Methods Endovenous laser, electrocoagulation, point incision stripping of the saphenous vein, partially combined with deep vein valve repair, lumpectomy subfascial traffic vein dissection, and N vein external tendon substitution flap combined with minimally invasive treatment of saphenous varicose veins were used. Results Postoperative follow-up 6 months-7 years, 9 cases of superficial varicose veins recurred within 5 years (3.2%) and disappeared with 1-2 local injections of sclerosing agents. Conclusion Minimally invasive treatment of varicose venous disease of lower extremities with combined procedure has the advantages of minimally invasive, fast recovery and reliable and significant results. Varicose veins of the lower extremities are the most common diseases in vascular surgery, which themselves belong to the category of venous insufficiency of the lower extremities, and some of them are combined with or secondary to deep venous insufficiency [1]. High saphenous vein ligation and segmental stripping has been the classic procedure for varicose veins in the lower extremities, but it has the shortcomings of greater invasiveness, longer operative time, significant surgical scar, less aesthetic, and higher recurrence rate [2]. From May 2002 to May 2009, a total of 251 cases of varicose veins in the lower extremities with 282 limbs were admitted to our hospital and treated with endovenous laser of the saphenous vein, electrocoagulation, partial combined deep vein valve repair, laparoscopic subfascial traffic vein dissection, and N vein external muscle collaterals, and the results were good after clinical observation, which are reported as follows: 1. Data and methods 1.1 Clinical Data There were 251 cases in this group, including 150 males and 101 females, aged 23-7O years, with an average age of 51 years. There were 121 cases of left lower extremity, 99 cases of right, and 31 cases of double lower extremity, with a total of 282 affected limbs. The affected extremities were swollen and sometimes edematous, which was obvious when standing upright, and light in the morning and heavy in the evening. There were 52 cases of dark brown skin or scattered pigmentation in the boot area, 46 cases of combined stasis dermatitis and 28 cases of ulcers. 1.2 Auxiliary examination All 251 cases were found to have simple saphenous vein valve insufficiency by vascular Doppler and deep venography, most of them combined with mild femoral venous regurgitation at the same time, 41 cases had moderate to severe superficial femoral venous regurgitation, among which 15 cases had congenital deep venous valve insufficiency or valvelessness, and 40 cases had traffic branch venous regurgitation. 1.3 Treatment method All cases were treated with epidural anesthesia, small incision under the oval fossa about 2cm or needle hole point incision, high ligation of the saphenous vein, puncture the saphenous vein at the beginning of the saphenous vein in the ankle with an 18-gauge trocar needle, place the catheter along the guide wire, place the fiber along the catheter, make the end of the fiber close to the vessel wall, emit the 810nm laser to achieve contact treatment, and apply pressure for 3-5 minutes. For the short, shallow, tortuous and dilated lateral branch veins, the mass varicose veins can be treated by placing laser fiber in multiple directions, and the high frequency electric knife can also be connected to make its tip discharge to destroy the varicose vein tissue and complete the auxiliary electrocoagulation treatment of the venous branches. For large mass varicose veins, point incision for stripping the varicose veins is feasible. 21 cases were combined with superficial femoral vein valve cessation, 30 cases were treated with N vein external muscle collaterals, 24 cases were treated with TV lumpectomy for subfascial traffic vein dissection. 30 cases were treated with modified subcutaneous saphenous vein high ligation using a point incision under the fossa ovalis. Postoperatively, all cases were treated with compression bandage, routine antibiotics and expectoration. Deep vein valve repair and N vein muscle collaterals were routinely anticoagulated with urokinase application for 5 days to prevent thrombosis. 2, results 2.1 complications 5 cases of calf skin burn blister (2 cases of which were discharged from the hospital after the formation of ulcers healed by drug exchange), 2 cases of catheter fracture in the saphenous vein, fluoroscopic removal, 4 cases of guidewire through the traffic branch into the deep vein, timely adjustment of withdrawal, 6 cases of puncture points with varying degrees of hard nodules, 6 cases of superficial vein thrombosis , complications of calf deep vein thrombosis, metatarsal vein thrombosis, 1 case each, calf skin numbness 15 cases. 