Venous Disease

What is Venous Disease?

Venous disease refers to a group of conditions that affect the veins responsible for returning blood from the body back to the heart. When vein valves become weakened, damaged or blocked, blood can pool within the veins, resulting in increased pressure, swelling and a variety of symptoms that range from cosmetic concerns to serious medical complications.

Venous disease is one of the most common vascular conditions worldwide and may affect adults of all ages. While some conditions such as spider veins are largely cosmetic, others—including deep vein thrombosis and chronic venous insufficiency – can lead to significant health problems if left untreated.

Fortunately, advances in minimally invasive vascular treatments now allow many venous conditions to be treated with little downtime while preserving healthy vein function.

How do healthy veins work?

Veins return oxygen-depleted blood from the body back to the heart. Because blood in the legs must travel against gravity, veins rely on one-way valves and the calf muscles to maintain forward blood flow.

Every time you walk, your calf muscles act as a “second heart”, squeezing the veins and pushing blood upwards. Healthy vein valves prevent blood from flowing backwards.

When these valves weaken or become damaged, blood leaks backwards (venous reflux), causing increased pressure within the veins. Over time, this may lead to varicose veins, chronic venous insufficiency, leg swelling and skin changes.

What causes varicose veins?

Both varicose veins’ causes and spider veins’ causes are unclear. Medical professionals do not yet fully understand why this exactly happens, but they do know that there are certain risk factors. Genetics, especially in women, play a role to some extent along with ageing and pregnancy. Vein issues, especially leg veins, are more common than you think and they can even affect people as young as 20!

Problems that affect the “muscle pump” efficiency of the calf muscles like osteoarthritis of the knee and poor mobility are associated with varicose veins. Working in certain professions that involve long periods of standing or sitting can also predispose you to varicose veins as they affect the veins on the legs.

The good news is that with the right treatment and care, varicose veins and their associated complications can be treated.

Condition	Description	Common Symptoms	Severity
Spider Veins (Telangiectasia)	Small, dilated blood vessels that appear close to the surface of the skin. They are usually cosmetic and rarely affect circulation.	Visible red, blue or purple veins, cosmetic concerns	Mild
Varicose Veins	Enlarged, twisted veins caused by weakened vein valves that allow blood to flow backwards (venous reflux), resulting in blood pooling within the veins.	Bulging veins, aching, heaviness, itching, leg fatigue, swelling	Mild to Moderate
Chronic Venous Insufficiency (CVI)	A long-term condition where damaged vein valves reduce the efficient return of blood to the heart, causing increased pressure within the leg veins.	Leg swelling, skin changes, heaviness, aching, venous eczema	Moderate to Severe
Deep Vein Thrombosis (DVT)	A blood clot forms within a deep vein, usually in the leg. Without prompt treatment, part of the clot may travel to the lungs and cause a pulmonary embolism.	Sudden leg swelling, pain, warmth, redness	Potentially Life-threatening
Superficial Thrombophlebitis	Inflammation and clotting within a superficial vein. Although generally less serious than DVT, medical assessment is recommended to exclude deeper vein involvement.	Painful tender vein, redness, local swelling	Mild to Moderate
Venous Leg Ulcers	Open wounds that usually develop around the ankle due to long-standing chronic venous insufficiency and poor venous circulation.	Slow-healing wound, skin discoloration, swelling, pain	Severe
Pelvic Congestion Syndrome	Enlarged pelvic veins caused by poor venous drainage, commonly affecting women and leading to chronic pelvic pain.	Chronic pelvic pain, pelvic heaviness, pain after standing	Moderate
May-Thurner Syndrome (Iliac Vein Compression Syndrome)	The left iliac vein becomes compressed by the overlying artery, reducing blood flow and increasing the risk of DVT in the left leg.	Left leg swelling, pain, recurrent DVT	Potentially Serious

Tired and painful legs
Cramps
Limb swelling, heaviness, colour changes in their lower leg especially brown pigmentation
Dry skin and itch
Bleeding, venous leg ulcers and blood clots

What are varicose veins?

Varicose veins are a manifestation of CVI and are abnormally dilated veins, which can be seen on the skin surface of the legs, ankles and feet, especially upon standing. They are blue or purple in colour, materializing as spider veins on legs, and can appear lumpy, twisted or bulging in nature.

Other conditions associated with CVI include:

Varicose eczema: Patches of skin become red, itchy and scaly. Varicose eczema usually occurs in the lower leg, ankle or over the affected vein.
Lipodermatosclerosis: The skin above the varicose vein becomes fragile, appears pink or brown and feels tight and hard to the touch. Further injury to the area can result in a leg ulcer.
Limb swelling, heaviness, colour changes in their lower leg especially brown pigmentation
Lymphoedema: Damage to the lymphatic system, causing swollen feet, ankles or toes.
Dermatitis: An itchy, inflamed rash on the skin surface. Cellulitis: A serious skin infection that causes inflammation to the soft tissue of the skin.

