Varicose veins should be treated with lasers, says NICE
People with varicose veins should be offered laser or heat treatment, say new guidelines for England and Wales.
The National Institute for Health and Care Excellence (NICE) says, in most cases, surgery should be a last resort.
Up to one third of adults in the UK develop varicose veins - swollen, unsightly and often painful veins that have stopped working properly.
As well as being less invasive for the patient, laser therapy is cheaper than surgery for the NHS, says NICE.
Some 35,000 varicose veins procedures are carried out in the NHS each year. Switching from surgery to these newer therapies could save the NHS £400,000 a year in England alone, says NICE.
There has been a gradual shift away from surgery, but many patients are still offered it as the first choice.
In some parts of the country, laser and heat treatment are rarely offered.
Although surgery will still be the best option for some, NICE says many patients should instead have either laser treatment or heat therapy (endothermal ablation).
Surgery takes around an hour-and-a-half and requires the patient to be given a general anaesthetic. They can usually go home on the same day if all goes well.
In comparison, heat or laser treatment takes about 60 minutes, the patient is awake throughout and they can normally be discharged from hospital within an hour or so of having the procedure.
These treatments are also less invasive than traditional surgery because they require fewer or smaller incisions.
For both laser and heat treatment, a catheter is inserted into the offending vein and then a short burst of energy is delivered to close and seal it.
Prof Alun Davies, who helped write the new advice, said: "This guideline shows quite clearly that interventional treatment for some patients who are suffering from symptomatic varicose veins is a better alternative to surgery, and is both clinically and cost-effective. It will help standardise care for all those with this condition."
Varicose veins affect mainly older people, but also people who stand for long periods in their work and pregnant women.
They can be very uncomfortable and are a common cause of leg ulcers.