The distribution of lower limb venous valves: no valves exist in the common iliac vein; the rate of valves in the external iliac vein is 44.68%, generally only 1 pair of valves; the rate of valves in the common femoral vein is 51%, generally only 1 pair of valves; the rate of valves in the deep femoral vein is 88%, with 0~4 pairs of valves; the rate of valves in the superficial femoral vein is 100%, with 1~5 pairs of valves, and the position of the first pair of valves (the highest pair of valves) is more constant, generally 11 pairs; peroneal veins (including medial and lateral branches) have 3~10 pairs of valves. The strength of the lower extremity venous valves: the external iliac vein valves, the common femoral vein valves, and the saphenofemoral valves are the weakest. It can be assumed that when the proximal segment of the deep venous trunk of the lower extremity valves is continuously strengthened by reverse gravity, it is easy to destroy the less strong common iliac-femoral valves, apply direct pressure to the saphenofemoral valves and the first pair of valves of the superficial femoral veins, and first destroy the less tolerant saphenofemoral valves, and then destroy the weaker valves in the great saphenous veins. The weaker valves in the saphenous vein are then destroyed, causing simple saphenous varicose veins. If the gravity of the reverse blood column continues to strengthen, it is possible to destroy the strongest superficial femoral valve pair 1, followed by the weaker valves distal to it, resulting in primary deep venous valve insufficiency. Clinical significance of venous valve insufficiency: Simple saphenofemoral valve insufficiency and primary deep venous valve insufficiency belong to different stages in the evolution of the same type of venous reflux disease. The magnitude of venous reverse pressure is the main factor that determines whether the venous reflux lesion is confined to the saphenous vein or involves the deep veins. Venous systemic hypertension caused by venous backflow in the lower extremities, especially in the deep veins of the lower legs, is the main cause of clinical symptoms. The venous hypertension in the lower extremities causes the superficial veins to dilate, the number of capillaries to increase significantly, the capillary bed to expand, and the gap between capillary endothelial cells to increase more than 10 times than normal, resulting in a great increase in capillary permeability. The fibrinogen and red blood cells in the blood escape into the tissue interstitial space. In addition to the early manifestation of varicose veins, clinically, it also gradually shows lower limb edema, lower leg skin pigmentation, bruising dermatitis, and ulcers. In recent years, studies on venous insufficiency due to iliac vein stenosis or occlusion have brought new concepts to the pathogenesis and treatment. Diagnosis of venous insufficiency: Most medical institutions use vascular ultrasound or lower extremity venography to understand the valve condition. ultrasound can be used to determine valve regurgitation time using the Valsalva maneuver. In contrast, a parallelogram of the deep veins of the lower extremities can show dilated superficial femoral veins in the form of straight cylinders and bamboo-like images of unseen valves. Retrograde femoral venipuncture angiography is rarely performed in clinical practice because it is more invasive and has been replaced by the widespread use of color ultrasound. Of course, an experienced vascular surgeon can make a preliminary determination of the valve lesion by physical examination. Only if the venous ultrasound diagnosis is uncertain or inadequate will the patient be advised to undergo a venogram of the lower extremities. It is important to note that ultrasound also shows venous valve regurgitation in about 20% of normal individuals. Therefore, the results of all tests have to be combined with the clinical reality before they can be used as a basis for choosing a treatment plan. If the patient has significant edema, ulceration, or hyperpigmentation, an intravascular ultrasound of the iliac veins (IVUS) is recommended to rule out stenosis or occlusion. It is important to note that it is important to use a standardized position for ultrasound examination of the deep veins of the lower extremities. For the diagnosis of thrombosis, the patient can be placed in a flat position. For monitoring of valve regurgitation, the standing position must be used. Perspectives on the treatment of venous valve insufficiency: Not all patients with ultrasound or imaging suggestive of deep venous regurgitation will undergo deep venous valve repair. For a long time, procedures targeting deep venous valve regurgitation were highly valued by clinicians, such as deep venous valve wear cessation, deep venous valve repair, and N vein myocardial trip substitution valve, which were performed in large numbers throughout China. Subsequent follow-up results show that deep vein surgery has disadvantages such as high trauma and many complications. In addition, Dr. Smile’s statistics on the recurrence of varicose veins in the lower extremities referred from all over the world in the past 20 years showed that some of the recurrences were due to traffic vein lesions or residual large and small saphenous vein lesions, and some were due to occlusive deep vein disease, especially occlusive iliac vein stenosis or occlusive disease. Combined with the new international understanding of the causes of varicose veins in recent years, a three-step treatment is recommended for varicose veins caused by venous valve insufficiency: 1. Saphenous vein surgery: Removal or closure of the diseased superficial veins can greatly reduce the ineffective circulation in the deep veins and improve the function of the deep veins. Despite the presence of deep venous regurgitation, the vast majority of patients can be treated by undergoing minimally invasive surgery targeting the superficial veins only. If the patient has significant lower extremity edema and severe lower leg skin lesions, it is recommended that the iliac veins be investigated. If there is significant narrowing or occlusion of the iliac vein, balloon dilation or stenting must be done first. 2. Saphenous vein surgery or endoscopic venous traffic branch dissection (SEPS): If recurrence occurs, it is recommended to check the small saphenous vein and the traffic vein. Saphenous vein surgery or endoscopic venous traffic branch dissection (SEPS) is used. Most patients with ulcers can be treated in this way. Deep vein surgery: Deep vein surgery can be considered if intravascular ultrasound (IVUS) can rule out iliac vein stenosis or occlusion, if the patient still has a persistent ulcer, and if there is severe valvular disease in the deep vein that is expected to be repairable. Limitations of deep vein valve repair surgery: Although theoretically, surgery that restores valve function should be truly radical in nature. However, to date, surgery for deep vein valves has not been widely accepted and recognized by the international medical community. The important reasons that limit the widespread promotion of deep vein surgery in clinical practice are: 1, large incision, extensive anatomy, slow postoperative recovery, and many complications of deep vein surgery. 2.The valve basically disappears or those with severe valve lesions cannot be repaired. 3, the diseased valve is difficult to be repaired precisely in the flat lying surgical state and suitable for the functional needs of the daily upright state. 4.There is a risk of deep vein thrombosis. The best treatment for venous valve insufficiency: early minimally invasive surgery for lower extremity superficial varicose veins can improve deep vein reflux. If the patient has significant afternoon edema of the lower extremities, severe skin pigmentation or even accompanying ulcers, intravascular ultrasound of the iliac veins (IVUS) is recommended. Once significant stenosis or occlusion of the iliac veins is confirmed, simultaneous balloon dilation of the iliac veins with stenting is recommended.