Objective: To demonstrate the efficacy of the use of a large contoured thigh cuff to distend varicose veins, with the patient in a horizontal position, prior to needle insertion for sclerotherapy. Design: Prospective study in varicose vein patients treated by injection-compression sclerotherapy. Setting: Outpatient Surgery Clinic, University of California San Diego, La Jolla, California. Patients: Patients presenting with varicose veins on the lower thigh and below. Interventions: Patients underwent injection-compression sclerotherapy. Needles insertion was done with the patient in a horizontal position after veins were distended using a large contoured thigh cuff. Main outcome measures: Successful vein distension and needle insertion. Results: Ninety-five percent of patients had adequate vein distension for needle insertion. Conclusion: Vein distension, prior to needle insertion for sclerotherapy can be achieved by using a large contoured thigh cuff.