Varicose veins are like icebergs - most of the problem lies beneath

Posted: 02/09/2013

The ‘Jeremy Vine’ show on BBC Radio 2 recently discussed the options for treatment of varicose veins and how surgery should not necessarily be the first resort. This comes shortly after the new NICE guidelines of July 2013.

Up to one third of adults in the UK will develop varicose veins. They are swollen, unsightly and often painful veins that have stopped working properly after valves have been lost resulting in back-flow and pools of blood which causes an unsightly bulge. Surgery to remove the affected vein has historically been the treatment offered, and usually entails ligation and stripping of the veins, but recently there has been a move towards laser treatment, heat therapy or sclerotherapy as alternative remedies. Surgery is rarely now the first resort.

For both laser and heat treatment, a catheter is inserted into the offending vein and a short burst of heat or energy delivered to close and seal it. The patient remains awake throughout the procedure. In sclerotherapy a special foam is injected into the vein under ultrasound and it scars the vein sealing it closed. These methods are performed under local anaesthetic while surgery to remove the vein is performed under a general anaesthetic, which carries risks by itself. It is also known that varicose veins can grow back, so surgical removal may not be the best long-term option. Finally non-surgical treatment is less invasive and much more cost effective for the NHS with the newer forms of treatment estimated to save the NHS £400,000 a year.

Left untreated, varicose veins can become painful and can lead to potentially debilitating leg ulcers, blood clots or a deep vein thrombosis, which if dislodged and travels up through the lungs can be fatal. Surface varicose veins are easy to see and many women will want them treated in any event for cosmetic reasons. It is the deeper varicose veins that are more difficult to diagnose as they can't necessarily be seen by a physical examination alone and an ultrasound and possibly also a venogram may be required to check vein structure and blood flow.

Previous NICE guidelines of 2001 advised GPs that most varicose veins required no treatment and could be managed in primary care. Patients were generally only referred when the veins were actively bleeding. However, the problem with varicose veins is that by the time they are noticeable, they may be far worse than the patient realises. In that sense they are like icebergs - most of the problem lies beneath.

The new NICE guidelines are very clear in stating that all patients with varicose veins and with symptoms (bleeding, aching or throbbing, swelling, itchy or restless legs) must be referred to a multi-disciplinary centre for assessment and treatment.

Alison Johnson, associate solicitor in the clinical negligence team at Penningtons Solicitors, said: "Patients should not shy away from seeking medical advice about varicose veins. They should not feel that varicose veins are purely a cosmetic issue and that treatment is in any way less justified. There are a number of treatment options for varicose veins and the risks and benefits of each should be explained carefully so patients can make an informed choice and be confident that their varicose vein treatment is right for them."

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