As a common disease, varicose veins of lower extremities not only affect the appearance of lower extremities, but with their development, they will eventually cause swelling, edema, skin dystrophy, pigmentation and even skin ulcers of lower extremities, which will seriously affect the function of lower extremities and the quality of life. Most of the varicose veins in the lower limbs are caused by superficial venous insufficiency of the lower limbs. Specifically, it is caused by superficial venous valve insufficiency, resulting in blood reflux. Traditionally, open surgery to remove the incompetent saphenous vein and its branches has been shown to provide good control of symptoms. For most patients, saphenous vein insufficiency is the cause. However, the superficial veins of the lower extremity include not only the saphenous vein but also its branches, such as the paraphenous vein in the thigh, the small L vein in the calf, and the more obscure penetrating veins. Particularly complex, variants of the venous system are common, such as double saphenous veins, which occur in up to 25% of cases in the lower leg and 8% of cases in the thigh. The small saphenous vein confluence is commonly the N vein, but variants are also common, such as high confluence into the great saphenous vein or even long-range confluence into the femoral vein. Exceptionally, varicose veins can be caused exclusively by the lesser saphenous vein or the paraphenous vein, while the greater saphenous vein functions normally. The monotonous surgical approach of traditional surgery (high saphenous vein ligation and stripping) is incompatible with the complexity of the anatomy of the superficial veins of the lower limbs. This fundamentally leads to the sometimes blinding nature of the classical procedure. Let’s say that a double saphenous vein variant is present and if only one stripping is performed (which is difficult to determine during surgery), there will be no significant postoperative therapeutic effect. The blinding of the procedure is ultimately reflected in unsatisfactory or ineffective postoperative symptom control or manifests as recurrence. This does not happen by chance, but first of all by a deficiency in disease awareness on the part of the vascular surgeon. Varicose veins of lower extremities are generally considered as diseases with simple onset and treatment, and vascular surgeons are “unintentionally” reluctant to invest too much energy to investigate its anatomical details; secondly, it is the disconnect between imaging and surgical procedures in the process of doctor training and in the setting of operating room equipment. The strict division of specialties in the physician training system has severed the close connection between imaging and surgery, especially the connection between image guidance technology and surgery. Vascular surgeons generally do not have the systematic learning process of imaging examination, the concept of image guidance in surgery, or the basic technology to perform image guidance. Inevitably, surgery is blinded in special cases. Given the complexity of the anatomy of the superficial veins of the lower extremities, preoperative imaging evaluation of the superficial veins of the lower extremities (mainly using color Doppler ultrasound) is very important and should preferably be performed by the attending surgeon himself. This is because the ultrasound task in ultrasonography is to diagnose the disease, not to design the surgical plan. Ultrasonography performed by the main surgeon himself can provide a comprehensive understanding of the superficial veins, which can effectively avoid surgical blindness and avoid missing diseased veins; ensure the effectiveness of the treatment and reduce postoperative recurrence. In this sense, in the treatment process of varicose veins of lower limbs, no matter what treatment method is used, without adequate preoperative imaging evaluation, especially the imaging examination (ultrasound examination) performed by the main surgeon himself; without intraoperative ultrasound guidance, the treatment will definitely lead to certain blindness, uncertainty, and it is also difficult to guarantee the treatment effect.