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Who needs a varicose vein or venous referral?

by – June 8, 2017

Who needs a venous referral?

Prof Mark Whiteley gave this breakfast tutorial at the Independent Doctors Federation (IDF) in London on 6 June 2017.

He went through different conditions and which patients need a referral:

  • varicose veins
  • leg ulcers
  • phlebitis (superficial venous thrombophlebitis or better known as superficial venous thrombosis)
  • thread veins (spider veins) of the legs
Who needs a venous referral - varicose veins - phlbebitis - leg ulcers - thread veins - Prof Mark Whiteley lectures the IDF London 6th June 2017

Who needs a venous referral – varicose veins – phlbebitis – leg ulcers – thread veins – Prof Mark Whiteley lectures the IDF London 6th June 2017

Varicose veins and leg ulcers – who needs a venous referral?

Prof Mark Whiteley explained that there are two reasons for patients with varicose veins who need a referral.

1] medical reasons for varicose vein treatment
2] cosmetic reasons for varicose veins treatment

1] although many patients and doctors think that varicose veins are “only cosmetic” research has shown this not to be the case in a very large number of patients. Since summer 2013, the National Institute of Health and Care Excellence (NICE) has published guidelines on who should be referred medically for treatment of varicose veins. These guidelines can be found on https://www.nice.org.uk/guidance/cg168/.

After going through all of the research, NICE has recommended that anyone with varicose veins and any symptoms or signs at all, get a benefit from varicose vein treatment. Therefore anyone with varicose veins and “troublesome symptoms” quoted as:

  • pain
  • aching
  • discomfort
  • swelling
  • heaviness
  • itching

will get a proven benefit from treatment. As such any patient with varicose veins and any of these symptoms should be referred to a specialist vascular service such as The Whiteley Clinic.

NICE also recommends that patients with varicose veins and any of the following:

  • skin changes in the leg, such as pigmentation or eczema
  • superficial vein thrombosis (phlebitis or hard, painful veins)
  • venous leg ulcer (that has not healed within 2 weeks)
  • healed venous leg ulcer

Any patient who fits into any of these categories should have a referral for medical reasons to a specialist unit as defined by NICE. The Whiteley Clinic satisfies all of the NICE criteria as such a specialist service.

2] Of course some people have unsightly varicose veins and want them removed for cosmetic reasons. In this case, The Whiteley Protocol still gives excellent results. However, in this situation, a referral is not for medical reasons and so is not covered by insurance nor funded by the NHS.

Phlebitis (superficial venous thrombosis) – who needs a venous referral?

The NICE clinical guidelines make it clear that anyone with phlebitis should be referred for a specialist opinion.

Guidelines from 2012 from both the UK and the USA explained that phlebitis is actually a clot in the superficial veins. (see: http://www.chestnet.org/Guidelines-and-Resources/CHEST-Guideline-Topic-Areas/Pulmonary-Vascular and http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2141.2012.09249.x/pdf).

If this clot extends within 5 cm of a deep vein, there is a 1% chance of a pulmonary embolism (clot in the lungs). To prevent this, patients need anticoagulation.

The only way to diagnose this is a specialist venous duplex ultrasound scan. It is for this reason that the NICE recommendation is that patients with phlebitis should now be referred to a specialist service such as The Whiteley Clinic.

Thread veins (spider veins) of the legs – who needs a venous referral?

A very large number of men and women suffer from thread veins of the legs. Microsclerotherapy is widely acknowledged as the best way to treat the thread veins. However, research clearly shows that 89% have underlying hidden veins.

Treatment of thread veins without performing a venous duplex to find these underlying veins often results in failure of treatment.

Therefore it is only sensible to get a specialist venous duplex ultrasound scan to check for underlying problems first. In almost 9/10 people, this will show there is an underlying problem that’s treatment first. Having this underlying venous problem identified and treated significantly increases the chance of a good result.

For more information on any of these conditions, please contact us through the website www.whiteleyclinics.co.uk

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