SRP 109 Varicose Veins

Policy number: SRP 109
Policy name: Varicose Veins
Status: Individual Prior Approval
Effective date: 1 April 2024
Next review date: 1 April 2026

Conservative management is the first line of treatment and applications will not normally be accepted without evidence that conservative management of asymptomatic and symptomatic varicose veins has been tried, and failed, for a period of at least six months.

Prior to consideration for intervention patients should be given information regarding:

Weight loss if they have a raised BMI.
Light to moderate physical activity
Avoiding factors which are known to make their symptoms worse, if possible
Use of compression stockings for a 6-month duration, where this is considered appropriate.
When and where to seek further medial help

Mid and South Essex ICB commissions treatment or surgery for Varicose Veins on a restrictive basis.

Funding for treatment or surgery will only be made available for Grade III and above Varicose Veins.

Grade III: Varicose veins with complications, including bleeding, recurrent phlebitis or eczema.

Patients who have had bleeding associated with varicose veins should be referred urgently.
Patients with recurrent thrombophlebitis and persistent varicose veins may be referred, especially if phlebitis has affected veins above the knee.
Patients with eczema near the ankle or associated with varicose veins below the knee should be referred for specialist advice.

VARICOSE ECZEMA

STASIS GRAVITATIONAL ECZEMA

Interventional treatment should be in line with NICE guidance which identifies endothermal ablation as the first line intervention where suitable. If endothermal ablation is unsuitable, offer ultrasound-guided foam sclerotherapy. If ultrasound-guided foam sclerotherapy is unsuitable, offer surgery.

Do not carry out interventional treatment for varicose veins during pregnancy other than in exceptional circumstances. Consider compression hosiery for symptom relief of leg swelling associated with varicose veins during pregnancy.

Patients whose veins are purely cosmetic and are not associated with any symptoms will not be funded. Do not refer for NHS treatment.

Patients not meeting the above criteria will not be funded unless there are clinically exceptional circumstances.

Individual funding requests should only be made where the patient demonstrates clinical exceptionality.

Find out more information on applying for funding in exceptional clinical circumstances