor and expensive second best to active endovenous laser treatment for varicose ulcers.

    Joe Brookes, Interventional radiologist, (member of NICE VV Guidelines Committee)

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  • what are the long-term results?

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