NICE has recommended that some people with varicose veins, such as those causing pain and ulcers, should be offered alternatives to surgery, known as endothermal ablation, heat energy treatment of the wall of the vein (radiofrequency or laser treatment), which are less invasive than surgery with a much speedier recovery time.
The new guidance recommends that people should be referred to a vascular service if they have symptomatic primary or recurrent varicose veins; lower limb skin changes such as pigmentation or eczema, hard painful veins), or leg ulcers below the knee. Duplex ultrasound should be used to confirm the diagnosis of varicose veins and plan the course of treatment. It also states that endothermal ablation (radiofrequency or laser) should be offered to treat confirmed varicose veins. Ultrasound-guided foam sclerotherapy should be offered to patients if endothermal ablation is not suitable. NICE recommends that only if neither treatment is suitable, surgery should be considered. Compression hosiery (e.g. tights and stockings) should be offered only if any of these treatments are unsuitable. Interventional treatments such as endothermal ablation, ultrasound guided foam sclerotherapy or surgery, should not be carried out during pregnancy.
