An elderly gentleman experienced the whole course of varicose veins evolution. Age 60: His calves became sore and swollen after walking, and he was diagnosed with varicose veins, so he thought he was not too serious and set them aside. Age 80: The skin of his ankles started to turn black and the skin of his calves slowly lost elasticity, so he thought he wouldn’t live for a few years and let it go. Age 90: Ulceration of the calf appeared, and the medication was changed for two years, and the wound became bigger and bigger. He wanted to have surgery, but was refused one after another from his family and doctors, the risk of surgery was too great. 93 years old: Rolled here, carefully evaluated his body, and after good communication, the surgery was completed successfully, and the ulcer healed after one month. The old man said: I didn’t expect to live this old, I’ve been fighting with my leg for the past few years, it would have been better if I had done it earlier. Dr. Su would like to say: If it had been done earlier, there would have been no need for the doctor and the family to worry about it. Thanks to all the members who completed the surgery, but despite the very complete care, advanced age clearly increases the risk of surgery. Even though minimally invasive techniques are gradually breaking down age exclusion zones, such an option is by no means preferable. Staging of Varicose Veins Complications of Varicose Veins Varicose veins can remain clinically insignificant for many years. But this does not mean that varicose veins are not harmful. As the disease progresses, superficial venous thrombosis, phlebitis (aseptic inflammation that is not treated with antibiotics), eczema (easily mistaken for skin disease), hyperpigmentation (a sign of serious disturbances in the skin’s internal environment), liposclerosis (loss of skin elasticity meaning susceptibility to injury), ulcers (the beginning of a long-lasting condition), acute rupture and bleeding (painless injury in which blood is lost unknowingly), and Chronic blood loss leading to anemia (loss of large amounts of nutrients and blood during prolonged medication changes), etc. It can even lead to pulmonary embolism (clinical talk) due to superficial venous thrombosis continuing into the deep veins (deep vein thrombosis, slience killer). Conventional treatment approach The old concept: for asymptomatic varicose veins or elderly patients, conservative treatment is used first, mainly consisting of medication or compression stockings (except for acupuncture, massage and bloodletting, which 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. The previous treatment methods need to be reconsidered by the doctors. Drugs and compression stockings as the main means of conservative treatment can only slow down the progression of the disease but not get rid of the root cause of varicose veins. Drugs can only be used as an auxiliary treatment after varicose vein surgery in the lower extremities. And although the effect of compression stockings is definite, they need to be worn for life, which is inconvenient to use, and it is difficult to choose a suitable model, so most of the patients who wear compression stockings often choose surgery in the end. The time and expense previously spent on conservative treatment is wasted and the risk of complications is assumed. An easily overlooked principle in the development of varicose veins (for specialists to read): as the blood from the deep veins flows back into the opening of the diseased saphenous vein, it flows backwards into the superficial venous system, creating an ineffective circulation, which in turn aggravates the burden on the deep veins and over time aggravates the deep venous valvular lesions. The degree of deep vein lesions is precisely one of the important factors for the recurrence of varicose veins after varicose vein surgery. The effectiveness of the surgery is greatly reduced when there is venous thrombotic inflammation, edema, hyperpigmentation, bruising dermatitis or ulceration. For example, surgery cannot eliminate skin darkening; loss of elasticity is never 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. The systemic condition of elderly patients deteriorates with age. If they do not undergo minimally invasive surgery early on and develop variceal complications later on, they often abandon treatment because they cannot tolerate surgery. （For varicose veins who wish to become pregnant, pregnancy can exacerbate the varicose veins and the hypercoagulable state of the 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, they can be very difficult to manage given 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.