Who forms these guidelines?

The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care in the United Kingdom.

What do the guidelines for varicose vein cover?

NICE guidelines for varicose veins are meant for diagnosing and managing varicose veins in people aged 18 and above.

They aim at

  • ensuring that people understand the options for treating varicose veins
  • ensuring that healthcare professionals know when to refer patients to specialist assessment and treatment.

For whom are the NICE guidelines written?

The NICE guidelines are written for the following persons:

  • Healthcare professionals
  • Health commissioners and healthcare providers in the governing bodies
  • People with varicose veins and their families and caretakers.


The following recommendations have been identified for implementation on a priority basis. These are for doctors, nurses and other healthcare providers. These include guidelines on when to refer the patient to a vascular service, how to assess the patient, what kind of treatment to give in which patient, etc.

Referral to specialized vascular services:

The patient must be referred to a vascular service (a team of doctors who can investigate, examine and provide a full range of vascular treatments) if they have any of the following:

  • Bleeding from varicose veins
  • Symptomatic primary or symptomatic recurrent varicose veins. Symptoms include pain, discomfort, swelling, heaviness, and itching.
  • Lower-limb skin changes, e.g. pigmentation, eczema, which is thought to be caused by chronic venous insufficiency.
  • Superficial vein thrombosis (characterized by the appearance of hard, painful veins) and suspected venous incompetence.
  • A venous leg ulcer (a break in the skin below the knee that has not healed within 2 weeks).
  • A healed venous leg ulcer.

Assessment guidelines:

  • Use duplex ultrasound to confirm the diagnosis of varicose veins,  the extent of truncal reflux, as well as to plan the treatment for people with suspected primary or recurrent varicose veins.

Interventional treatment:

These are the treatment guidelines for people with confirmed varicose veins and truncal reflux:

  • Offer endothermal ablation and endovenous laser treatment for the long saphenous vein.
  • If endothermal ablation is unsuitable, suggest ultrasound-guided foam sclerotherapy to treat varicose veins.
  • If ultrasound-guided foam sclerotherapy is unsuitable, suggest surgery.
  • Consider treating incompetent varicose veins at the same time.

Non-interventional treatment:

  • Do not offer compression hosiery as a treatment for varicose veins unless other interventional treatments are unsuitable.
  • A pregnant woman should always be given non-interventional treatment such as compression bandage for the relief of swelling of legs except in extreme circumstances.


(Source: NICE Guideline 2012)

  • Ensure that the person understands the reasons for wearing compression therapy.
  • Ensure that the person has been shown how to put on and take off the stocking. The best time to put stockings on is first thing in the morning before any leg swelling develops.
  • Check, that the person is happy with the color of the stocking. Men often prefer black or other colors, rather than flesh colored.
  • Recommend application of an emollient while the stocking is off, to reduce skin dryness and irritation.
  • Ensure that the stocking is a correct fit – if standard sizes are not suitable, the person may need a custom-made stocking.
  • If the person is having difficulty tolerating the level of compression, try a lighter compression stocking.
  • If the person is having difficulty using a thigh-length stocking, consider switching to a below-knee stocking.
  • If the person is having difficulty putting the stocking on, an application aid may be helpful.
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