Is an Evaluation Necessary?

An evaluation is necessary to determine the underlying cause of your varicose veins. Your history, an examination and an ultrasound scan are all used in determining the type and extent of treatment needed. An ultrasound is required to determine the extent of venous reflux (backflow of blood), the severity and the anatomy of your varicose veins, which can guide the vascular specialist to offer the best treatment for you.

Treatment options

We offer a full range of effective varicose vein treatment options in Singapore for patients with varicose veins.

Traditional open varicose veins surgery

Treatment can be painful and demands a significant amount of downtime and rest but may still be the best option for some types of varicose veins.

Hook phlebectomy is a complementary technique to remove varicose side branches from the main truncal vein through very small incisions which usually require only one stitch to close. This is an effective minimally invasive technique to remove the unsightly twisted veins that appear as bulges on the surface of the skin. This is used in conjunction with either open surgery to strip the main truncal vein or with minimally invasive ablative techniques such as microwave, ClariVein® or glue ablation.

We offer an array of minimally-invasive procedures as an alternative to conventional open varicose veins surgery, including:

Endovenous thermal techniques

Laser, radiofrequency and microwave ablation

Endovenous non-thermal options

Cyanoacrylate glue (VenaSeal™), mechano-chemical ablation (MOCA – or ClariVein®) and foam sclerotherapy.

Flebogrif® is another new minimally invasive, safe and effective method to treat varicose veins without surgery and without pain. Like ClariVein® – it is a type of mechano-chemical endovenous ablation – and has the advantage of not requiring heat and therefore no risk of nerve injury. Dr Tang from the VEC is the first to use the device in Singapore for varicose veins and has a place to treat truncal reflux below the knee.

Foam sclerotherapy

Foam sclerotherapy is considered the treatment of choice for varicose and spider veins, especially the small ones. In this, a  solution is directly injected into the vein. The solution causes the vein to scar and forces blood to reroute through healthier veins, then the collapsed vein is reabsorbed and fades.

Advantages:

No surgery is required
Reduced appearances of varicose veins
Short and easy recovery
Precise treatment zone
Minimal side effects
Foam sclerotherapy for varicose veins

Microsclerotherapy

Microsclerotherapy is a technique used in varicose veins treatment to treat the smaller veins on the surface of the skin on the leg such as spider veins or thread veins of the legs. It is a relatively straightforward procedure, which involves injecting a liquid sclerosant into the veins.

The solution causes the vein to scar and forces blood to reroute through healthier veins. The collapsed vein will be resorbed and will then fade in time. Microsclerotherapy is the most preferable treatment for thread veins below the heart.

High Intensity Focused Ultrasound (HIFU)

We are also one of the first clinics in South East Asia to offer HIFU, which is a new truly non-invasive way to treat varicose veins using ultrasound waves. HIFU can offer huge advantages over other varicose veins treatments because nothing is inserted into the vein and so there is no risk of bleeding or of anything breaking off inside the vein that may go to the lungs.

These can all be theoretically performed via one or several small needle pricks. At times we do offer these mainline therapies together to complement each other, along with ambulatory phlebectomy (small incision to remove larger branch veins).

Intravascular Ultrasound Assessment, Venoplasty (Ballooning) and Stenting

(IVUS) and deep vein ballooning and stenting – In some instances of advanced CVI, especially after an extensive blood clot in the leg we would investigate whether there is any scarring or compression of the major veins in the abdomen/pelvis and if so we may offer a keyhole procedure using a special ultrasound scope to assess the extent of blockage more carefully and when severe, we may insert a balloon and stent (a special metal scaffold) to open up the blocked vein to allow blood to more efficiently flow back from the leg.

Can venous disease be cured?

The answer depends on the type and severity of the venous disease. Many forms of venous disease can be effectively treated and well controlled, but damaged vein valves do not naturally repair themselves.

Modern minimally invasive treatments such as radiofrequency ablation, endovenous laser ablation (EVLA), VenaSeal®, ClariVein®, Flebogrif® and ultrasound-guided foam sclerotherapy can close or remove diseased veins, relieve symptoms and improve blood flow through healthier veins. These treatments can significantly reduce pain, swelling and the risk of complications while improving quality of life.

Although treated veins usually do not return, venous disease is a chronic condition, and new varicose veins or areas of venous reflux may develop over time, particularly in people with a family history of vein disease or ongoing risk factors. Regular follow-up, maintaining a healthy weight, staying physically active and following your vascular specialist’s advice can help reduce the risk of recurrence and support long-term vein health.

