Download Varicose veins (PLCV) - North Derbyshire CCG

Varicose veins (PLCV)
Local Care Maps - NDCCG > NDCCG PLCV > Varicose veins (PLCV)
Care map
information
Information resources
for patients and carers
Updates to this care
map
Varicose veins
Lipodermatosclerosis
(varicose eczema)?
Venous ulcer?
No to all of the above
Manage in primary
care
Major bleeding?
Yes to one or more of
the above
Eligibility criteria
PLCV referral form
R
Published: 16-Oct-2015
Valid until: 30-Apr-2017
Printed on: 20-Nov-2015
© Map of Medicine Ltd
This care map was published by NDCCG and HCCG. A printed version of this document is not controlled so may not be up-to-date with the
latest clinical information.
Page 1 of 4
Varicose veins (PLCV)
Local Care Maps - NDCCG > NDCCG PLCV > Varicose veins (PLCV)
1 Care map information
Quick info:
Scope:
• the assessment and management of varicose veins in adults, including surgical and non-surgical interventions, across primary
care
Out of scope:
• chronic venous insufficiency
• thrombophlebitis
• deep vein thrombosis (DVT)
• children and young people (age under 18 years)
• varicose veins in places other than legs
• patients with venous malformations
Definition:
• varicose veins:
• are twisting, dilated, superficial veins [1], generally dark purple/blue in colour [2]
• are the most common presentation of chronic venous disease [2]
• are associated with incompetent valves in the affected vein − results in reflux of blood and increased pressure in the vein [1]
• are unable to transport blood properly [2]
• occur most commonly in the feet and legs [3] (particularly the calves), however other parts of the body are
also susceptible, eg [2]:
• pelvis (more common during pregnancy)
• oesophagus
• vagina
• uterus
• rectum
Prevalence:
• affects at least one-third of adults [3]
• higher reported incidence in women [1]:
• in certain studies, incidence found to be approximately 30% in women and 15% in men [1,4]
• evidence suggests that female hormones relax vein walls, making valves more prone to leaking [2]
• however, it has been suggested that the lower reported incidence in men is due to an increased reluctance to report
symptoms [2]
Risk factors:
• increasing age [3] (veins lose elasticity with age)
• pregnancy [1]:
• approximately 40% of pregnant women will be affected [3]
• increase in blood volume puts increased strain on the venous system
• hormones cause relaxation of the blood vessel walls
• enlarging uterus puts pressure on the pelvic veins and inferior vena cava
• family history [2]
• increased body mass index (BMI; puts extra pressure on vein valves) [2]
• prolonged periods of standing/sitting, eg for occupation [2]
• DVT [2]
• previous leg trauma or fracture [2]
Complications include:
• bleeding (should be referred urgently to vascular specialist − see 'Active/recent bleeding' care point) [3]
• ulceration [3]:
Published: 16-Oct-2015
Valid until: 30-Apr-2017
Printed on: 20-Nov-2015
© Map of Medicine Ltd
This care map was published by NDCCG and HCCG. A printed version of this document is not controlled so may not be up-to-date with the
latest clinical information.
Page 2 of 4
Varicose veins (PLCV)
Local Care Maps - NDCCG > NDCCG PLCV > Varicose veins (PLCV)
• increased pressure in veins causes fluid to seep out and collect under the skin [2]
• skin can thicken, swell, and eventually break down to form an ulcer [2]
• most commonly form in the ankle area [2]
• areas of pigmentation [3], venous eczema, or lipodermatosclerosis [4]
• thrombophlebitis [1]
References:
Please see the care map's Provenance.
2 Information resources for patients and carers
Quick info:
Recommended resources for patients and carers, produced by organisations certified by The Information Standard:
• 'Compression stockings' (URL) from Bupa at http://www.bupa.co.uk/
• 'Varicose veins' (PDF) from Patient UK at http://www.patient.co.uk
• 'Varicose veins' (URL) from Bupa at http://www.bupa.co.uk/
• 'Varicose vein surgery' (URL) from Bupa at http://www.bupa.co.uk/
• 'Understanding NICE guidance: Radiofrequency ablation of varicose veins' (PDF) from National Institute for Health and Clinical
Excellence (NICE) at http://www.nice.org.uk
The following resources have been written or recommended by national policy bodies or guideline producers whose content has
informed this care map:
• 'Varicose veins' (URL) from Clinical Knowledge Summaries (CKS) at http://www.cks.nhs.uk
For details on how these resources are identified, please see Map of Medicine's document on Information Resources for Patients
and Carers (URL).
