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Varicose Veins

 

Most varicose veins respond to conservative management, i.e. exercise, weight loss and elevation of the leg 2-3 times daily.

Varicose eczema can often be treated effectively with emollients and topical steroids.

 

Urgent referral

Refer people with persistent bleeding varicose veins to the vascular service immediately via the on-call surgical team at Treliske.

 

Consider routine referral of patients with varicose veins who meet the criteria below

The referral letter and patient’s medical record need to clearly evidence how these criteria are met.

·       Superficial vein thrombosis (characterised by the appearance of hard, painful veins)

·       Symptomatic varicose veins in the presence of arterial insufficiency (absent pedal pulses)

·       Recurrent or ascending superficial phlebitis (DVT risk may be as high as 10-20% at presentation)

·       Severe swelling or pitting oedema

·       Marked lower-limb skin varicose eczema, that has not responded to conservative measures

·       Lipodermatosclerosis  http://www.dermnetnz.org/topics/lipodermatosclerosis/

 ·For venous ulcer and incipient ulceration with erythema and skin induration see:

http://rms.kernowccg.nhs.uk/rms/primary_care_clinical_referral_criteria/vascular/leg_ulcer_management

 

Do not refer for NHS treatment:

· Patients who do not fulfil the above criteria

· Patients whose concerns are cosmetic only

 · Patients with pain or ache only, itch, mild swelling, minor changes of skin eczema and haemosiderosis

 

In the absence of these referral criteria, exceptional cases may be referred via approval from the KCCG Individual Funding Request Panel:

http://www.kernowccg.nhs.uk/get-info/individual-funding-requests/