Diagnosis

• Explain likelihood of progression including complications: DVT, skin changes, ulcer, bleeding and thrombophlebitis
• Explain symptom relief, compression, interventional treatments
• Explain treatment options, including recurrence rates (higher than primary varicose veins)
• If bleeding varicose veins refer immediately to vascular service

Refer if:

• Symptomatic
• Lower limb changes: pigmentation, eczema
• Superficial vein thrombosis
• Venous leg ulcer (including if healed)

Investigation

• Duplex ultrasound to determine extent of truncal reflux and plan treatment

Management

Conservative management:

• Weight loss
• Light to moderate activity
• Avoid activities known to make symptoms worse

Interventions:

• Endothermal ablation or if not suitable,
• Ultrasound guided foam scleropathy
• Only offer compression hosiery if interventional therapy unsuitable
• Do not offer during pregnancy unless exceptional circumstances, instead consider compression therapy

NICE Source: CG168 Varicose veins: diagnosis and management. Summary compiled by Dr D P Sheppard MBBS.