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Varicose Veins


Varicose veins are swollen and enlarged veins – usually blue or dark purple – that usually occur on the legs.

Classification of Varicose Veins

Refer to the locally agreed protocol for referral of varicose veins and the five classifications:

  • Class 1 – thread veins or reticular veins with cosmetic symptoms                                    NOT FUNDED
  • Class 2 – varicose veins with no complications                                                                NOT FUNDED
  • Class 3 – represents varicose veins with skin changes at the ankle with the additional possibility of further complications (bleeding, superficial thrombophlebitis, oedema). Funded
  • Class 4 – represents skin changes ascribed to venous disease pigmentation, venous eczema, lipodermatosclerosis. Funded
  • Class 5 and 6 – represents severe skin changes and/or active ulceration. Late stage venous disease. Funded subject to full vascular assessment.
Referral Guidelines

Prior approval from the CCG will be required before any treatment proceeds in secondary care.

Refer to Secondary Care provider via RSS using the appropriate Prior Approval Referral Form.

Do not refer for NHS treatment:

Cosmetic varicose veins not associated with any symptoms (Class 1 or 2)

Refer to a vascular service any of the following (Class 3 to 6) :

  • Lower‑limb skin changes, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency.
  • Superficial vein thrombophlebitis (characterised by the appearance of hard, painful veins) and suspected venous incompetence.
  • Venous leg ulcer (a break in the skin below the knee that has not healed within 2 weeks).
  • Healed venous leg ulcer.

Refer immediately:

Bleeding varicose veins to a vascular service / A&E.

Compression Hosiery:

Do not offer compression hosiery to treat varicose veins unless interventional treatment is unsuitable.

Classification of compression hosiery
Class Pressures Support Indications for use
I 14-17 mmHg Light Varicose veins

Mild oedema

II 18-24 mmHg Medium Severe varicose veins

Mild oedema

Prevention of ulcer recurrence

III 25-35 mmHg Strong Severe varicose veins

Post-phlebitic limb

Prevention of ulcer Recurrence

Chronic venous insufficiency

Compression hosiery exerts a resting pressure. The daily build-up of pressure is controlled by the limited ability of the hosiery to stretch, so incompetent venous valves are approximated, venous return is accelerated, the fibrinolytic activity of the venous wall is increased and the risk of thrombosis reduced.

Limited evidence from a systematic review of randomized controlled trials indicates that wearing compression stockings reduces symptoms of varicose veins in men and non-pregnant women. Compression stockings which exert an ankle pressure of 10–20 mmHg seem to be as effective as stockings which exert an ankle pressure greater than 20 mmHg.

Therefore, for most people, class 1 light compression stockings (14–17 mmHg) or class 2 medium compression stockings (18–24 mmHg) will be suitable.

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