Varicose Veins
Please see the CKS guidelines for advice on management: Varicose Veins
The BNSSG ICB varicose vein surgery policy was updated in May 2024 to bring into line with these guidelines.
Leg Ulcer
For further advice on management of leg ulcers see the Leg Ulcer page.
Before Referral - please consider the Referral Criteria as stated in the policy and as below:
Criteria Based Access:
1. A venous ulcer (a break in the skin below the knee that has not healed within 2
weeks).
OR
2. Recurrent venous ulceration of the lower limb*
* Patients with persistent or recurrent venous leg ulcers should be managed conservatively in primary care initially. If persistent leg ulcers do not respond to treatment after 6 months, or if there are 2 or more episodes of recurrence of venous ulceration within a 12 month period, then refer for consideration of varicose vein surgery.
Prior Approval:
Severe changes of the lower limb including:
** Evidence of venous incompetence should be included such as the clinical findings described in the following BMJ best practice article: Chronic venous insufficiency - Symptoms, diagnosis and treatment
If Referral is not indicated
If criteria for referral are not met, offer compression stockings (after excluding arterial insufficiency). Please see the Hosiery page for advice on the use of compression stockings
If the person is pregnant
Advise the person to seek further medical help if:
Chronic leg ulceration may also be caused by skin cancer. If malignant change in an ulcer is suspected then refer to dermatology 2WW pathway
Patients with infected diabetic foot ulcers should be referred immediately to the Vascular Hot Clinic.
Criteria Based Access Referrals
If a patient with varicose veins meets the criteria for referral with the CBA section of the policy then a referral can be made via eRS - please state clearly how criteria have been met.
Prior Approval Referrals
If a patient with varicose veins does not have features that meet the criteria in the CBA section of the policy but is eligible for referral via the prior approval route, then the PA form should be submitted at the same time as a referral. The PA application will be reviewed by the Referral Service and if adequate evidence has been supplied to support the application this will be forwarded on to the vascular service as below
Vascular referrals are sent via eRS to the Vascular Surgery Triage Service. Clinics are held in Southmead, BRI, WGH & Bath RUH. Referrals will be triaged on a daily basis by the vascular team and booked into appropriate clinics. Please include all relevant clinical and contact details in referrals to help facilitate the triage process.
Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.