3 Updates to this care map
Quick info:
Local pathway enhanced by wording from international map. Date of publication: 31-Oct-2013
4 Varicose veins
Quick info:
Varicose veins are often asymptomatic (patient's concern may be purely cosmetic), however, some patients may present with:
• fatigue, heaviness, aching, throbbing, itching, and cramps in the legs [5]
• night cramps – particularly during pregnancy [2]
• swelling – particularly during pregnancy [3]
Symptoms may be worse:
• after prolonged periods of standing/sitting – puts extra pressure on the veins in the lower body [1]
• in the evening, and may interfere with sleep [2]
Walking, elevation of legs, or wearing compression stockings are often reported to improve symptoms [1].
Patients with chronic or severe varicose veins may present with:
• skin discolouration [3]
• venous eczema [3,4]
• lipodermatosclerosis (hardened, tight, red, or brown skin) [4]
• venous ulceration [3]
• severe swelling
Patients may present acutely with complications such as:
• bleeding (should be referred urgently to vascular specialist − see 'Active/recent bleeding' care point) [3]
Published: 16-Oct-2015
Valid until: 30-Apr-2017
Printed on: 20-Nov-2015
© Map of Medicine Ltd
This care map was published by NDCCG and HCCG. A printed version of this document is not controlled so may not be up-to-date with the
latest clinical information.
Page 3 of 4
Varicose veins (PLCV)
Local Care Maps - NDCCG > NDCCG PLCV > Varicose veins (PLCV)
• thrombophlebitis [2]
• cellulitis [2]
• infection [2]
References:
Please see the care map's Provenance.
9 Yes to one or more of the above
Quick info:
The National Institute for Health and Care Excellence (NICE) defines symptomatic varicose veins as those associated with pain,
aching, discomfort, swelling, heaviness, or itching [3].
Patient with symptomatic primary or recurrent varicose veins may present with:
• skin discolouration [3]
• venous eczema [3,4]
• lipodermatosclerosis (hardened, tight, red or brown skin) [1,4]
• venous ulceration [3]
• severe swelling
• additional complications, such as:
• bleeding (should be referred urgently to vascular specialist − see 'Active/recent bleeding' care point) [3]
• thrombophlebitis (potential indicator of deep vein thrombosis (DVT) [2]
• cellulitis [2]
• venous ulceration [3]
References:
Please see the care map's Provenance.
11 Eligibility criteria
Quick info:
Please read the referral criteria before referring the patient.
All of the following criteria must apply:
• Appropriate weight management advice has been given to those with a raised BMI.
• Non-smoker or confirmed abstinence for at least 6 weeks prior to procedure.
One or more of the following criteria must apply:
• Patient has lipodermatosclerosis, venous eczema or a venous ulcer.
• Patient has had superficial thrombophlebitis, with suspected venous incompetence as the most likely cause.
• Patient has had a major episode of bleeding from the varicosity.
• Patient has symptomatic primary or recurrent varicose veins (with “symptomatic” defined as pain, aching, discomfort, swelling,
heaviness and itching).
The following additional patient information must apply:
• The patient is willing to undergo a surgical procedure should it be offered.
• I have discussed with the patient the fact they will be referred for a possible procedure but there is no guarantee that a surgical
intervention will be the preferred outcome following the consultation with the secondary care specialist.
Published: 16-Oct-2015
Valid until: 30-Apr-2017
Printed on: 20-Nov-2015
© Map of Medicine Ltd
This care map was published by NDCCG and HCCG. A printed version of this document is not controlled so may not be up-to-date with the
latest clinical information.
Page 4 of 4
Varicose veins
Surgery / Vascular surgery
___________________________________________________________________________________________
Provenance certificate
Provenance certificate for this International Map of Medicine pathway for Varicose veins published on 31 October
2013.