Varicose Veins and Thread Veins - Criteria Led Commissioning Statement

Scope

This commissioning statement refers to:

  • Tortuous, superficial veins resulting from faulty valves which allows reverse venous blood flow, with subsequent venous pooling and distension in the lower leg. Causes include obesity, occupation, pregnancy and age

This commissioning statement does not refer to:

  • Red Flag Symptoms
  • Deep vein thrombosis (DVT) should be excluded in any patient presenting with a red, hot swollen leg with use of the Well's criteria and d-dimer testing.
  • Superficial vein thrombosis above the knee should be discussed with the vascular team as admission is sometimes indicated for high tie and/or anticoagulation as there is a significant potential for clot migration and PE
  • Bleeding varicose vein which has caused significant blood loos and/or will not stop with direct pressure may require admission

Status

Eligibility Criteria

NICE has issued a clinical guideline on the management of varicose veins (CG168, July 2013). This policy statement is broadly consistent with criteria for referral recommended by NICE with the exception that referral for patients with symptomatic primary or symptomatic recurrent varicose veins without complications is not routinely commissioned.

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

Unless an exceptional case is presented, the CCGs will not fund Secondary Care for the treatment of:

  • Grade 0: Thread/Flare/Reticular veins
  • Grade I: Varicose veins without symptoms
  • Grade II: Varicose veins with symptoms such as pain, aching, heaviness or swelling

The CCGs will fund specialist advice and surgery if appropriate for the following:

  • Grade III: Varicose Veins with complications, including bleeding, recurrent phlebitis or eczema
  • Grade IV: Signs of venous insufficiency – lipodermatosclerosis or healed Ulceration
  • Grade V: Active leg ulceration

To receive exceptional funding, a clinical advocate for the patient needs to be able to demonstrate that the patient is:

  • significantly different to the general population of patients with the condition in question
  • likely to gain significantly more health benefit from the intervention that might be normally expected for patients with that condition.

NOTE:

  • Varicose veins surgery in pregnancy are not routinely commissioned and would require IFR approval.
  • Consideration of exceptional circumstances will be via the Individual Funding Request Panel. For an application for consideration of funding by the Independent Funding Request Panel
  • The presence of telangiectasia and reticular veins do not meet the criteria for referral.

Lifestyle Factors - Best Practice

Obesity

  • Patients with a BMI >30 should be encouraged by their Clinician to lose weight prior to surgery and signposted to appropriate support to address lifestyle factors that would improve their fitness for surgery and recovery afterwards.
  • There is a clinical balance between risk of surgical complications with obesity and the risk to delaying any surgery.
  • See Weight Management Care Pathways

Smoking

  • In line with 'Healthy Lives, Healthy People; a tobacco control plan for England', local authorities and health professionals are committed to encourage more smokers to quit.
  • Smoking remains the leading cause of preventable morbidity and premature death in England.
  • There is sufficient evidence to suggest that people who smoke have a considerably increased risk of intra- and post-operative complications such as chest infections, lung disorders, wound complications and impaired healing.
  • See Smoking Cessation Care Pathways
Please Note: The life style factors above are not a restriction to the commissioning statements unless otherwise stated

Evidence/Rationale

NICE states the following:

"People with varicose veins that are causing symptoms or problems such as bleeding, eczema or leg ulcers should be referred to a specialist vascular service"

Links listed below in Reference section:

References

  1. Varicose veins: diagnosis and management - https://www.nice.org.uk/guidance/cg168
  2. Patient Info - Varicose Veins - http://www.patient.co.uk/health/varicose-veins-leaflet
  3. Patient Info - Superficial Thrombophlebitis - http://www.patient.co.uk/health/Phlebitis.htm
  4. Gp Notebook - Varicose Veins https://www.gpnotebook.co.uk/simplepage.cfm?ID=1301938199
  5. Ultrasound-guided foam sclerotherapy for varicose veins. NICE interventional procedure guidance 440 (2013). https://www.nice.org.uk/guidance/ipg440
  6. Promoting physical activity in the workplace. NICE public health guidance 13 (2008). https://www.nice.org.uk/guidance/ph13
  7. Physical activity and the environment. NICE public health guidance 8 (2008). https://www.nice.org.uk/guidance/ph8
  8. Obesity. NICE clinical guideline 43 (2006). https://www.nice.org.uk/guidance/cg43
  9. Four commonly used methods to increase physical activity. NICE public health guidance 2 (2006). https://www.nice.org.uk/guidance/ph2
  10. Endovenous laser treatment of the long saphenous vein. NICE interventional procedure guidance 52 (2004). https://www.nice.org.uk/guidance/ipg52
  11. Transilluminated powered phlebectomy for varicose veins. NICE interventional procedure guidance 37 (2004). https://www.nice.org.uk/guidance/ipg37
  12. Radiofrequency ablation of varicose veins NICE interventional procedure guidance 8 (2003). https://www.nice.org.uk/guidance/ipg8

Supporting Polices

  • NHS North Kirklees and NHS Wakefield CCG Commissioning Policy

Assurance & Governance

  • This policy was developed on: 05.2017
  • This policy was approved by: Clinical Strategy Group (NK) and Clinical Cabinet (WK)
  • Date approved: 05.2017
  • Publication Date: 05.2017
  • Review Date: 04.2018
  • Ref No: PA1 - 05.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

Home > Policies > Criteria Led - Commissioning Statements > Varicose Veins and Thread Veins - Criteria Led Commissioning Statement