Patients should be given verbal and written information on varicose veins, as well as self-care advice to relieve symptoms and reduce the risk of complications.

The National Institute for Health and Care Excellence (NICE) recommends referral to a vascular service for consideration of interventional treatment of varicose veins, in the following cases:

• Primary or recurrent varicose veins associated with lower limb symptoms.

• Lower-limb skin changes, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency.

• Superficial vein thrombosis.

• An active venous leg ulcer.

• A healed venous leg ulcer.

Compression stockings should only be offered if referral is not indicated (after excluding arterial insufficiency). This patient has skin pigmentation, so referral is warranted.

Resources

• NICE. Clinical Knowledge Summary. Varicose veins. Updated 2020.

• Varicose veins (CKS)​

• Varicose veins (NHS Choices)