Varicose Veins in the Legs: The Diagnosis and Management of Varicose Veins

Excerpt

Varicose veins are dilated, often palpable subcutaneous veins with reversed blood flow, most commonly found in the legs. Estimates of the prevalence of varicose veins vary. Visible varicose veins in the lower limbs are estimated to affect at least a third of the population. There is little reliable information available in the literature on the proportion of people with varicose veins who progress to venous ulceration. One study reported that 28.6% of those who had visible varicose veins without oedema or other complications progressed to more serious venous disease after 6.6 years.83 However there was no information about the numbers progressing to ulceration. Other data on the lifetime prevalence of varicose veins estimate that approximately 3–6% of people who have varicose veins in their lifetime will develop venous ulcers.71 Risk factors for developing varicose veins are unclear although prevalence rises with age and they often develop during pregnancy. In some people varicose veins are asymptomatic or cause only mild symptoms, but in others they cause pain, aching or itching and can have a significant effect on their quality of life. Varicose veins may become more severe over time and can lead to complications such as changes in skin pigmentation, eczema, superficial thrombophlebitis, bleeding, loss of subcutaneous tissue, lipodermatosclerosis or venous ulceration.

There are several options for the management of varicose veins, including:

1. advice and reassurance

2. interventional treatments

3. compression hosiery

Interventional treatments include surgery, foam sclerotherapy and endothermal ablation. Surgery is a traditional treatment that involves surgical removal by 'stripping' out the vein or ligation (tying off the vein). In foam sclerotherapy sclerosant foam (irritating agent) is injected into the vein to cause an inflammatory response which consequently closes it. There are two main endothermal methods: radiofrequency and laser ablation, these methods heat the vein from inside causing irreversibly damage to the vein and its lining and closes it off. All treatments may be performed under general or local anaesthesia and do not usually require an overnight stay in hospital.

A review of the data from the trials of interventional procedures indicates that the rate of clinical recurrence of varicose veins at 3 years after treatment is likely to be between 10–30%. One of the aspects which prevents being able to provide clear figures on retreatment rates is that many of the treatments are relatively new and the long term rates have not yet been published.

In 2009/10 there were 35,659 varicose veins procedures carried out in the NHS indicating a considerable financial cost and impact on workload. There is no clear simple system to identify which people benefit the most from interventional therapy and currently there is no established framework within the NHS for the diagnosis and management of varicose veins. This has led to considerable regional variation in the management of and in the treatments offered to people with varicose veins in the UK. Hence this guideline was developed with the aim of giving healthcare professionals guidance on the diagnosis and management of varicose veins in the leg, in order to improve patient care and minimize such disparities in care across the UK.

Copyright © National Clinical Guideline Centre (July 2013).