What criteria should I use to determine if a patient with varicose veins requires referral for surgical intervention?

Criteria for referral of patients with varicose veins for surgical intervention include:

• Presence of symptomatic primary or recurrent varicose veins, characterized by troublesome lower limb symptoms such as pain, aching, discomfort, swelling, heaviness, and itching.
• Lower-limb skin changes attributable to chronic venous insufficiency, including pigmentation or venous eczema.
• Superficial vein thrombosis with suspected venous incompetence, especially when veins are hard and painful.
• Active venous leg ulcer (a break in the skin below the knee that has not healed within 2 weeks) or a healed venous leg ulcer.
• Bleeding varicose veins, which require immediate referral to a vascular service.

Referral to a vascular service is recommended to confirm diagnosis with duplex ultrasound, assess the extent of truncal reflux, and plan appropriate interventional treatment such as endothermal ablation, foam sclerotherapy, or surgery if other treatments are unsuitable.

Compression stockings should not be offered as sole treatment unless interventional treatment is unsuitable, and arterial insufficiency must be excluded before prescribing compression.

Pregnant women are generally not candidates for interventional treatment except in exceptional circumstances and should be managed conservatively with compression hosiery if appropriate.

These criteria are based on NICE guidelines and expert consensus to ensure symptom control and prevent disease progression.

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