OBJECTIVE: To investigate the safety and effectiveness of endovenous laser combined with conventional surgery for the treatment of superficial varicose veins in the lower extremities. METHODS: 117 cases (179 limbs) with superficial varicose veins in the lower extremities underwent high ligation of the saphenous vein and endovenous laser closure of the varicose veins. RESULTS: All patients recovered well, with disappearance of clinical symptoms and complete vein occlusion. Conclusion: Endovenous laser combined with traditional surgery for superficial varicose veins of lower extremities is easy to operate, less traumatic, aesthetically pleasing after surgery, with exact efficacy, and worthy of clinical promotion. 1.Clinical data 1.1 General data 68 cases of men and 49 cases of women in this group. Age 38-72 (average 46) years. The duration of the disease ranged from 6 to 32 (average 15) years. There were 57 cases of double lower limbs, 38 cases of simple left lower limbs and 27 cases of simple right lower limbs, a total of 179 limbs. All of them exhibited tortuous and dilated superficial veins of the lower extremities, partly in the form of masses. There were 164 limbs with soreness and heaviness of the affected limbs, 87 limbs with skin pigmentation in the boot area, 23 limbs with superficial phlebitis, and 10 limbs with chronic ulcers. Preoperative color Doppler ultrasonography was performed, and all deep veins were patent. 1.2 Methods 1.2.1 Saphenous vein high ligation Epidural anesthesia. The femoral artery in the inguinal region was incised medially along the cortex for 3-4 cm, the main trunk of the saphenous vein was revealed, and 5 branches of the genus were cut and ligated, and the main trunk of the saphenous vein was cut 0.5 cm below the femoral saphenous junction, and the proximal segment was ligated and sutured in 1 way each. 1.2.2 EVLT was performed by placing a 5F catheter from the severed end of the saphenous vein using an ultra-slip guidewire, following the saphenous vein distally to the internal ankle vein, withdrawing the guidewire and placing a fiber optic to reach the anterior aspect of the internal ankle, with the end of the catheter 2 cm beyond the catheter. 810 nm laser was used, with a laser emission power of 12 W, pulse time of 1 s, and interval time of 1 s. The operator fired the laser to cauterize the varicose vein while simultaneously withdrawing the catheter and fiber optic. The assistant compresses the stroke of the saphenous vein to help the vein to close. In most cases, the fiber could be delivered smoothly from the upper end of the saphenous vein, but in 11 cases, the 5F catheter and the fiber were inserted proximally from the internal ankle vein and cauterized in the same way because of the valve or excessive varicosity or local stenosis. In the case of the saphenous vein and the small saphenous vein with obvious tortuous dilatation and thicker, the 18F cannula was punctured and the fiber was directly inserted for cauterization. After the operation, an elastic bandage is applied with pressure. 1.2.3 Postoperative treatment The affected limb was elevated by 15° to 20°, and the lower limb was moved in bed and removed from bed on the second postoperative day. Prophylactic application of antibiotics for 1 to 3 days. Low molecular heparin was applied for 3 days to prevent deep vein thrombosis. The stitches of the femoral incision were removed in 7 days. The elastic bandage was wrapped for 2 weeks and then changed to wearing sequential decompression type elastic stockings for 3 months. 2. Results The group was hospitalized for 3 to 8 (mean 4) days. Postoperative follow-up ranged from 1 to 12 months. The clinical efficacy was satisfactory, the soreness and heaviness of the lower limbs were significantly reduced or disappeared, the tortuous and dilated superficial veins disappeared, the local skin nutritional disorders were significantly reduced, and the chronic ulcers were gradually reduced or healed. There was no incision infection, hematoma and deep vein thrombosis of the lower limbs. The laser burned skin in 4 cases healed spontaneously within 2 weeks. The color Doppler ultrasound was repeated at the 1st, 3rd and 12th months after surgery, which indicated no recurrence or recanalization of the occluded vessels. 3.Discussion The regurgitation of blood caused by saphenous vein valve insufficiency is the most important pathophysiological basis of varicose veins in the lower extremities, therefore, to successfully treat varicose veins in the lower extremities, eliminating the regurgitation of saphenous vein is the key. Although traditional surgical methods can completely eliminate the reflux of the saphenous vein trunk, the surgical incisions are many, traumatic and seriously affect the aesthetics. Since the clinical application of EVLT is still short and there is no longer-term follow-up data, the long-term efficacy cannot be determined. Its recent recurrence rate has also been reported differently by various authors; Yang Bohua [1] reported 232 cases with 384 limbs, with 26 limbs recurring; Lu Shaoying [2] reported 207 cases with 268 limbs, with 17 limbs recurring; Liu Peng [3] reported 250 cases, with 2 mild recurrences among 98 cases followed up. According to current reports, the recent results of EVLT are good, and the recurrence cases are mostly main stem recanalization and residual. Therefore, EVLT alone should be applied to treat superficial varicose veins of the lower extremities, and patients should have mild varicose veins and good results within clinical grading (CEAP) grade 2, otherwise the treatment will not be complete [4]. When the varicose veins are severe and the diameter of the main trunk of the saphenous vein is greater than 8 mm, it is not suitable to apply EVLT alone for treatment [5]. This is because this may lead to a poor cautery closure of the saphenous trunk, and the cautery closed saphenous trunk can open again by repeated impingement of blood returning through the femoral saphenous valve, which in turn can cause recurrence of varicose veins. According to traditional surgical experience, one of the keys to effectively reduce the recurrence of varicose vein surgery in the lower extremities is to effectively close the saphenous valve and the ligation and dissection of the corresponding branches. Therefore, EVLT should be performed simultaneously with direct visualization of high saphenous vein ligation and branch dissection [6]. This achieves a minimally invasive and aesthetic procedure, while ensuring an effective and complete procedure. Unlike the usual EVLT procedure, in which fiber optics are inserted from the internal ankle vein to cauterize the saphenous vein, in most of our cases the fiber optics are inserted from the proximal saphenous vein to cauterize the entire saphenous vein trunk in one go. It is easier to completely cauterize the whole trunk of the saphenous vein at one time. By not making a surgical incision on the anterior aspect of the medial ankle and the medial aspect of the knee, the chance of saphenous nerve injury is reduced. The combined application of high saphenous vein ligation and EVLT for the treatment of superficial varicose veins in the lower extremities is simple, less invasive, aesthetically pleasing and efficacious after surgery, and deserves further trial.