What criteria should I use to determine if a patient with a venous ulcer requires referral to a specialist?

Criteria for referral of a patient with a venous ulcer to a specialist vascular service include:

• A venous leg ulcer that has not healed within 2 weeks.
• A healed venous leg ulcer for ongoing specialist management.
• Presence of lower-limb skin changes such as pigmentation or eczema thought to be caused by chronic venous insufficiency.
• Symptomatic primary or recurrent varicose veins associated with troublesome lower limb symptoms (pain, aching, swelling, heaviness, itching).
• Bleeding varicose veins requiring immediate referral.

Referral should be made to a vascular service capable of full clinical and duplex ultrasound assessment and providing a full range of treatment options.

This approach ensures timely specialist assessment and management to promote healing and prevent complications.

References: All criteria are based on NICE guideline CG168 on varicose veins: diagnosis and management ¹.