The VEnous INtervention (VEIN) Project

Varicose veins affect up to 25% of the adult population in the UK. Their management comprises a significant proportion of the workload of most vascular specialists. However, over the last few years the number of interventions for varicose veins has been falling in the UK, with no apparent reduction in their incidence. It is thought that this is largely an effect of cost pressure on resources and this has lead to a clear inequity in the provision of venous services across the country. There is good evidence that treating symptomatic uncomplicated varicose veins improves quality of life and is cost-effective. At the same time as the number of interventions has decreased, a variety of new minimally invasive treatments have become available for varicose veins. The new methods have allowed interventions for varicose veins to move away from the operating theatre and general anaesthesia into ambulant day-care facilities, or even the outpatient setting. This has reduced costs, but risks being seen as downgrading the importance of the condition. An efficient cost-effective pathway for dealing with varicose veins benefits both patients and providers. Yet, the bewildering array of treatments now available has lead to controversy about when and how to employ them. The VEnous INtervention (VEIN) Project was conceived to define how services should be provided for patients with symptomatic, uncomplicated varicose veins, and the way the interventions should be delivered. Standardization of facilities and methods is expected to produce optimal results from all the interventions. The project is confined to patients with uncomplicated varicose veins, since evidence-based pathways of care already exist for patients with complicated venous disease, such as varicose ulceration. The VEIN project publication comprises six evidence-based articles concerning interventions for uncomplicated varicose veins, and the methods currently available to treat them. The articles have been written by experts in the field of venous disease with a wide range of experience in the management of varicose veins and the new interventions. They include an analysis of the indications for any intervention, and then comprehensive reviews of compression hosiery, standard surgery, endovenous laser ablation, radiofrequency ablation and sclerotherapy. They contain a wealth of data about the delivery and outcomes of each intervention. A separate summary document will use this reference base to define the components of good practice for treatment of uncomplicated varicose veins. The document will define the various interventions (particularly the new ones) and standards for their use, and the training needed before they should be introduced. It is envisaged that the project documents will be valuable to health-care professionals, commissioning groups and even patients, to influence the provision of varicose vein treatment in their hospitals. A copy of the summary document is available on the Venous Forum website (see www.rsm.ac.uk/venous). We hope that the VEIN Project will provide the evidence that supports the development of contemporary pathways of care that will encourage equity of access to individuals with venous disease.