When varicose veins of the lower extremities progress to a certain extent, complications such as intravenous thrombosis, aseptic inflammation (phlebitis), hyperpigmentation, ulceration, bruising dermatitis, rupture and bleeding can occur. Therefore, early treatment with surgery is the main medical tool to prevent these consequences. Varicose vein surgery was once mistakenly considered as a “common minor surgery” for a long time in the past, but a large number of surgical complications were encountered clinically, which made many patients “cold to the knife” and delayed the disease. In recent years, the emergence of minimally invasive techniques and updated concepts, and the emergence of professional vascular surgeons, have significantly reduced the incidence of postoperative complications. Even with the use of minimally invasive means such as laser, radiofrequency, electrocoagulation, and TRIVEX, various post-operative complications can still occur. For patients, it is important to choose doctors with adequate clinical experience, good level of competence and responsibility so that complications are less likely to occur or can be identified and managed early. So what are the complications after varicose vein surgery? Clinical symptoms: Significant swelling of the lower extremity, shiny skin, and deep pressure pain in the calf gastrocnemius muscle. (Unilateral prevalence) Early recognition: If there is bruising or hard nodules on the skin and the pressure or tenderness is on the surface of the skin, it is often a normal postoperative reaction. If there is deep tenderness on one side of the calf, it should be confirmed by D2 polymorphism and ultrasound of the deep veins at the hospital. Prognosis: The prognosis is good for early detection. Surgery for varicose veins in the lower extremities does not directly cause DVT, but the hypercoagulable state caused by surgery and prolonged postoperative bed rest may induce DVT. Prevention points: choose minimally invasive surgery, walk off the floor early, and choose experienced specialists to shorten the procedure time. Clinical symptoms: Dull or absent skin sensation in the area of the medial ankle or dorsum of the foot. Early recognition: dull sensation by feeling the skin of the region with fingers. Prognosis: No effect on function. Sensory recovery is slow but without serious consequences. The saphenous nerve, which innervates skin sensation, begins to travel gradually below the knee with the saphenous vein, and at the ankle the two are almost adherent. In some patients, part of the nerve has to be sacrificed in order to deal with the diseased vein here. Prevention point: Experienced surgeons use a range of surgical techniques to reduce the incidence of nerve injury. Examples include selective management of the saphenous vein trunk, separation of the ankle trunk from the nerve, and stripping the vein from the bottom to the top. Clinical symptoms: Long, cord-like hard lump on the inner thigh with darkened surface skin and sometimes pressure pain. There is a pulling sensation when walking. Early recognition: as above. ultrasound can confirm. Prognosis: good. It usually subsides gradually after several weeks. Superficial phlebitis often occurs with laser and radiofrequency procedures that preserve the main trunk of the saphenous vein. Prevention points: postoperative bandage compression should be kept tight and bandage duration should be extended appropriately. This complication can be completely avoided by choosing a procedure that removes the saphenous vein trunk. Clinical manifestations: high fever, chills, redness, tenderness and edema in large areas of the lower leg, early recognition: touch the red skin with fingers and feel pain. Blood count suggests elevated white blood cells. Prognosis: generally high fever in the calf after 1 to 2 days. Other symptoms subside in about two weeks. Acute reticulolymphangitis, also known as “dermatophytosis”, with tinea pedis and diabetes as the main causes. Severe varicose veins cause skin dystrophy, which can also cause lymphatic reflux obstruction, leading to inflammation. The main causative agents are Staphylococcus aureus and Streptococcus, so penicillin is very effective in treatment. Prevention points: early surgery. Choose minimally invasive surgery. Pre-operative control of tinea pedis, blood sugar, etc. Keep the skin clean. Clinical manifestations: Patchy bruised skin (more common on the inner thigh), may be painful. Early recognition: as above Prognosis: usually resolves in a few days or weeks with no sequelae. Subcutaneous hematomas are often due to loose bandage wrapping, patient obesity, and other factors. Surgery is more common and has no adverse consequences. Points of prevention: Experienced surgeons will use certain intraoperative techniques to stop the bleeding and postoperative bandages should be tight. Clinical manifestations: blistering of the skin is found after removal of the bandage. Early recognition: the skin has strangulation marks from over-tightened bandages. Prognosis: generally sterilized and bandaged and healed after one week. Usually occurs in obese patients with overly tight bandages. Caused by allergy to antiseptic solution or excipients in some patients. Points of prevention: Thorough intraoperative hemostasis and avoid overtightening of bandages. Clinical manifestations: massive bleeding, cold skin temperature and pale color of the lower extremities. Early recognition: disappearance of the dorsalis pedis artery and bright red jet of bleeding. Prognosis: serious consequences if left untreated. Femoral artery injury is a serious medical malpractice, and the lack of vascular expertise and inexperience of doctors is the main reason. Prevention points: choose a vascular surgery specialist to do the surgery. Clinical manifestations: heavy bleeding and swelling of the lower limbs. Early recognition: Severe lower limb swelling can be seen right after surgery. ultrasound can confirm. Prognosis: severe deep vein thrombosis. Femoral vein injury is medical malpractice. It occurs when the saphenous vein is ligated too high, or when the femoral vein is mistakenly ligated as the saphenous vein. This does not occur with experienced vascular surgeons. Prevention point: choose an experienced vascular surgeon to perform the surgery. Clinical presentation: Redness and painful incision with pus flow several days after surgery. Early recognition: as above. Localized redness only is often an incisional tissue reaction that gradually subsides. Prognosis: Good prognosis with removal of stitches and drainage. Most varicose vein procedures fall into the category of sterile procedures that do not require prophylactic antibiotics and have a very low rate of postoperative infection. Patients who present with skin dystrophy or ulcers are susceptible to incisional infections in this area. Prevention points: avoid incisions in areas of dystrophy or ulceration and use minimally invasive techniques to reduce the length and number of incisions. Although varicose vein surgery may have these complications, most of them are not serious for professional vascular surgeons, as long as proper precautions are taken and treatment is timely. In contrast, delayed treatment may lead to more serious consequences such as venous thrombosis, ulceration, and bleeding.