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The new NICE guidelines regarding varicose veins are to be congratulated for highlighting endothermal ablation techniques as the first choice treatment for patients with symptomatic varicose veins. NHS patients will benefit from these ambulatory procedures which offer a less painful recovery and a quicker return to function.
However the eligibility for referral to a vascular specialist for treatment is now guided by this broad statement "symptomatic primary or symptomatic recurrent varicose veins". Worryingly this may be open to all kinds of interpretation by patients, GP commissioners and secondary care treatment providers. The challenge is that existing guidelines guiding NHS varicose vein care across the country are non-uniform with some funding treatment for patients with ankle oedema (CEAP class C3) whilst others will only allow treatment for those with a healed or active ulcer (CEAP class C5 or C6). This leads to a treatment postcode lottery with many frustrated patients. It will be interesting to see how the new NICE guidelines will affect CCG commissioning practice. We recommend that adopting a treatment threshold of skin changes of pigmentation and venous eczema (CEAP class C4) may allow more equitable access to NHS varicose vein services.
No competing interests
12 August 2013
Consultant Vascular Surgeon
Neville Dastur, Telemoarchos Cleanthis, David Gerrard, Peter Leopold
Frimley Park Hospital NHS Foundation Trust
Regional Vascular Unit, Portsmouth Road, Camberley, Surrey GU16 7UJ