Understanding Varicose Veins
Varicose veins are enlarged, twisted veins that most commonly appear on the legs. They develop when the one-way valves inside leg veins fail, causing blood to pool and veins to stretch and bulge. Varicose veins affect approximately 25–30% of women and 15–20% of men in Singapore, with prevalence increasing with age, prolonged standing, obesity, and pregnancy.
Symptoms
- Visible, bulging, rope-like veins — typically blue/purple, on the thighs and calves
- Aching, heaviness, or fatigue in the legs — worse after standing
- Swelling of ankles and calves, particularly at end of day
- Itching, burning, or tingling around the vein
- Restless legs, especially at night
- Skin discolouration (brown staining) around the ankle — indicates advanced venous disease
- Venous ulcers — open wounds near the ankle/lower leg that are slow to heal
CEAP Classification
| CEAP Stage | Clinical Finding | Treatment Urgency |
|---|---|---|
| C0 | No visible signs; symptoms only | Compression + monitoring |
| C1 | Spider veins / telangiectasias | Sclerotherapy if symptomatic |
| C2 | Varicose veins (3mm or larger) | Treat if symptomatic |
| C3 | Leg oedema (swelling) | Treat to prevent progression |
| C4a/b | Skin changes (pigmentation, eczema, lipodermatosclerosis) | Recommend treatment |
| C5 | Healed venous ulcer | Treat to prevent recurrence |
| C6 | Active venous ulcer | Urgent treatment required |
Diagnosis
A vascular surgeon will perform a duplex ultrasound — the gold standard diagnostic tool that maps the venous anatomy, identifies sites of reflux (valve failure), and guides treatment planning. This non-invasive scan takes 30–45 minutes and costs $150–$400 at private vascular centres.
Treatment Options Compared
| Treatment | How It Works | Anaesthesia | Recovery | Cost/Leg (SGD) |
|---|---|---|---|---|
| EVLA (Endovenous Laser Ablation) | Laser fibre inserted into vein; heat seals vein shut | Local (tumescent) | 1–3 days | $3,500–$8,000 |
| RFA (Radiofrequency Ablation) | Radiofrequency catheter heats and seals vein | Local (tumescent) | 1–3 days | $4,000–$9,000 |
| VenaSeal (Glue Closure) | Medical adhesive injected to close vein — no heat | Local (minimal) | 1–2 days | $4,000–$9,000 |
| Foam Sclerotherapy | Chemical foam injected to shrink veins | Not required | Same day | $600–$2,000/session |
| Phlebectomy (Ambulatory) | Small hooks remove visible bulging tributaries | Local | 1–3 days | $2,000–$5,000 |
| Strip Surgery (Traditional) | Vein physically removed through incisions | General/Spinal | 2–4 weeks | $8,000–$18,000 |
*Most patients require a combination — e.g., EVLA for the main truncal vein + foam sclerotherapy for smaller branches. Medisave claimable when medically indicated.
What is the Best Varicose Vein Treatment?
For truncal varicose veins (great saphenous vein, small saphenous vein reflux), EVLA or RFA are the current evidence-based gold standard with 5-year success rates of 93–95%. VenaSeal is an excellent option for patients who cannot tolerate tumescent anaesthesia or multiple needle punctures — the procedure involves fewer injections. For small to medium branch veins, foam sclerotherapy or ambulatory phlebectomy are added in the same or a subsequent session.
Frequently Asked Questions
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View the shortlist →EVLA and RFA have 5-year success rates of 93–95%, meaning the treated vein stays closed in the vast majority of patients. However, new varicose veins can develop over time from other veins, particularly if the underlying risk factors (obesity, prolonged standing, pregnancy) continue. Wearing compression stockings after treatment and maintaining a healthy weight help reduce recurrence risk.
Most patients return to desk work within 1–3 days. Walking is encouraged immediately after treatment. Strenuous exercise and prolonged standing should be avoided for 1–2 weeks. Compression stockings must be worn continuously for 1–2 weeks post-procedure. Bruising and soreness along the treated vein are normal and resolve within 2–4 weeks.
Medisave is claimable for medically indicated varicose vein treatment (C2 and above on CEAP classification, or symptomatic veins). Pure cosmetic spider vein treatment (C1) is generally not Medisave-claimable. Your vascular surgeon will assess your clinical indication. For day surgery procedures at MOH-licensed centres, the Medisave day surgery withdrawal limit applies.
Spider veins (telangiectasias) are tiny (less than 1mm), red/purple, flat surface vessels — usually purely cosmetic. Varicose veins are larger (3mm+), blue-green, raised or ropy — and often cause symptoms. Both can coexist. Spider veins are treated with microsclerotherapy or laser. Varicose veins require a duplex ultrasound to map the underlying reflux before deciding on treatment.
For symptomatic or larger varicose veins, a fellowship-trained vascular surgeon (FRCSEd/FAMS vascular) is the appropriate specialist. They can perform duplex ultrasound mapping, properly stage your disease, and perform the full range of treatments. Aesthetic clinics may offer sclerotherapy for small spider veins but are not equipped for the full vascular workup or to manage complications.