Varicose Veins In Primary Care

### What you need to know\n\nA 62 year old woman presents to her general practitioner with bilateral lower leg swelling and aching. She has extensive varicose veins on both legs which developed during her last pregnancy, 25 years ago. She has experienced increasing discomfort in both legs over the past five years and lower leg swelling which worsens during the day. She has started to develop some eczematous skin changes around the ankle of the right leg. \n\nAnnually, 1-2% of people with skin changes related to varicose veins develop lower limb ulceration,1 which affects their quality of life and creates socioeconomic burdens on health services.1 Each year up to 7% of people with varicose veins develop lower leg skin changes (such as haemosiderin deposition and/or lipodermatosclerosis),1 which are a sign that they are at increased risk of slow wound healing and ulceration. Ulceration and skin changes are both signs of chronic venous insufficiency and require treatment. Timely specialist referral can reduce the impact on quality of life and reduce costs.2\n\nThis article offers guidance to general practitioners and non-specialists on the assessment of patients presenting with varicose veins, how to recognise chronic venous insufficiency, when to refer to secondary care, and appropriate management strategies that can be initiated in primary care. We also provide a summary of management options that might be considered in secondary care.\n\nThe advice offered in this paper is based on our clinical experience as well as the limited evidence that is available on non-specialist assessment and management of varicose …