Varicose veins

Many patients with varicose veins do not need intervention and merely need to be reassured with regard to their problems. Many patients can also be managed within the community and if clinicians think that they need specialist assessment, they can be referred to the vascular specialists on a selective basis.

Primary care assessment

All patients should be assessed and scored by GP using the ‘C’ component of CEAP classification.
Patients must score at least C3 on CEAP scoring to be suitable for referral.
If a patient has C3 disease or above on CEAP with minor varicose veins, other causes of ankle oedema should be excluded before it is attributed to varicose veins.
Where no other cause of oedema is found, the patient should be referred to the specialist vascular services for assessment.
If the patient is below the threshold for referral to specialist services, then symptomatic management along with reassurance should be undertaken by the GP.
Patients with bleeding varicose veins and those with superficial venous thrombophlebitis should be referred to vascular services.

CEAP Score

CEAP Clinical Score	Description
C0	No visible or palpable varicose veins
C1	Telangectasia (Thread veins / Spider veins / Broken veins)
C2	Varicose veins
C3	Swollen ankle (oedema) due to varicose veins or hidden varicose veins (venous reflux)
C4	Skin damage due to varicose veins or hidden varicose veins (venous reflux)
C5	Healed venous leg ulcer
C6	Venous leg ulcer

Primary care assessment

CEAP Score

Editorial Information