Venous Disease: Varicose Veins, Swollen Legs, Deep Vein Thromboses and Ulcer Surgery and Treatment in Singapore

Background

The venous system consists of blood vessels that return blood from the extremities (such as the tips of the fingers and toes) back to the heart. From there, blood is pumped to the lungs to be oxygenated before being recirculated around the body.

Unlike arteries, which have a thick muscular wall and are driven by the pressure of the heartbeat, veins are thin-walled, low-pressure vessels. They rely on a system of one-way valves and the pumping action of surrounding muscles to transport blood back to the heart against gravity.

When this system fails, a range of venous diseases can develop, leading to swollen legs, varicose veins, deep vein thrombosis (DVT), venous ulcers, skin changes and long-term discomfort.

Varicose Veins and Chronic Venous Insufficiency

Varicose veins are enlarged, twisted veins most commonly seen in the legs. They occur when the valves in the veins weaken or fail, allowing blood to pool. Symptoms may include aching, heaviness, swelling, restless legs and visible bulging veins.

Chronic venous insufficiency (CVI) is the broader condition where poor valve function leads to long-term problems such as skin pigmentation, eczema, lipodermatosclerosis (hardening of the skin) and venous ulcers.

Deep Vein Thrombosis (DVT)

A deep vein thrombosis occurs when a blood clot forms in the deep veins of the leg or pelvis. DVT can cause pain, swelling and redness, but is especially dangerous because clots can break off and travel to the lungs, causing a pulmonary embolism — a potentially fatal condition.

Risk factors for DVT include prolonged immobility (long flights or hospital stays), recent surgery, cancer, pregnancy, hormone therapy, obesity and inherited clotting disorders.

Venous Ulcers

Venous ulcers are open wounds, usually around the ankles, that fail to heal because of poor venous circulation. They are often painful, prone to infection and have a major impact on quality of life. Treatment requires a combination of compression therapy, wound care, and often surgical or minimally invasive procedures to correct the underlying venous problem.

Other Venous Conditions

Other venous disorders include:

• Superficial vein thrombosis (phlebitis) — inflammation and clot in surface veins

• Pelvic congestion syndrome — pelvic vein dilatation leading to chronic pain

• Post-thrombotic syndrome — long-term damage after DVT, causing swelling, pain and skin changes

Treatment Options for Venous Disease

Modern vascular surgery offers a wide range of treatments for venous disease:

• Lifestyle & medical therapy: Compression stockings, exercise, weight loss, smoking cessation, and anticoagulation when needed.

• Minimally invasive procedures for varicose veins: Radiofrequency ablation (RFA), endovenous laser treatment (EVLT), mechanochemical ablation, VenaSeal™ glue closure, ultrasound-guided foam sclerotherapy, and microphlebectomy.

• DVT management: Anticoagulation, catheter-directed thrombolysis, mechanical thrombectomy, and in selected cases, venous stenting.

• Venous ulcer care: Compression bandaging, advanced wound care, venous interventions to improve healing.

Every patient’s treatment plan is tailored to their condition, anatomy, lifestyle and overall health.

Summary

Venous disease includes a wide spectrum of conditions, from cosmetic varicose veins to life-threatening deep vein thrombosis and debilitating venous ulcers. Early diagnosis and treatment can prevent complications, improve quality of life, and in serious cases, save lives.

As a vascular and endovascular surgeon in Singapore, I offer comprehensive care for patients with venous disease, using the latest minimally invasive techniques alongside proven open surgical methods.

Frequently Asked Questions (FAQ) about Venous Disease

Patients often ask me about swollen legs, varicose veins and blood clots. Here are answers to some of the most common questions I hear in clinic.

What causes varicose veins?

Varicose veins are caused by weak or faulty valves inside the veins. Risk factors include family history, pregnancy, obesity, prolonged standing, and age.

Are varicose veins dangerous?

Most varicose veins are not dangerous, but they can cause significant discomfort. If untreated, they may progress to skin changes, ulcers, or clot formation (superficial thrombophlebitis).

What is the difference between varicose veins and spider veins?

Spider veins are small red or blue veins visible on the skin’s surface. They are mainly cosmetic. Varicose veins are larger, bulging, and often symptomatic.

What are the symptoms of a deep vein thrombosis (DVT)?

Symptoms include leg swelling, pain, warmth and redness. Sometimes DVT has no symptoms and is only detected when a complication such as pulmonary embolism occurs.

How are DVTs treated?

Most DVTs are treated with blood-thinning medication (anticoagulation). Selected cases may benefit from minimally invasive procedures to remove the clot and restore blood flow.

How are varicose veins treated?

Minimally invasive options like laser or radiofrequency ablation, VenaSeal™ glue, or foam sclerotherapy are highly effective and require only local anaesthetic. In some cases, small surgical removal (microphlebectomy) is also performed.

Do compression stockings help?

Yes, compression stockings improve blood flow in the legs, reduce swelling, and support ulcer healing. They are often part of both conservative and post-procedure care.

When should I see a vascular surgeon for venous disease?

If you have painful or swollen legs, visible varicose veins, skin changes, ulcers, or symptoms suggestive of a blood clot, you should seek a vascular surgeon’s opinion.