I often hear the questions in the title asked by my patients, so it seems necessary to deepen my understanding and talk about them. First of all, to answer the first question: What kind of varicose veins need surgical treatment? To answer this question, first of all, we need to understand the general classification of varicose veins, according to the CEAP classification standard of the American Venous Forum in the 1990s (don’t look at the age, this is a very classic classification method, there is no better classification so far), all varicose veins can be specifically described and classified according to the following aspects: C (i.e. clinical, clinical description): from 0 to 6 can be divided into 7 categories, 0 is no varicose veins (that is, normal people), 1 is mild varicose veins (you can see the twisted veins, but not into a mass, not serious, generally no discomfort, but affect the appearance) 2 is mild varicose with limb swelling (standing for a long time may be accompanied by a certain degree of limb soreness) 3 is more serious varicose veins (seriously affect the appearance, generally standing for a long time will feel) 4 is varicose veins with limb skin pigmentation (affects the skin) 5 is varicose veins and healing skin ulcers (skin rotten but can still grow well) 6 is varicose veins with non-healing active ulcers (rotten legs have been growing badly). You can check the number to see which kind you are, as for how to treat, we will talk about it later. E (i.e. etiology): mainly from the etiology of varicose veins: is it a family genetic or occupational disease (once I met a patient with severe varicose veins who was a fruit vendor and had to stand for more than 12 hours a day, so it’s hard not to have varicose veins), or is it a bigger vein problem (e.g. Buga’s syndrome)? A (i.e. anatomy, anatomical description): describe the varicose veins from the anatomical site, is it the calf or the thigh, is it the saphenous vein or the small saphenous vein? Or are they present along with the perineum and lower abdomen? P (i.e. pathophysiology): Is there a combination of deep vein thrombosis? Is there valvular insufficiency of the communicating veins and deep veins? Or is there simple superficial venous valve insufficiency? Is the direction of blood flow downstream, or is it backflow, etc.? The last three of these, or EAP, are more advanced questions that doctors should think about and patients should just understand. After describing your varicose veins from these four aspects of CEAP (which, I should say, is a very adequate description), the diagnosis follows. For example, a varicose vein confined to the saphenous vein, without any other co-morbidities, caused by simple valvular insufficiency, and with a clinical classification of 3, can be diagnosed as a simple saphenous varicose vein (C3). Back to the sufferer’s point of view, what we can generally judge is C, which is the clinical description, so let’s put aside EAP for the moment to talk about which needs surgical treatment. c0 is normal and obviously does not need surgery. c1 generally only affects the appearance without any discomfort, so those who need surgery are beautiful people with high requirements for leg appearance. This reminds me that every time summer approaches, there is a bright landscape in the clinic, where beautiful women come and point to a blood vessel that is not particularly obvious and say to me with hatred: get rid of it! C2 does not usually require surgery, but it is also necessary for aesthetic reasons. For C1-2 patients, the important thing is to prevent further aggravation of varicose veins, and generally wearing elastic stockings is enough. For C3 patients, conservative treatment is not enough to solve the problem, which means that surgery is needed, otherwise the disease will gradually progress. But C3 is generally a long process, most patients may take 5-10 years to develop to C4, therefore, C3 needs surgery, but there is no hurry. C4-C6, needless to say, must be operated, only surgery, can solve the problem. Here’s how the surgery is done. The surgery generally requires three steps: A. High ligation, to solve the problem of the source of reflux blood; B. Trunk removal, to solve the problem of reflux blood pathway; C. Removal of varicose veins (that is, those curved vessels that protrude from the skin most obviously). a high ligation surgery requires a small incision of about 1.5 cm in the groin, and a variety of surgical methods are currently available without this step. b There are many ways to remove the trunk, from traditional stripping, to the more mainstream laser closure, to sclerotherapy injection closure.C There are also many ways to remove the varicose veins, such as: point excision, laser closure, sclerotherapy injection, Trivex shaving excision, etc. The combination of A and various B and C produces a variety of surgical methods, each with certain advantages and disadvantages, but in general, as long as the operation method But in general, as long as the operation method is standardized, the final result is not particularly different. Of course, there are some extreme clinical cases, for example, some patients have a very wide saphenous vein trunk, and laser closure is difficult to guarantee the result, so the surgical method of stripping is used. There are also some surgical procedures, which are used relatively rarely, such as: the lumpectomy deep subfascial traffic branch dissection (SEPS procedure), which is often attached to the ABC procedure for reflux traffic branch veins that cannot be removed by the latter, and some patients with C5-C6 need this procedure to solve the problem. Back to the patient’s perspective, which procedure is better for you? For C1-C2 patients, if you really need cosmetic surgery, you can choose sclerotherapy injection. Strictly speaking: limited sclerotherapy (currently the most commonly used is polyglactin) injection cannot be considered as surgery, it does not require hospitalization, there is no surgical incision, and the results are still good. Basically, it can reach the psychological standard of beautiful people. Patients with C3-C4, ABC surgical steps can not be missing. Which B and which C are used, this is a slightly specialized issue, so let the doctor decide for you. For C5-C6 patients, in addition to the ABC procedure, some patients will need to undergo the SEPS procedure. Only then can the problem be better resolved and recurrence avoided.