Staging of varicose veins 1. Complications of varicose veins: Varicose veins can have no obvious clinical symptoms for many years. But this does not mean that varicose veins are not harmful. When the disease progresses to a certain extent, superficial venous thrombosis, phlebitis (aseptic inflammation, ineffective antibiotic treatment), eczema (easily mistaken for skin disease), hyperpigmentation (a sign of serious disturbance of the skin’s internal environment), liposclerosis (loss of skin elasticity means easy damage), ulcers (the beginning of a long period of time without healing), acute rupture and bleeding (painless damage, blood is lost unknowingly), and Chronic blood loss leads to anemia (loss of large amounts of nutrients and blood during long-term drug changes), etc. It can even lead to pulmonary embolism (clinical talk) because superficial venous thrombosis continues into deep veins (deep vein thrombosis, slience killer). 2.Conventional treatment methods: The past concept: for asymptomatic varicose veins or elderly patients first use conservative treatment, mainly including drugs or elastic stocking treatment (acupuncture, massage, bloodletting must be excluded, can induce thrombosis). This view is still quite common even nowadays, based on the consideration of surgical trauma, economic burden, and the risk of surgery at the patient’s advanced age, which has its certain justification in a specific period. However, it is no longer fully applicable to the era of minimally invasive surgical techniques. (1) Drugs and compression stockings as the main means of conservative treatment can only delay the development of the disease but not get rid of the root cause of varicose veins. Drugs can only be used as an adjunctive treatment after varicose vein surgery in the lower extremities. And although the effect of elastic stockings is definite, they need to be worn for life, which is inconvenient to use, and the selection of a suitable model is also quite difficult, so most of the patients who wear elastic stockings often choose surgery in the end. Then the time and cost previously spent on conservative treatment is wasted, and the risk of complications is also assumed. (2) An easily ignored principle in the development of varicose veins is that because the blood from the deep veins flows back to the opening of the diseased saphenous vein, it flows backwards into the superficial venous system, forming an ineffective circulation, which in turn increases the burden on the deep veins and over time aggravates the deep venous valvular lesions. And the degree of deep vein lesion is exactly one of the important factors of recurrence or not after varicose vein surgery. (3) The effect of surgery is greatly reduced when there is venous thrombotic inflammation, edema, hyperpigmentation, bruising dermatitis or ulceration. For example, surgery cannot eliminate skin darkening; skin that has lost its elasticity can never be restored; surgery is poorly effective for edema; surgery is less than 80% effective for dermatitis; phlebitis takes a long time to fade; and once a pulmonary embolism develops it is no longer a surgical problem – pulmonary hypertension in pulmonary embolism survivors will severely affect the patient’s quality of life. (4) The systemic condition of elderly patients decreases with age. If they do not undergo minimally invasive surgery early in life and develop varicose veins later, they often abandon treatment because they cannot tolerate surgery. (5) For varicose vein patients who wish to get pregnant, pregnancy can aggravate the varicose veins and the hypercoagulable state of blood during pregnancy can significantly increase the risk of thrombosis, and if complications such as deep vein thrombosis or even pulmonary embolism occur during pregnancy, it can be very difficult to manage considering the safety of the fetus. So the best option is to solve varicose veins with early surgery before complications arise. Advances in medical technology have made surgery for varicose veins in the lower extremities less and less invasive, reducing what used to be a 7-14 day hospital stay to less than a day, with the vast majority of patients being able to wake up, get off the floor within minutes and go home the same day. Although we have been able to reduce the post-operative recurrence rate of varicose veins to 1%, which is well below the average. But even if recurrence occurs, it is much better than if complications occur with conservative treatment.