Injection Sclerotherapy for Varicose and Spider Veins

Sclerotherapy uses an injected medicine, called a sclerosant, to damage the lining of a selected vein so that it closes. It can be used for different vein problems, from small surface vessels to some larger refluxing veins. The medicine, its form and the need for ultrasound depend on the vein being treated. It is different from cyanoacrylate vein glue.

When is liquid sclerotherapy considered?

Liquid injections may be considered for suitable small surface veins, including spider or reticular veins. Treatment planning includes skin appearance, symptoms, previous reactions and the distribution of the veins. A visible vessel alone does not establish that it needs treatment.

If there is aching, swelling, a history of clots or more extensive varicose-vein disease, assessment may identify an underlying problem that small surface injections would not address. Cosmetic goals and treatment of symptomatic reflux should be discussed clearly, rather than treated as interchangeable reasons for intervention.

What is ultrasound-guided foam sclerotherapy?

Foam contains bubbles that help a sclerosant contact the vein lining. Ultrasound allows the specialist to identify and monitor a deeper or less visible target. Foam may be considered for selected varicose branches, recurrent veins or refluxing trunk veins when appropriate.

The role of foam depends on anatomy and the wider plan. Read why a vein scan should come before treatment. A patient may need treatment of a source of reflux as well as a visible branch; injecting the branch alone does not necessarily resolve the cause.

Who needs particular assessment before treatment?

The clinician reviews medicines, allergies, previous DVT or PE, recent immobility, pregnancy, and any previous reaction to sclerotherapy. Tell the team about migraine with visual symptoms or a known connection between the heart’s chambers. Foam should not be used when there is a known symptomatic right-to-left shunt, such as a heart connection that has caused symptoms.

A new painful, swollen leg should be assessed before elective vein injections. The sclerosant’s own prescribing information matters: products and formulations are not interchangeable. The proposed sclerosant must not be used if you are allergic to it. Elective sclerotherapy should not proceed during acute DVT or PE, with an infection at the treatment site or during a severe general infection. No online checklist replaces this assessment.

What happens during a treatment session?

The specialist injects the selected veins, using ultrasound where indicated. The plan may involve several sites or staged sessions. Dressings or compression may be advised according to the procedure and circulation. Follow-up allows the response to be assessed before deciding whether further treatment is useful.

Veins and skin do not necessarily change appearance immediately. A treated area may initially feel firm or look more noticeable. Ask how the likely course of healing relates to your goals, especially before scheduling treatment around travel or an important event.

What are the risks and limitations?

Local problems include bruising, discomfort, inflammation, skin staining, small new surface vessels and trapped blood within treated veins. Skin injury or ulceration can occur, and pigmentation may persist. Allergy, including a severe reaction, is possible.

DVT, pulmonary embolism and neurological events are serious possible complications. Visual disturbance or migraine-like symptoms have been reported after foam; stroke is a rare but important risk to discuss. New neurological or breathing symptoms must not be dismissed as an expected reaction.

Some veins may persist, reopen or recur. Multiple sessions may be needed, and treatment cannot promise flawless skin or permanent freedom from venous disease. The intended benefit should be weighed against these possibilities before proceeding.

What other choices are available?

Observation is reasonable when a vein is not troublesome and treatment is not wanted. Advice and suitable compression can help some symptoms. For appropriate refluxing veins, alternatives include radiofrequency or laser ablation, glue closure and open surgery. Larger bulging surface branches may be suited to microphlebectomy.

How should I plan recovery?

Ask about walking, compression, skin care, exercise, work and travel, and follow the individual plan. Seek prompt advice for worsening local pain, blistering, a wound, fever or marked leg swelling. Sudden weakness, speech or visual disturbance, severe breathlessness or collapse needs emergency help: call 995 in Singapore.

Common questions

Is foam stronger or better than liquid?

The form is chosen for the target and clinical situation. A label such as “foam” does not establish suitability or a guaranteed result.

Can I have injections after a previous vein procedure?

Possibly. Returning veins need reassessment so that treatment addresses the current anatomy and any ongoing reflux.

Discuss sclerotherapy in Singapore

For a planned assessment, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Bring previous vein-treatment records and details of allergies.