Varicose veins are a common disease

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2. February 2015

New NICE guideline recommends foam sclerotherapy in preference to surgery

In recent years, sclerotherapy has gained importance in the treatment of varicose veins of widely differing manifestations. The current guideline issued by the National Institute for Health and Clinical Excellence (NICE) confirms this by recommending foam sclerotherapy rather than surgical procedures for trunk varicose veins. Putting foam sclerotherapy before surgery for the first time creates a paradigm shift, as experts reckon that most trunk varicose veins worldwide are still treated surgically.

The National Institute for Health and Clinical Excellence (NICE) is an independent body, whose remit is to provide reliable guidance on current methods of treatment for healthcare professionals and the general public. The current NICE guideline on the therapy of varicose veins that require treatment from the medical point of view is primarily orientated to improving symptoms and the patient’s quality of life as well as to the elimination of visible varicose veins. High-quality clinical trials and economic aspects were included in the assessment of the individual therapeutic options. The quality of the NICE guidelines is rated very highly throughout the world.

Treatment options for trunk varicose veins are thermal procedures (endovenous laser therapy and radiofrequency ablation), foam sclerotherapy, and surgical procedures such as crossectomy (high saphenofemoral ligation) and stripping. The guideline rates all treatment methods as similarly effective and does not find any relevant clinical differences. Overall, the authors’ appraisal of the thermal methods was slightly more positive, although sclerotherapy remains the most cost-effective of all the methods. For the first time, the NICE guideline gives preference to foam sclerotherapy over surgery in the treatment of trunk varicose veins. Surgery should be offered only if sclerotherapy is not an option. This is particularly significant as experts estimate that 80-90% of all trunk varicose veins worldwide are still treated surgically – something that is no longer recommended by the current guideline.

“The new recommendations in the NICE guideline represent a revolution in phlebology. For the first time, foam sclerotherapy is preferred to surgery. Until now, the vast majority of trunk varicose veins have been treated surgically in most countries throughout the world. It will be interesting to see what effects these recommendations have on the choice of treatment options in the future”, says Professor Eberhard Rabe, Head of Phlebology in the Department of Dermatology at the Bonn University Hospitals, emphasising the importance of the current guideline on the treatment of varicose veins.

Author: Sophia Post