May 2013

New NICE Guidelines for Varicose veins  will recommend more people are treated using new techniques, despite recent NHS drives to prevent people from receiving the needed vein treatment.

Varicose veins are a major problem for a large number of us, with over 50% of people over the age of 50 years having symptoms form veins in their legs.

Despite some of these problems being very significant, such as leg ulcers, bleeding or significant aching, itching or throbbing, there has been a drive in the NHS to reduce the number of vein operations undertaken under the false guise that all varicose veins treatments are from cosmetic reasons.


Also over the last few years improved  techniques have been developed to replace the more traditional surgical stripping out of the veins. These include heating the inside of the vein with a laser or radio-frequency pulse or sticking the vein together with a glue or sclerosant. The introduction of these new techniques into the NHS has been prevented on a perceived cost basis and lack of clinical advantage reason


The National Institute for Health and Clinical Excellence (NICE) is the powerful body which reviews the available evidence and makes recommendations  on patient management, based on clinical and cost effectiveness. Few NHS hospitals can ignore their recommendations.


Guidelines on Varicose vein management are soon to be published which should ensure the correct indications for treatment and the correct methods of treatment within the NHS.

In particular all people with significant leg vein problems will be reviewed by a specialist, namely a vascular surgeon and if appropriate offered treatment. This will hopefully remove the General Practitioner as the gate keeper preventing good clinical practice.


The evidence suggests that intervention is more cost effective than just treating the veins with stockings. This is therefore likely to correctly herald an increase in the number of varicose vein operations undertaken.


Of the different procedures available the newer technique of heating the vein from inside to cause it to shrivel up is the treatment of choice. This recommendation should therefore force NHS hospitals to offer this service.


Daryll Baker is a Consultant Vascular Surgeon at the Royal Free Hospital London and Clinical Lead for North Central Region Vascular Services.

He read Medicine at Oxford University and trained in Vascular Surgery in Nottingham, London and Edinburgh. He obtained his research PhD from the University of Wales.


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