NICE (the National Instiute for Health and Care Excellence) evaluates the efficacy and safety of treatments to determine whether they are appropriate for use by the National Health Service.
In 2013, NICE issued an overview document making recommendations about which patients should be referred to hospital for investigation and treatment of symptomatic varicose veins. This is NICE Clinical Guidline 168 and refers only to patients who might be considered for treatment by the NHS. CG168 makes it clear that minimally invasive procedures are recommended over surgical treatment for varicose veins. No recommendations have been made by NICE concerning the treatment of thread veins since these would not normally be treated by the NHS.
NICE has also issued advice on the interventional procedures commonly used to treat varicose veins:
Patients seeking treatment for varicose veins may find the advice offered by NICE useful in deciding on which treatment they would prefer.
A randomised clinical trial, undertaken by Rasmussen, has compared the outcome of the newer treatments and conventional surgical methods. His findings were that all treatments resulted in similar clinical and patient reported outcomes. However, foam sclerotherapy was less effective in ablating the saphenous veins, although some experts would argue that the technique used in this study was not very satisfactory.
Patients seeking advice should consult a specialist in the treatment of venous diseases. The European specialism of ‘Phlebology’ does not exist in the UK, but some surgeons consider that they are experts in this field.