LLR Policy for Surgical Treatment of Varicose Veins

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Category

Threshold Criteria

Varicose veins are swollen and enlarged veins that usually occur on legs and feet. They may be blue or dark purple and are often lumpy, bulging or twisted in appearance.

Symptoms include

  • Aching, heavy and uncomfortable legs
  • Swollen feet and ankles
  • Burning or throbbing legs
  • Muscle cramp in legs particularly at night
  • Dry, itchy and thin skin over the affected vein

Eligibility

LLR ICB will fund  treatment of varicose veins (by endothelium ablation, foam sclerotherapy or surgical stripping) only when one, or more, of the following clinical criteria are met *:
a.       Varicose eczema
b.       Lipodermatosclerosis or a varicose ulcer
c.        At least two episodes of documented superficial thrombophlebitis
d.       A major episode of bleeding from the varicosity.
 
*These criteria equate approximately to Clinical, Etiologic, Anatomic and Pathophysiologic (CEAP) stage C4 onwards or Class 4 & 5 of the Nottingham/Derby Guidelines (published 2001) ‘Varicose Veins – who and what to treat’.
 
For those patients that did not meet the policy criteria (i.e. CEAP 2-3) compression hosiery and lifestyle advice could be offered. Given the natural history of varicose veins to progress in some patients, a patient could be referred at a later date if they developed clinically so that they met the criteria.
ARP 100 Review Date: 2026

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