Duplex-Guided Sclerotherapy (DGS): Ultrasound-Guided Vein Injection

What is ultrasound-guided sclerotherapy?

Sclerotherapy means injecting a medicine, called a sclerosant, into a vein. The sclerosant irritates the inner lining so the vein walls stick together and close. Over the following weeks and months the body gradually absorbs the closed vein, and blood reroutes through healthy veins.

Standard sclerotherapy is done by looking at the skin, so it only works on veins you can see. Many of the veins that keep varicose disease going are deeper: branches running beneath the fat layer, connecting (perforator) veins, or segments squeezed between muscles. Duplex ultrasound shows both the vein and the direction of blood flow, so the doctor can guide the needle precisely into these hidden targets and watch the medicine spread.

Who needs duplex-guided sclerotherapy?

DGS is usually part of a combined plan rather than a stand-alone treatment. You may be a candidate if your ultrasound exam shows:

• Refluxing side branches that are too twisted or short for a laser fiber.
• Leaking perforator veins that connect the surface and deep systems.
• Residual reflux after EVLT closes the main trunk.
• New reflux found during follow-up, or recurrent varicose veins after earlier surgery.
• Advanced skin changes or ulcers, where non-surgical injection treatment is generally preferred first.

Injection therapy is also well tolerated by older patients and people with serious chronic illnesses, because it needs no general anesthesia and very little recovery.

How is DGS performed at LEDAS?

1. Mapping: the leg is scanned standing up on a LEDAS-designed examination table, and each refluxing segment is marked.
2. Positioning: you lie down and the ultrasound probe is placed over the target vein.
3. Injection: a fine needle enters the vein under live imaging. The sclerosant, often prepared as a foam, is injected in a controlled amount.
4. Confirmation: the doctor watches the medicine fill the target and checks that it stays in the intended vein.
5. Compression and walking: a medical compression stocking goes on and you walk to keep blood moving in the deep veins.

Why the ultrasound matters

Without imaging, an injection into a deep vein is guesswork. With duplex guidance, the doctor can confirm the needle is inside the vein, avoid arteries and nerves, and adjust the dose to the vein's size. LEDAS uses Philips EPIQ Elite systems with large monitors, so you can watch the screen and see what is being treated.

How does DGS fit with laser treatment?

LEDAS stands for Laser, Endovenous, Duplex guided, Ablation, Sclerotherapy. In practice, the laser closes the large straight saphenous trunk, DGS deals with hidden refluxing branches, and surface sclerotherapy (SCT) fades visible spider and reticular veins. Dr. Kim Byoung Joon considers DGS a key step in reducing recurrence, because untreated hidden branches are a common reason varicose veins return. See sclerotherapy vs laser for how the two methods divide the work.

What should I expect after DGS?

You can walk out and resume normal daily activity right away. Common, temporary effects include:

• Treated veins feeling firm or lumpy, and looking darker, for some weeks. This is part of normal healing.
• Mild tenderness or bruising at the injection sites.
• Occasionally, when foam is used, a brief feeling of chest heaviness or a dry cough that settles on its own.

Walk lightly for two to four weeks, wear your stockings as instructed and attend check-ups. Read our full aftercare instructions .

Seek emergency care if you develop sudden shortness of breath, chest pain, or a painful, swollen, warm calf. These can be signs of a blood clot.

DGS vs surface sclerotherapy (SCT)

Duplex-guided sclerotherapy – frequently asked questions