Varicose Veins

What are Varicose Veins?

Varicose veins are enlarged, twisted veins that bulge beneath the skin, most often appearing on the legs. These veins usually have a thick, lumpy appearance and are commonly dark purple or blue. Because they form just under the skin’s surface, varicose veins are typically easy to spot. However, if you are overweight, excess fatty tissue might conceal these veins, making them less visible.

In addition to varicose veins:

  • Spider veins are smaller and look like thin, red or blue lines resembling spider webs.
  • Reticular veins are slightly larger and have a bluish-green appearance.
Sometimes these veins appear alongside varicose veins, but they can also occur independently.
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Diagnostic Tests for Venous Conditions

Ultrasound Scanner

Duplex Ultrasound Scan

Duplex ultrasound scan is a non-invasive and pain free investigation. It is the gold standard investigation for venous diseases.

It allows assessment the condition of both deep and superficial veins. It is often the only investigation required in majority of patients with varicose veins as it is able to provide adequate information to allow decision making on treatment.

With colour duplex ultrasound imaging, all veins and arteries can be visualized so that the direction of the blood flow can be demonstrated and measured. In patients with varicose veins, it will demonstrate incompetent valves and reversal of blood flowing toward the feet. A venous mapping and report are then produced to indicate all incompetent veins and where they arise from. This will assist surgeon to decide how to best manage your varicose veins.

Magnetic Resonance Venography (MRV)

Magnetic Resonance Venography (MRV) is Magnetic Resonance Imaging (MRI) of veins.

It is a radiation-free scanning technique that uses radio waves and magnetic fields to produce detailed three-dimensional images of the body. It is a very sensitive test for deep and superficial venous disease in the lower legs and in the pelvis, where other imaging methods (eg duplex ultrasound scan) cannot reach.

MRV is particularly useful for investigating nonvascular causes for leg pain and oedema. In addition, non-contrast imaging techniques are available with MRV, making MRV the preferred technique in patients with renal impairment or contrast allergy.

CT scan venography

CT Venography

CT venography is also useful for evaluation and visualization of the anatomical structure of venous system varicose veins and venous malformations.

CT venography has advantages of speed and spatial resolution in comparison with MRV. Many patients who are not candidates for MRV by virtue of pacemakers or other MRI incompatible devices, or claustrophobia, can be examined with CT venography. CT venography always requires the use of intravenous contrast and radiation exposure which are the main limitations of this technique.It is especially useful when:

  1. Veins in the pelvis and abdomen are suspected to be abnormal, for example- DVT, iliac vein compression
  2. There is suspicion of congenital venous abnormalities
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More About Varicose Veins

How Common are Varicose Veins?

Varicose veins affect about 3 out of every 10 adults at some point in their lives. Women develop varicose veins more often than men. In most cases, varicose veins appear without an underlying health issue and have no clear cause.

  • Usually cause no symptoms or health problems
  • Some people dislike their appearance
  • If varicose veins cause discomfort or affect self-esteem, a vein specialist can help with treatment

Recognizing early signs of varicose veins can help manage the condition effectively.

How Do Veins Work?

Healthy and Diseased Vein Valves

Veins carry blood from the organs and tissues back to the heart, while arteries deliver blood from the heart throughout the body.

  • Leg veins have one-way valves to stop blood from flowing backward.
  • When valves weaken or are damaged, blood can flow backward toward the feet due to gravity.
  • This backward flow causes veins close to the skin surface to swell, forming varicose veins.

Varicose veins can appear as small enlarged veins or larger clusters resembling bunches of grapes, often seen on the calf.

Why Do Varicose Veins Occur?

Approximately 30% of adults experience varicose veins, with genetics being a major risk factor.
Environmental influences also contribute:

  • Occupations with prolonged standing
  • Western diet high in fat and refined sugars, low in fibre
  • Ageing increases risk
  • Hormonal fluctuations (puberty, pregnancy, menopause)

Note: 60–70% of pregnancy-related varicose veins usually resolve within several months postpartum.

What are the Symptoms of Varicose Veins?

Varicose veins may cause:

  • Fatigue, heaviness, aching
  • Burning, throbbing, itching
  • Cramps in the legs
  • Swelling of the ankle

Spider veins can also produce the same symptoms. These symptoms are usually worse during warm weather or after long periods of standing.

Potential Complications of Untreated Varicose Veins

Most people with varicose veins do not develop complications. However, chronic high venous pressure may cause skin and tissue changes around the ankle.

Complications may develop several years after varicose veins first appear. The visible size of the veins does not predict risk.

