Synopsis
Recognise clinically important varicose veins, identify complications and alternative causes, and refer patients to a vascular service at the right urgency.
- Immediately refer any person with bleeding varicose veins; first control haemorrhage with elevation and firm direct pressure while assessing circulation.
- Refer symptomatic primary or recurrent veins, venous skin changes, superficial vein thrombosis with suspected incompetence, an active venous ulcer unhealed for two weeks, or a healed venous ulcer.
- At vascular assessment, full clinical examination and lower-limb duplex ultrasound confirm reflux anatomy and plan treatment; appearance alone cannot map truncal incompetence.
Key red flags
Active or recent bleeding from a varicose vein requires immediate vascular referral even when simple pressure has stopped the bleeding.
A suddenly swollen painful leg, chest pain, breathlessness, haemoptysis or collapse raises concern for deep vein thrombosis or pulmonary embolism and needs an urgent VTE pathway.
A hot rapidly spreading erythematous limb, fever, hypotension, severe pain or crepitus suggests cellulitis, sepsis or necrotising infection rather than uncomplicated venous disease.
Rest pain, tissue loss, a cold pale foot or absent pulses suggests limb-threatening arterial disease; do not assume swelling or ulceration is purely venous.
Investigation priorities
Confirm reflux or obstruction, identify affected superficial trunks and deep veins, and provide the anatomical map needed for intervention.
Management branches
Use when a patient reports troublesome symptoms or develops skin change around visible varicosities.
- Clarify symptom pattern, functional effect, prior thrombosis, bleeding, ulcer history, pregnancy status and previous venous procedures.
- Examine both legs with the patient standing when safe, then assess pulses, oedema, venous skin changes, ulceration and alternative systemic causes.