Varicose veins

Treatment for Varicose Veins by the Clinical Nurse Specialist

Patients with COMPLICATED varicose veins

• Risk of ulceration is high
• There has been a history of ulceration and risk remains high
• There has been a history of bleeding veins
• Recurrent phlebitis (ie > 1 documented episode)
• Skin changes that have not responded favourably to the use of compression after 3/12 daily use
• Moderate to severe ankle oedema
• There is a strong family history of varicose veins and ulceration and where there is clinical evidence of varicose veins
• Gross varicose veins that are extensive and symptomatic
• Symptoms are not controlled by daily use of compression and are severely affecting quality of life
• Chronic leg pain - treatment aims will be for conservative management but may necessitate onward referral to 2º for a vascular opinion

For patients with ROUTINE uncomplicated varicose veins i.e. surgical intervention is not usually indicated, dependant on arterial assessment, are often amenable to the use of compression hosiery and as such should be managed routinely in Primary Care e.g:

• Bilateral Varicose veins
• Phlebitis
• Varicose veins with skin changes
• Recurrence with no skin changes
• Varicose eczema
• Symptomatic varicose veins
• Mild Bilateral ankle oedema
• Pain in legs
• Itchy legs
• Achy legs
• Restless legs
• Night cramps
• Family history of varicose veins

Criteria

Exclusion: Children, patients with routine varicose veins, patients with leg ulcers and bleeding varicosities.

Referral Process

Referral form available on the right hand side of this page should be faxed to the Varicose Vein Nurse Led Clinic on 020 8274 6167.

Service Address

12-18 Lennard Road
Croydon
Surrey
CR9 2RS

Tel No.: 020 8274 6163
Fax No. 020 8274 6167

Waiting Times

Approximately 6 - 12 weeks according to clinical priority. All referrals are clinically triaged on receipt and prioritised according to need.

Not available on Choose and Book

Service Lead

Sian Carter, RGN - Varicose Veins clinical nurse specialist

When secondary referral is indicated 'patient choice is fully discussed at the time.

All supporting information for patients, car parking, what to bring, etc… is sent with the appointment letter , time and venue is discussed with the patient at the time of booking.

Treatment Aims:

• To reduce progression / risk / recurrence of ulceration, unresolved chronic symptom control
• Reinforce health promotion advice
• Advise on compression hosiery
• Provide written information
• Monitor
• Review and if ongoing concerns refer to Vascular Consultant
• Letter to referring clinician and discharge from VVCNS

When 2º surgical intervention is clinically indicated for COMPLEX varicose veins (VVCNS refer only)

• Is the patient medically fit for surgery?
• Does the patient want surgery?
• Give advice & written information regards surgery, considering potential risk vs benefit e.g. bruising, haematoma, numbness, scarring, infection, DVT etc
• Offer “Choice”
• Letter to referring clinician and discharge from VVCNS

NB: Some patients with mild or asymptomatic varicose veins may have expectations of surgical treatment under the NHS - it would be helpful therefore if the referral criteria is made clear at consultation.