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A recent audit in Western locality has revealed that varicose vein surgery is being performed on a significant number of Grade 2 varicose veins.
DRSS has been asked by NHS Devon and secondary care to tighten implementation of the current Varicose Veins Policy.
The majority of GP referrals will be unaffected, but there is going to be stricter implementation of the policy wording on "skin change".
It is considered that mild skin changes, for example haemosiderin deposition, thread veins and non varicose eczema are in keeping with Grade 2 veins and will therefore not be suitable for onward referral.
Recurrent thrombophlebitis, significant bleeding from varicosities, lipodermatosclerosis, varicose eczema and active or healed ulceration imply grade 3 or higher and can be referred into secondary care.
Bleeding – emergency control is by elevation and pressure, followed by bandaging. Refer urgently
No special investigations required before referral
Grade 0: Telangectasia and reticular veins: Cosmetic significance only. People may seek treatment outside the NHS.
Grade I and II: Varicose veins without symptoms or with symptoms such as aching, heaviness or swelling:
Grade III. Varicose veins with complications, including bleeding, recurrent phlebitis or eczema.
Grade IV: Signs of severe venous insufficiency – lipodermatosclerosis or healed ulceration.
NHS Devon Commissioning Policy "Referral for Varicose Veins"
MyHealth patient information - Varicose veins
This guideline has been signed off on behalf of NHS Devon.
Publication date: January 2020