What are the early signs and symptoms of venous disease?

Early symptoms of venous disease may include aching or heavy legs, swelling around the ankles, visible spider or varicose veins, leg cramps, itching and a feeling of tiredness after prolonged standing or sitting. As the condition progresses, skin discolouration, thickened skin and venous leg ulcers may develop.

Can venous disease be treated without surgery?

Yes. Many patients can be treated without traditional surgery. Depending on the severity of the condition, treatment may include compression stockings, regular exercise, weight management and minimally invasive procedures such as radiofrequency ablation, endovenous laser ablation, foam sclerotherapy, ClariVein®, VenaSeal® or Flebogrif®. Your vascular specialist will recommend the most appropriate treatment based on your symptoms and ultrasound findings.

What happens if venous disease is left untreated?

Untreated venous disease may gradually worsen over time. While mild cases may initially cause only cosmetic concerns, progressive venous disease can lead to chronic leg swelling, skin discolouration, venous eczema, bleeding varicose veins, recurrent superficial thrombophlebitis and painful venous leg ulcers. Early treatment can help prevent these complications and improve quality of life.

Can venous disease be prevented?

Although not all cases can be prevented, you can reduce your risk by maintaining a healthy weight, exercising regularly, avoiding prolonged standing or sitting, elevating your legs when resting, staying well hydrated and wearing compression stockings if recommended by your doctor. People with a family history of venous disease may benefit from early assessment if symptoms develop.

When should I see a vascular specialist for venous disease?

You should consult a vascular specialist if you experience persistent leg swelling, painful or enlarging varicose veins, skin discolouration around the ankles, recurrent leg ulcers, bleeding from varicose veins or symptoms that interfere with your daily activities. Sudden swelling, pain or redness in one leg should be assessed promptly to exclude deep vein thrombosis (DVT).

Our Screening Packages (Non-insurance)

Varicose veins screening package (single leg)

Consultation & Review – assess history, risk factors, life style, symptoms
Examination – to check distribution and anatomy plus to assess skin problem
Ultrasound reflux scan – to check for venous insufficiency (two legs add $450 + GST)
$799 + GST

Spider veins screening package (single leg)

Consultation & Review – assess history, risk factors, life style, symptoms
Examination – to check distribution and anatomy plus to assess skin problem
1 session laser treatment – (additional session $450 + GST)
$766 + GST

Varicose veins and spider veins package (single leg)

Consultation & Review – assess history, risk factors, life style, symptoms
Examination – to check distribution and anatomy plus to assess skin problem
Ultrasound reflux scan – to check for venous insufficiency (two legs add $450 + GST)
1 session spider vein laser treatment (additional session 450 + GST)
$1,460 + GST (two legs – add $400 + GST)

Diabetic foot screening (basic)

Consultation & Review – assess history, risk factors, life style, symptoms
Examination – to check circulation, biomechanics of foot arch, sensory loss
Ankle brachial pressure index (lab) – to check blood flow in legs
Blood test – to check average sugar levels in 3 months
$498 + GST

Diabetic foot screening (extensive)

Consultation & Review – assess history, risk factors, life style, symptoms
Examination – to check circulation, biomechanics of foot arch, sensory loss
Ankle brachial pressure index (lab) – to check blood flow in legs
Blood test – to check average sugar levels in 3 months
Single leg arterial duplex – to identify specific artery problem (additional leg scan $400 + GST)
X-ray one foot – to check bone infection
$966 + GST

Cardiovascular screening (normal)

Consultation & Review – assess history, risk factors, life style, symptoms
Examination – full cardiovascular examination including the heart and limb arteries
Ankle brachial pressure index (lab) – this is a marker for longevity and cardiovascular health
Blood tests (lipids) – to check all the types of cholesterol
Carotid scan – to identify block artery to the brain hence stroke
Echocardiogram – to identify heart muscle function
$1,446 + GST

Cardiovascular screening (comprehensive)

Consultation & Review – assess history, risk factors, life style, symptoms
Examination – full cardiovascular examination including the heart and limb arteries
Ankle brachial pressure index (lab) – this is a marker for longevity and cardiovascular health
Blood tests (lipids) – to check all the types of cholesterol
Carotid scan – to identify block artery to the brain hence stroke
CT coronary Angiogram plus calcium score – gold standard to identify block heart arteries
$2,544 + GST

Our Doctors

MBChB, FRCS(Glas), FRCS(Eng), FRCS(Gen), FAMS

MA Honours, MB BChir (Distinction in Surgery), MRCS Glas, MD (Cambridge), FRCS (Gen); FAMS; CWSP

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