Management of Varicose veins

1. Specialty: General Surgery

Ailment Name Procedure Name ICD Code

Varicose veins Laser Ablation, foam I83.001
sclerotherapy,RFA
2. ALOS: 3 days

3. Minimum Qualification of treating doctor -

Essential: Diploma in surgery

Desirable: MS/ DNB/ equivalent (General Surgery)

4. Special empanelment criteria/linkage to empanelment module: As per IRDAI guidelines
5. Clinical Key Pointers
Varicose veins are the most common vein disorder. Varicose veins are dilated, tortuous veins caused by
dilation of normal veins due to increased venous pressure. They are visible surface manifestations of an
underlying syndrome of venous insufficiency. They occur in varying severity and in different clinical
presentations. 2% of these patients present with skin changes and morbid chronic venous ulcers.
Causes
● Hereditary, history of phlebitis
● Female, pregnancy, pelvic tumors
● Prolonged standing
● Secondary to DVT and arteriovenous malformations
Varicose veins may involve
● Greater saphenous vein (GSV)
● Lesser saphenous vein (LSV) with their tributaries
● Perforator veins, which connect them to the deep venous system of the leg
● Combination of the above veins

Clinical presentation depends on the severity of the disease

● Aching pain in the leg
● Tiredness and discomfort
● Hyperpigmentation
● Venous ulceration
● Lipodermatosclerosis
● Itching
● Bleeding
● Superficial thrombophlebitis
The clinically relevant tests performed at the bedside are
1 Copyright @2022 Medi Assist. All rights reserved.
 ● Trendelenberg test – To assess Saphenofemoral or Saphenopopliteal valve reflux
● Three bandage test – To assess site of perforator reflux
● Perthes test – To assess patency of deep venous system
Investigations
● Basic investigations
● USG abdomen
● Venous doppler scan of limbs
Management
Non pharmacological treatment
Reassurance, elastic compression stockings, foot elevation.
Pharmacological treatment
Injection sclerotherapy, foam sclerotherapy.
Surgical treatment

● Saphenofemoral junction ligation and greater saphenous stripping with or without

incompetent perforator ligation
● Saphenopopliteal junction ligation and lesser saphenous stripping with or without
incompetent perforator ligation
● Split thickness skin grafting for venous ulcers, if present

6. Mandatory documents to be submitted by hospital

Mandatory Documents Varicose veins

ICD Code I83.001
1. At the time of Pre-authorization
Completely filled pre-authorization form along with cost estimate Yes
Clinical notes - detailed history, signs & symptoms, examination findings and Yes
indication for procedure?
Duplex scan confirming the diagnosis? Yes
2. Additional documents at the time of discharge
Completely filled claim form Yes
Is the Discharge summary with follow-up advice at the time of discharge? Yes
Indoor case papers Yes
Was the indication for surgery mentioned?
Hospital Bill Yes
2 Copyright @2022 Medi Assist. All rights reserved.
Was the duplex scan report submitted? Yes
Are the detailed procedure / Operative Notes available? Yes

By Dr Padma & Dr Sushma – Jan 2022

3 Copyright @2022 Medi Assist. All rights reserved.