The recommended goal in the United Kingdom's National Institute of Care and Excellence (NICE) Clinical Guideline 168 for immediate referral of patients with bleeding varicose veins is not being achieved.

Cragg, James; Nyamekye, Isaac

OBJECTIVE Published in July 2013 NICE Clinical Guidelines 168 (CG168) recommended that people with bleeding varicose veins should be referred immediately to a vascular service. We have examined the impact of CG168 on referral practice for patients with bleeding varicose veins from primary to secondary care in a local NHS service. METHODS Referrals to a local vascular service in the 6 years before (Group 1) and 6 years after (Group 2) publication of CG168 were analysed to assess patients' management following a bleed, with particular reference to a patient's initial presentation and delays in referral to the vascular service. This was done by retrospective electronic database and case-note interrogation of patients presenting with bleeding varicose veins. Relevant data was collected onto an Excel spread sheet in relation to demographic information, comorbidities, clinical presentation and treatment pathway. RESULTS 73 patients presented with bleeding varicose veins during the period studied. Their mean age was 66 and 56% were men. Their mean BMI was 28. Of note Thirty-three patients (45%) initially self-treated, before going to see their General Practitioner (GP), another 18 (25%) went to the Emergency department (ED). In 51 patients (70%) the underlying superficial pathology involved the great saphenous vein (GSV) and most patients (73%) were treated with foam sclerotherapy with or without truncal thermal ablation. 45 patients (Group 1) were treated in the 6 years before CG168 and 28 patients, allowing 6 months for dissemination, were treated in the 6 years after CG168 (Group 2). Mean time from index bleed to referral to the vascular service was faster after CG168 (84 days pre and 20 days post CG168). P=0.00842. Publication of CG168 was also associated with reduced mean bleed to intervention times (194 vs 60 days P=0.00097). CONCLUSIONS Publication of UK NICE guidelines CG 168 has been associated with a significant reduction in the delay to referral of patients presenting with bleeding varicose veins however the goal of immediate referral to a vascular service is not being met. CG168 is likely to have been a significant component of the factors that have led to the improvements seen thus far.