1. Guidelines
NICE guidelines and comparative effectiveness in the treatment of chronic venous disease.
A. Davies
The National Institute for Health and Care Excellence (NICE) in the UK analyzes and assesses the treatment for varicose veins. In 2010, it was shown that day-case procedures were all cost-effective with surgery being the most cost-effective, but the guidelines have also shown that despite modern advances and day-case surgery, patients expect an extended period off work!
The progression of the disease is still poorly understood. Body mass index, female sex, and increased age were associated with increased rates of disease progression and a weaker association was found for subjective sensations of leg heaviness, leg swelling, and leg tension. The rate of disease progression to ulceration increased with male sex and history of serious leg injury.
It was difficult to determine key factors for outcomes postintervention, but being female did confer a risk for a higher rate of complications after foam sclerotherapy. A raised body mass index was associated with greater reflux recurrence.
Patients with symptomatic varicose veins, active or healed ulceration, or superficial venous thrombosis should be referred to a specialist’s vascular service. Patients do not have to wait as long for a referral. As venous intervention is cost-effective, the compression hosiery should not be a holding measure unless the patient is unsuitable for treatment. A full duplex ultrasound venous mapping should be done because it has been shown to reduce recurrence rates and improve short-term disease specific quality of life measures. Endovenous thermal ablation is the first-line treatment. The important message delivered in this communication is that, nowadays, no patient with varicose vein disease should be without a treatment option.
