Diagnosis and management of varicose veins in the legs: summary of NICE guidance

Varicose veins in the lower limbs are a common problem, estimated to affect at least a third of the UK population.1 Although some individuals with varicose veins remain asymptomatic, others may experience pain, aching, heaviness, and itching, that can impair quality of life.2 3 About 10% of people with varicose veins go on to develop skin changes, such as pigmentation or eczema,4 while about 3% may develop venous ulcers.5 At present there is substantial variation across the UK as to who qualifies for referral or treatment, and how varicose veins are treated.6 Clear guidance on which individuals should be referred to specialist vascular services, as well as the most clinically effective and cost effective treatment, is required. This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE).7 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### Referral to a vascular service Refer people to a vascular service if they have any of the following: