Varicose Veins (Swollen, twisted veins, usually in the legs)

Threshold

Norfolk and Waveney Integrated Care Board will fund patients for referral to secondary care if they meet at least one of the following criteria:

a) Ulceration secondary to venous stasis.

b) Bleeding varicose vein or if the patient is at high risk of re-bleeding. (i.e. there has been more than one episode of minor haemorrhage or one episode of significant haemorrhage from a ruptured superficial varicosity).

c) Significant and/or progressive lower limb changes such as varicose eczema, lipodermatosclerosis or oedema caused by chronic venous insufficiency.

d) High risk significant superficial vein thrombosis (previously known as superficial thrombophlebitis), with a hard, painful, red vein (these patients should be referred to the thrombosis team/pathway as an emergency).

e) If the patient is severely symptomatic (not covered by the above criteria) and this is affecting activities of daily living and/or instrumental activities of daily living*

* Activities of daily living include functional mobility, eating, bathing and personal care. They can be measured using the Barthel activities of daily living index. Instrumental activities of daily living include more complex tasks such as care of others, community, mobility, health management and meal preparation.

Overview | Varicose veins: diagnosis and management | Guidance | NICE

NOTE: Refer people with bleeding varicose veins to a vascular service immediately.

Policy Exceptions:

Do not carry out interventional treatment for varicose veins during pregnancy other than in exceptional circumstances. Provide information on the effects of pregnancy on varicose veins and consider compression hosiery for symptomatic relief of leg swelling.

Cases for Individual Funding Consideration (Patients who do not meet the policy criteria)

On a case to case basis, patients might be eligible for intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.