2.2 Follow-up The patients were followed up for 6 months-7 years after surgery, with a return rate of 83.7%. 9 cases of superficial varicose veins recurred within 5 years, and disappeared with 1-2 local injections of sclerosing agent. Skin burns healed in 2 weeks, co-infections healed in 2 months, and all calf skin numbness recovered within 1 year. Skin ulcers heal in 3 weeks at the latest, and superficial varicose veins disappear completely. 3.Discussion The effect of the superficial varicose vein surgery of the lower extremity alone for pure saphenous varicose vein is ideal, but the treatment of the primary deep venous valve insufficiency and the regurgitant superficial varicose vein caused by the traffic branch vein should be combined with the treatment of the deep vein. Therefore, for those who are to be treated surgically, vascular Doppler, color ultrasound or deep venography should be routinely performed before surgery [3]. Patients examined for simple saphenous varicose veins should be treated by electrocoagulation of the saphenous vein with a homemade electrocoagulator or by endovenous laser treatment (after 2004). Previously, a small 2-cm incision was used for high ligation of the saphenous vein at the root of the femur, but in the last 3 years we have used direct high intradermal suturing, leaving only a pinhole punctate incision and achieving incisionlessness. If imaging and ultrasound reveal the presence of significant traffic branch venous reflux it is appropriate to use lumpectomy subfascial traffic branch ligation (SEPS), which generally dissociates 1-4 traffic veins while only 2 small 1cm incisions are made. For deep venous regurgitation more than 2 degrees or greater than 1000ms, extravalvular repair of deep vein (wear ring) is performed, and for deep venous regurgitation more than 3 degrees or congenital deep venous valveless disease, extravalvular muscle collaterals of N vein are performed. In our group, the treatment of saphenous varicose vein by endovenous laser, electrocoagulation, point incision resection, partially combined with deep vein valve repair, laparoscopic subfascial traffic vein dissection, N vein external muscle collaterals, i.e., combined with minimally invasive treatment of saphenous varicose vein achieved good therapeutic results. 5-year recurrence rate was 3.2% (9/282) and healed by sclerotherapy injection 1-2 times. We agree with some scholars who propose to introduce the concept of secondary surgery. Patients with large varicose masses, thick varicose vessels, multiple vascular levels, unclear location of traffic branches, and varicose vessels near the skin are likely to have missed laser emission or insufficient local action intensity resulting in postoperative varicose residual or recurrence. If only one-stage cure is emphasized and too much local laser treatment is performed, the chance of complications such as liquefaction of subcutaneous tissue, skin burns and saphenous nerve injury is inevitably increased [4]. The intraoperative residual varicose veins were treated with laser fiber placement or electrocoagulation, and postoperative varicose vein recurrence was treated with sclerotherapy. 2 cases of superficial varicose vein recurrence were due to poor contact with the initial electrocoagulator, 3 cases were due to inappropriate laser puncture level, 2 cases were too loose pressure, and 2 cases had too large a varicose vein mass and insufficient laser energy. One case of secondary thrombosis was a thrombosis of the metatarsal vein and gastrocnemius plexus, which was related to tight bandaging and lack of activity, and recovered after thrombolysis. In conclusion, endovenous laser of saphenous vein, electrocoagulation, spot stripping, SEPS, needle hole subcutaneous high ligation of saphenous vein, deep vein valve repair, muscle collaterals, is a new technology developed in recent years, and the combined laser minimally invasive treatment of varicose vein disease of lower extremities has exact advantages, especially there is no incision after simple saphenous varicose vein surgery, which has simple operation, minimally invasive, fast recovery, reliable effect, and no surgical scar. It has the significant advantages of simple operation, minimally invasive, fast recovery, reliable effect, aesthetic and even no surgical scar.