All information is correct at time of printing and is subject to change without notice. The Devon Formulary and Referral Website is not in any way liable for the accuracy of any information printed and stored by users. For the most up-to-date information, please refer to the website.
Varicose veins are very common and most people with varicose veins do not need referral or treatment.
People with varicose veins and eczema or lipodermatosclerosis (colour changes in the skin and hardness of the subcutaneous tissues of the lower leg) should be referred because they are at risk of ulcers.
People with varicose veins often have leg pains from other causes (e.g. arthritis). Varicose veins do not cause groin pain, pain on activity, or restriction of movement.
The Commissioning Policy for Devon and Cornwall does not allow referral of people with symptomatic varicose veins in the absence of skin changes, ulcers, bleeding or recurrent phlebitis. This policy differs from the recommendations of NICE Clinical Guideline 168 (July 2013) on Varicose Veins. Patients with symptoms can only be referred within the NHS if they are designated as exceptional cases.
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