Minimally invasive treatment of varicose veins has been reported in recent years. In 1999, Robert Min, an American physician, invented the endovenous laser treatment of saphenous varicose veins, which has been widely used in China. We have treated more than 200 cases of saphenous varicose veins with laser, and some of the follow-up cases are analyzed and reported as follows. Data and methods 1. General data 133 patients with saphenous varicose vein, 71 male and 62 female; age 25-70 years old, average 47 years old. The duration of the disease ranged from 3 to 40 years, with an average of 14 years. Patients felt that the affected limbs were sunken and swollen, and sometimes edema appeared in the affected limbs, which was obvious when standing upright, and light in the morning and heavy in the evening. The veins in the saphenous vein area were tortuous and dilated, and some of them were in the form of masses. There were 35 cases of dark brown skin or scattered pigmentation in the foot and shoe area, and 21 cases of combined bruising dermatitis. The left lower limb alone was 60 cases, the right lower limb alone was 47 cases, and both lower limbs were 26 cases. 133 cases were examined by vascular multispectroscopy and lower limb veins without injury, and 102 cases had simple saphenous vein valve insufficiency and saphenous vein blood reflux, and 31 cases had combined with mild superficial femoral vein reflux. 2.Surgical method Preoperative preparation The perineum and the affected limb were prepared, shaved and the skin was cleaned. The main trunk of the saphenous vein and the direction of the varicose vein should be marked with nail violet and iodine 1h before surgery. One 810nm 30W semiconductor laser, one bare fiber with 600μm core diameter and 750μm outer diameter, one 5F straight tip angiographic catheter, one 0.035″ 150cm long hydrophilic guidewire, two 18-gauge puncture needles, and several self-adhesive elastic bandages were prepared. Fiber introduction The saphenous vein is punctured with a trocar needle in front of the patient’s inner ankle, a hydrophilic guidewire is placed through the trocar, and a contrast catheter is placed below the inguinal ligament through the guidewire. The guide wire is removed and the laser fiber is inserted through the catheter, and the red spot of the fiber can be seen moving subcutaneously under the inguinal ligament. Needle hole high ligation A 0.2 mm puncture hole is made 3 cm below the inguinal ligament, centered on the light spot, on both sides of the saphenous vein. The needle is entered from the puncture point on one side, and a double 7-gauge suture is drawn through between the saphenous vein and the superficial femoral vein, and the needle is exited from the puncture point on the other side. Then the suture is fed through the original exit needle hole, the risk passes between the saphenous vein and the skin, the needle is exited from the original entry needle hole, the suture is pulled tightly to detect whether the fiber can pass through, it cannot pass through indicating that the saphenous vein ligation is satisfactory, the risk can be ligated, the thread is buried under the skin with mosquito hemostatic forceps to complete the high ligation, there are only two pinhole size traces at the root of the thigh, there is no incision and no need to remove the thread. The depth of needle entry should be mastered during the operation to avoid damaging, or suturing, the superficial femoral vein. Saphenous vein trunk coagulation treatment Turn on the laser pulse, slowly retract the fiber, and coagulate the saphenous vein from top to bottom at a frequency of one pulse every 0.5 to 1.0 cm, while the assistant presses the saphenous vein with the light spot. The laser power is 15~l8 w above the knee, 1S every 0.5~1cm of blood vessel with 1S interval. l2 w below the knee, 1S every 0.5~1cm of blood vessel with 1S interval. for those with severe varicose varices in the middle saphenous vein or combined with local stenosis where the cannula cannot pass, the saphenous vein can be punctured medially in the knee and the coagulation catheter and fiber can be inserted upward from the saphenous vein here. This operation was performed in 17 cases in this group. Coagulation of varicose vein masses For obviously tortuous and dilated, short and shallow lateral branches of the saphenous vein, a 16-gauge trocar needle is used to puncture the varicose vein, the laser fiber is inserted through the trocar lumen, the trocar is retracted, and the varicose vein and the subcutaneous tissue surrounding the vein are laser coagulated. For severe varicose vein masses, local sutures with cotton pad fixation are feasible, and percutaneous sutures are feasible for the medial traffic branch veins of both calves. Postoperative treatment After the treatment, the large gauze pad was compressed along the saphenous vein and the coagulation site, and the elastic bandage was wrapped with pressure, and the patient was moved to the ground after 6 h. After 7 d, the bandage was reviewed and removed. The bandage was removed after 7 d. The elastic stocking was worn for 1 month instead. The patient was reviewed after 1, 3 and 12 months after surgery, and ultrasonography was performed to confirm whether the treated vein was occluded. 