When it comes to varicose veins, we may not be unfamiliar with them, and many people think that this is a simple disease, but in fact it is not. A young man in his 20s had varicose veins in both legs and his calves were black and itchy, so he was diagnosed with “varicose veins in both lower limbs” in the local hospital and had a high ligation and stripping of the saphenous veins in both lower limbs. After the operation, both lower limbs were swollen and flowing, which was unbearable. Later, I examined and diagnosed it as Buga syndrome, which was cured by interventional treatment. This is the trouble caused by the risky surgery. Varicose veins are thickened, twisted and dilated veins, mainly caused by venous hypertension, so as long as the disease can cause venous hypertension can cause varicose veins, basically can occur in all parts of the body, including the body surface and viscera, often referred to varicose veins mainly refers to the subcutaneous superficial veins, such as the ear, upper limbs and hands, chest and abdominal wall, lower limbs and other superficial varicose veins, the most common in the lower limbs. But even varicose veins of lower extremities are only a manifestation of the disease, not an independent disease, because they can be caused by many diseases, in the past, the ones without other diseases and with varicose veins as the main manifestation are called simple varicose veins or primary saphenous varicose veins, and the varicose veins caused by other diseases are called secondary varicose veins. The most common diseases that can cause varicose veins in the extremities are: 1. Deep venous valve insufficiency We all know that the blood in the veins flows back to the heart, so how can the blood in the lower extremities flow higher and back to the heart? To achieve the “water flow to the high” must have a pump, the pump have a one-way valve, to ensure that the water can only flow upward not downward flow. There are also many such “valves” (medically called valves) in the veins of the body to ensure that blood flows back to the heart. In the lower extremities, some people are born with few valves or abnormal structure, and some people have high venous pressure due to long-term standing work or heavy physical labor, which leads to thickening of venous lumen and poor closure of “valves” and backflow of blood, causing varicose veins over time. There are many valves in the lower limbs, including the valves of the saphenous vein, the valves of the deep veins, and the valves of the traffic branches of the deep and superficial veins, and each group of valves can cause varicose veins if there are problems. Therefore, varicose veins in the lower limbs should be firstly understood which valves have problems, and only by treating the cause can the problem be solved at the root. The valve abnormality is one of the main reasons why some varicose veins will recur after surgery. 2, deep vein thrombosis sequelae The veins of human body can be divided into two groups: deep veins and superficial veins. Superficial veins are located under the skin and can be seen on the body surface, so varicose veins occur in superficial veins. While the veins are under the muscle, which cannot be seen on the body surface, they are the main pathway of venous blood return, which can be said to be the “highway” of venous return in the human body. Under normal circumstances, if the “highway” is open, the next ordinary highway will not be crowded with vehicles, but if the “highway” is closed, the vehicles can only go from the next ordinary highway, it will cause congestion on the ordinary highway. In the same way, if the deep main vein of human body is blocked, blood has to flow back through the superficial vein, which can cause the expansion of superficial vein over time. If you risk surgery before the deep veins are reopened and then remove the superficial veins, then the obstruction of venous return will cause stasis and swelling. 3.Buga syndrome, inferior vena cava syndrome Just as all the tributaries have to merge into the Yangtze River, all the blood in the lower part of the body has to merge into the inferior vena cava to return to the heart, including the kidney, liver (gastrointestinal, spleen) in addition to the blood in both lower limbs. When a segment of the inferior vena cava becomes obstructed, the blood flow to its distal end is blocked. Simply put, obstruction of the inferior vena cava below the opening of the hepatic vein will cause varicose veins in the lower extremities due to impaired venous return. If obstruction of the inferior vena cava occurs above the opening of the hepatic vein, it can cause not only depressed blood in the lower extremities, but also depressed hepatomegaly (post-hepatic portal hypertension) and ascites, which is called Buga syndrome. (Above: Buga syndrome varicose veins of chest and abdominal wall, varicose veins of right lower limb, large unhealed ulcers for a long time) 4. arteriovenous fistula, KT syndrome Normally arteries and veins are connected with each other through many tiny capillaries, there is no big direct traffic, so the pressure of veins is much lower than arteries, if a big direct connection occurs between arteries and veins, forming “short circuit”, called arteriovenous fistula. The direct transfer of pressure from the arteries to the veins causes venous hypertension, which can also form varicose veins. Acquired arteriovenous fistulas are most often caused by trauma or surgery. There is a type of congenital arteriovenous fistula called KT syndrome, which is caused by multiple microscopic arteriovenous fistulas that cause localized venous hypertension, manifested as varicose veins, and may be accompanied by thickening and growth of the affected limb and bone hypertrophy. It is mostly seen in adolescents and sometimes in young children as young as a few years old. The youngest I have treated is 3 weeks old. 5.Iliac vein compression syndrome (Cockett syndrome) The iliac vein is the main channel of venous return in the lower extremity, located in the lower abdomen and pelvis, and is often narrowed by the compression of the crossed arteries, resulting in poor return flow and increased pressure in the distal veins, causing varicose veins in the lower extremity, which can even cause thrombosis and blockage of blood vessels, mostly in the left lower extremity (this is also the main reason why deep vein thrombosis in the lower extremity mostly occurs in the left leg). This is the main reason why deep vein thrombosis of the lower extremities occurs in the left leg) and also in the right lower extremity. Most patients present with varicose veins in the lower extremities and swelling of the lower extremities in the afternoon. These patients are often operated on as simple varicose veins and are prone to recurrence after surgery. Anyone who has had varicose vein surgery and has a recurrence after surgery or still has symptoms after surgery should first consider the possibility of this disease. 6, varicose veins and thrombophlebitis Varicose veins with high saphenous vein ligation and stripping is a relatively simple surgery, but it is not uncommon for people to die suddenly on the operating table during varicose vein surgery. One of the main reasons is that varicose veins cause thrombotic superficial phlebitis, in which the thrombus in the superficial vein can spread upward along the saphenous vein to the intersection of the saphenous vein and the femoral vein. If no clear diagnosis is made before surgery and no corresponding precautions are taken during surgery, the thrombus in the vein may be dislodged to form a pulmonary embolism and sudden death. In conclusion, varicose veins are only a symptomatic manifestation, and their causes are complex and varied. It is better to consult a specialist for treatment of varicose veins to clarify the cause and treat the symptoms in order to get the best results. If the surgery is not clearly diagnosed, the results will not be good in light cases and may lead to irreversible consequences in serious cases.