NICE – NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE
NICE Guidelines on Varicose Veins in the legs were published in July 2013 and a Management Pathway in Aug 2014. Although long overdue we are pleased that at last the Endovenous Laser techniques introduced over 10 years ago have been officially recognised as the treatment of choice for varicose veins.
Sunshine Vein Clinic was the first company in the Sunshine Coast to be established specifically to provide Endovenous Laser (we were ahead of the game and now the local surgeons have moved to non-surgical procedures, but still under general anaesthesia , not medically justified). It is a shame though that these NICE guidelines are still largely being ignored by Medicare and Insurance companies that still pay for stripping when it is the last option recommended!
The guidance by NICE established 3 key recommendations:
- All patients with Varicose Veins and Symptoms should be referred to a Vascular Service.
- Assessment should include full Colour Duplex Ultrasound scanning
- Treatment should be by Endovenous Thermal Ablation and if this not possible or required Foam Sclerotherapy. Surgery should only be undertaken if both these fail.
In expert experienced hands surgery is in fact never required.
Sunshine Vein Clinic has been doing all this since its opening in 2012.
NICE defines a vascular service as “a team of healthcare professionals who have the skills to undertake a full clinical and duplex ultrasound assessment and provide a full range of treatment.” This is precisely what we have at Sunshine Vein Clinic.
Dr Hugo Pin – Sunshine Vein Clinic
Dr Pin is highly skilled in Colour Duplex Ultrasound Scanning. This is an essential part of the patient’s assessment in order to define exactly what is causing the problem and determine what treatment is required and precisely where.
We have seen rather disparaging and misleading comments claiming that doctors are not capable of undertaking quality Duplex Ultrasound assessment! This is arrant nonsense and must be challenged.
The truth lies elsewhere. Surgeons who wanted to undertake Endovenous Ablation had no training in ultrasound and were forced to rely on the sonographers or radiologists to undertake the scanning for them; and many still do. This is not the best way to plan treatment. In our view it is far better for the person undertaking the treatment to also undertake the scan so that they have a perfect picture in their head of what the scan shows. To rely on a written report from a third person to plan treatment is less than ideal. Judgments need to be made as to the relevance of what is detected on the scan. To treat all abnormalities that a sonographer may detect without assessing their importance and relevance to the condition the patient is complaining of will lead to unnecessary overtreatment. Following such a policy may be great for the finances of a company, but is certainly not in the best interests of the patient’s health, comfort or bank balance.
The involvement of sonographers gets more intriguing! Some doctors without a natural background in ultrasound scanning and its use in guiding interventions also use sonographers to guide them during the procedures. The sonographer holds the ultrasound probe and the surgeon places the needle. This is not only highly inefficient (two persons rather than one to do one task) but also illogical. One brain operating two hands (right hand with the needle left hand with the ultrasound probe) is, in our opinion, far better than two brains operating two different persons’ hands!