OBJECTIVE: The aim was to describe the results of starting a foam sclerotherapy service, focussing on patients with complicated venous disease. METHODS: Consecutive patients undergoing ultrasound-guided foam sclerotherapy for truncal varicose veins underwent clinical and hand-held Doppler assessment at 2 weeks and venous duplex imaging at 6 months. RESULTS: One hundred and eighty-five truncal veins were treated in 165 patients. A high proportion of veins were complicated (109 CEAP classes 4-6, 76 CEAP 1-3). Ninety-one percent (168) had a single treatment session. After 2 weeks, ninety-three percent (136/147) of the truncal veins appeared occluded on hand-held Doppler examination. Ten percent (15/147) of patients had remaining visible varicosities in the lower leg. After six months, the truncal vein remained occluded in 74% (68/92), was partially occluded in 10% (9/92) and fully patent in 16% (15/92). There was no significant difference in occlusion rates between: primary (45/
60-75%) and recurrent (23/32-72%) veins; CEAP 2-3 (22/30-73%) and CEAP 4-6 (46/62-74%) veins; veins with diameter<7mm (29/38-76%) or >/=7mm (13/23-57%). No patient had evidence of deep vein thrombosis, though nine (10%) had new segmental deep venous reflux compared with pre-treatment scans. CONCLUSION: Foam sclerotherapy was equally effective for complicated and uncomplicated varicose veins.