Possible complications include:

  • Inflammation of the vein (thrombophlebitis)
  • Swelling of the foot or lower leg
  • Skin changes such as discolouration, eczema, ulcers, or lipodermatosclerosis (hardening of the fat layer under the skin)
  • Bleeding from veins close to the skin due to minor trauma

Why Should I Have My Varicose Veins Treated?

  • To ease unpleasant symptoms such as pain, cramps, or discomfort
  • To treat complications including skin discolouration, ankle swelling, bleeding, thrombophlebitis, or leg ulcers
  • To restore the natural appearance of your legs
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Varicose Veins Treatment in Singapore

Endovenous Thermal Ablation (Laser or Radiofrequency)

A minimally invasive procedure that replaces traditional vein stripping surgery. The aim is to destroy the vein from the inside using heat.

  • Performed under local anaesthesia, sedation, or general anaesthesia
  • Uses ultrasound guidance to pass a laser fibre or radiofrequency probe into the vein
  • Tumescent anaesthesia is applied around the vein to reduce pain and prevent tissue injury
  • The vein is closed off and eventually absorbed by the body

Procedure details:

  • Typically takes 1 hour or less for one leg
  • Often combined with microphlebectomy
    (adds 30–40 minutes)

Risks:

  • Bleeding, bruising
  • Inflammation (thrombophlebitis)
  • Pain along the ablation site
  • Infection
  • Deep vein thrombosis
  • Nerve injury

Endovenous Non-thermal Ablation

Mechanico-chemical sclerotherapy (ClariVein):

  • Rotating wire + sclerosant injection
  • Minimally invasive, no thermal injury
  • No tumescent anaesthesia needed
  • Suitable for veins below the knee where nerve injury risk is higher with thermal techniques
  • Less pain and bruising than thermal ablation

VenaSeal Glue Ablation:

  • Uses medical-grade “superglue” to permanently seal diseased veins
  • Minimally invasive, non-thermal, no anaesthesia required

Microphlebectomy

A minimally invasive surgery for large or medium-sized varicose veins.

  • Tiny 2–3 mm incisions, usually no stitches required
  • Vein hook used to elevate and remove the vein
  • Often combined with other procedures
  • Guided by ultrasound for precision

Ultrasound-Guided Foam Sclerotherapy

Reserved for larger veins or recurrent cases.

  • Foam sclerosant pushes blood out of vein and destroys it more effectively than liquid
  • Vein shrinks into fibrous cord and is absorbed by the body
  • Outpatient procedure with little discomfort and minimal bruising

Surgery (Ligation and Stripping)

For large or tortuous veins requiring surgical removal.

  • Performed under general or spinal anaesthesia in an operating theatre
  • Usually requires overnight hospital stay
  • Two incisions (groin and leg)
  • Vein tied off (ligation) and removed with a flexible wire (stripping)

Conservative Treatment Options

Compression Stockings / Bandaging:

  • Medical-grade graduated compression (30–40 mmHg at ankle)
  • Improve circulation and symptoms
  • Must be properly measured and fitted
  • Come in various colours, fabrics, and styles

Other conservative measures:

  • Weight loss: reduces venous pressure
  • Leg elevation: improves venous drainage
  • Exercise: activates calf muscle pump to push blood upward
  • Medications:
  • Daflon: treats venous insufficiency symptoms and aids ulcer healing
  • Pentoxifylline: effective adjunct for venous ulcer healing when combined with compression

Cost of Varicose Veins Treatment in Singapore

The cost of treating varicose veins in Singapore can vary depending on the procedure type, the extent of the condition, and the medical facility chosen. To guide patients, the Ministry of Health (MOH) has published benchmark fee ranges for surgeons’ charges. These figures do not include additional costs such as GST, hospital or day surgery charges, consultation, or equipment fees.

Surgeon’s Fee Guide (Single Leg)

Endovenous Ablation & VenaSeal

MOH code: SD713V
$ 4,900 – 7,300
  • Endovenous Laser Ablation (EVLA)
  • Radiofrequency Ablation (RFA)
  • VenaSeal (medical adhesive closure)

Ligation & Vein Stripping

MOH codes: SD805V / SD806V
$ 2,600 – 4,300
  • High ligation
  • Radiofrequency Ablation (RFA)

Micro Phlebectomy

MOH code: SD808V
$ 2,600 – 4,300
  • Micro Surgical Avulsion (MSA)

Sclerotherapy

MOH code: SD717V
$ 2,600 – 4,300
  • Injection treatment for smaller varicose and spider veins

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