Varicose veins should be removed using heat or laser treatments as an alternative to surgery, according to new guidance from NICE.
Endothermal ablation, which involves heat energy treatment of the wall of the vein using radiofrequency or laser treatment, is less invasive than surgery and leads to speedier recovery times.
The new guidance aims to help clinicians match treatment options to the severity of the patient’s symptoms. It states that those suffering from leg pain and ulcers should be offered alternatives to surgery.
For example, those with symptomatic primary or recurrent varicose veins should be referred to a vascular service, along with those who have skin changes in their legs such as pigmentation or eczema, superficial vein thrombosis, or leg ulcers below the knee.
NICE said duplex ultrasound should be used to confirm the diagnosis and plan the best course of treatment, with endothermal ablation being offered to treat confirmed varicose veins.
Patients who are unsuitable for endothermal ablation should be offered ultrasound-guided foam sclerotherapy as an alternative, NICE said. It recommends that surgery should only be considered if neither option is suitable.
Compression tights or stockings should be offered if all other treatments are unsuitable, for example if the patient is pregnant and unable to undergo endothermal ablation, ultrasound guided foam sclerotherapy or surgery.
Varicose veins are a common complaint affecting up to a third of UK adults, but NICE said there has previously been no established NHS framework for diagnosis and treatment. Some sufferers may develop painful symptoms and varicose veins are also a common cause of leg ulcers.
Director of the NICE centre for clinical practice Professor Mark Baker said: “This guidance sets out the options for patients and their physicians to treat the individual symptoms of each patient so that no matter where they live, they have access to the therapy that’s right for them.”
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