3. Results The puncture sites healed well without infection and moved freely. 7 cases had mild skin burns, no subcutaneous hematoma and lower limb edema, and no other complications. The saphenous vein was occluded by ultrasound examination without recurrence or recanalization, and the local skin dystrophic lesions were significantly reduced, the superficial varicose veins disappeared completely, and the soreness and swelling of the lower limbs were reduced or disappeared during the follow-up period of 5 to 36 months, with an average of 18 months. 4.Discussion Traditional saphenous varicose vein surgery includes high ligation of saphenous vein trunk, segmental resection, stripping and stripping and ligation of superficial varicose vein, with many incisions, long incisions, trauma, long operation time, slow recovery, high cost and more scarring of lower limbs after wound healing, which affects the beauty, especially women and beauty-loving patients are unwilling to accept. In recent years, with the development of minimally invasive medicine, varicose vein treatment by endovenous laser coagulation has the unique superiority of small trauma, beautiful and fast recovery, which is well developed in China. At present, the endovenous laser treatment of saphenous vein carried out in China, the high recurrence rate of early simple radical coagulation closure is due to the one-sided pursuit of minimally invasive, while the root of saphenous vein is afraid of having incision without high ligation, resulting in high rate of postoperative 1-stick recurrence. Later, the development of combined inguinal incision with high ligation effectively reduced the recurrence history, but made the “minimally invasive” treatment much less invasive. Complications such as local incision infection, lymphatic fistula, wound pain, and bleeding increased. In recent years, we have improved the method of high ligation by using the needle hole technique to ligate the saphenous vein at a high level, together with intracavitary coagulation of the main trunk and branches of the saphenous vein, which achieves radical treatment, but also realizes a fully minimally invasive, incision-free high ligation. At present, we have completed 133 cases of saphenous varicose veins treated with needle-hole high ligation and endovenous laser. With the application of fiber optic to complete the needle hole high ligation, the surgical “incision” is reduced to 0.2-0.3mm, which effectively reduces the surgical trauma. The laser energy of l2~18 w and the exposure time of 1S were selected to ensure the coagulation of blood vessels and prevent the damage of surrounding tissues. With the red light at the end of the fiber, the operator can clearly see where the fiber is located, which facilitates local anesthesia and surgical operation. The thermal coagulation effect produced by coagulation destroys the vessel wall and occludes the vessel, which not only maintains the relative integrity and position of the saphenous vein, but also avoids the occurrence of bruising or hematoma caused by the bleeding of the traffic branch break caused by the stripping procedure. It is important to note that the catheter and fiber should be withdrawn slowly and evenly during posterior withdrawal to ensure that each vein receives relatively uniform laser exposure to avoid missing and prevent recurrence. When coagulating the femoral saphenous vein, adequate local pressure should be applied to make the saphenous vein as empty as possible to ensure the coagulation effect. Finally, the fiber is removed, and care is taken to protect the skin of the patient and the operator to avoid skin burns at the incision and hand burns. Simple saphenous varicose vein is the best indication for this protocol. This treatment was also performed in 31 patients with combined mild superficial femoral venous reflux with satisfactory postoperative results. In general, the main trunk of the saphenous vein is not significantly narrowed, and the 5F trocar and fiber are relatively easy to pass, but in cases of significant local inflammation, narrowing of the vessel after healing of previous skin ulceration or folded varices, and twisting of the main trunk vein, the guidewire and trocar cannot pass, at this time, the saphenous vein at the knee can be punctured, and the guidewire, trocar and fiber are delivered to achieve coagulation, and this treatment was used in 17 cases in this group. For the veins with obvious varicose and short course, especially the traffic branch veins, trocar needle puncture with fiber optic coagulation is used to prevent recurrence of saphenous varicose vein after surgery.