A woman who came to the clinic: You also do ultrasound standing up here, ah, I was in Hong Kong and Singapore is also the same way to visit the clinic. The voice kind of can’t hide the surprise. The next question was why do ultrasound standing up, this is indeed not a question that can be clarified in one sentence, the detailed answer of the ultrasound of the deep veins and superficial veins of the lower limbs is here. In patients with typical symptoms of venous insufficiency of the lower extremities, ultrasound can monitor the widening of the diameter of the veins, slowing of the blood flow, failure of the venous valves to converge in the midline, and persistent regurgitation of the blood flow at the valves for a certain period of time as seen on deep inhalation or even on calm breathing. However, the assessment of the severity of the disease is carried out by the following indicators. Regurgitation duration Number of regurgitant segments and total regurgitation time Regurgitation index Internal diameter of lower limb veins and average flow velocity Regurgitation time at the first valve of femoral vein is generally referenced to the standard of 0.5s as the physiological regurgitation time, and most of the scholars believe that the more severe the deep venous insufficiency is, the longer the regurgitation time is, and that if it is greater than 0.5s it will produce the symptom of insufficiency. The clinical fact so far is that there is still a debate on the specific value and application value of the regurgitation time threshold, which is an important parameter for judging the presence or absence of deep venous regurgitation in the lower limbs: because there are many venous valves in the lower limbs, the assessment of the first valve alone cannot show all of them, and we often see some patients in the clinic with the results of deep venous valvular insufficiency, and the psychological pressure is quite large to find us, but the patients actually don’t have any definite clinical symptoms. The actual patient does not have definite clinical symptoms. There are some studies that have found no correlation between regurgitation time and lower extremity venous insufficiency or that regurgitation time is disproportionate to the severity of venous closure insufficiency, which is consistent with my clinical observations. Due to the limitations of single venous valve regurgitation time in determining the degree of venous insufficiency, researchers have further proposed more complex parameters such as the number of regurgitant segments and total regurgitation time, as well as the regurgitation index. Based on the results of the parameters, they also judged the susceptibility to ulceration and the criteria for judging venous regurgitation. This is undoubtedly more comprehensive and objective, but in practice there are some objective factors that affect the results. For example, when measuring the reflux time parameter, the Sparrow’s method is good for the proximal veins, while the distal limb compression test is more effective for the superficial femoral vein and the N vein. The lack of method is simple and easy to perform, and the results depend on how well the patient understands and cooperates with the physician’s instructions, while the squeezing of the distal limb method requires the cooperation of an assistant, and the site of squeezing should be different for different segments. Different methods can have a significant impact on the measurement of reflux parameters and are complex to perform clinically. Therefore, the patient should not only be given a result of deep venous valve insufficiency, but further research is needed to evaluate the patient’s actual symptoms. It is believed that in the near future there will be a professional rehabilitation team to give a satisfactory answer. Reasons for choosing the upright position in the varicose vein clinic As the upright position is closest to the physiologic state, especially for the superficial veins of the lower extremities. Although it is easy for the patient to cooperate in the lying position, the veins are often empty and lesions are easily missed. While standing position can easily find superficial dilated veins, professional surgeons can effectively judge the root cause of the disease, understand the detailed direction of blood flow and distribution of the lesion, and make precise incision design to reduce blind incision, less incision, less postoperative pain, less chance of incision infection, and precise incision design will greatly help to reduce the recurrence rate. This type of treatment with standing ultrasound is the international mainstream and one of the significant differences in the varicose vein treatment process in different regions of the country.