Often asked on the site to have varicose veins, doctors recommend surgery, but inquire about varicose veins is to draw and peel, very scary, and heard where the hospital is laser without surgery is what is going on, here it is necessary to do a summary of the main surgical methods of varicose veins to help patients in need of medical information and increase confidence in treatment. The basic principle of varicose vein surgery is to remove or close the diseased veins, because the valves in these veins have been destroyed and the blood flows backwards, which not only fails to return the normal blood flow, but also causes the blood flowing back through the normal veins to return to these diseased veins again, forming a dead circulation locally, which manifests as varicose veins. The classical method of surgical treatment is a high ligation of the saphenous vein (which is the most important site of reflux), a tap of the venous trunk and a spot stripping of the small varicose veins. In recent years, many new methods have emerged, including laser, radiofrequency, microwave, and sclerotic closure. The basic principle is to close the vein that would otherwise require surgical stripping by physical heat (laser, radiofrequency, microwave) or chemical (sclerosis) methods to block venous reflux and dead circulation. (1) High ligation of the vein + spot stripping The basic procedure is performed by making a small incision at the root of the thigh (in the groin), performing a high ligation of the saphenous vein (which is the most important site of reflux), and then stripping the main saphenous vein and the varicose branch veins. This procedure has been clinically tested for more than 100 years and is safe and reliable. In recent years, with the improvement of surgical skills and the application of minimally invasive techniques, many vascular surgery centers can make small incisions (about 2 cm in the inguinal area and about 3 mm in the rest of the body) and recover quickly, and the postoperative hospital stay has been shortened from about a week to about a day. Improvements in technology have also reduced the complication rate of this procedure to almost zero and the cost is low, and so far this is still the main surgical procedure for varicose veins. (2) Vein Closure (Laser, RF, Microwave) The basic principle of the new names that have puzzled many patients, such as laser, RF, microwave, etc., is that the main trunk of the saphenous vein, which was originally surgically ablated, is closed by physical heat instead, to block the backflow of the vein. Some of the varicose branch veins can also be closed by laser, but most of the branch veins still need to be surgically stripped. The advantages of this type of approach are relatively less invasive, smaller and less incision, better postoperative cosmetic results, and faster postoperative recovery. The disadvantage is that the diseased vein remains in place and there is a certain chance of recurrence of recanalization. In addition the nature of these methods is artificially induced phlebitis and some patients can have a longer period of local pain after surgery which is not suitable for pigmentation. In addition, laser or radiofrequency closure has a certain probability of nerve and skin “burns”. Minimally invasive closure methods are relatively expensive and are mainly suitable for cases with mild lesions and particularly high cosmetic requirements. (3) Scleroclastic closure Scleroclastic closure is to stop the venous reflux by injecting drugs into the diseased vein to destroy the vein lining and close it, (i.e., the advertised treatment of varicose veins without an incision). The principle is the same as laser and radiofrequency closure. Sclerotherapy has a history of several decades, but it was not widely carried out in large domestic hospitals in the past, because the sclerosing agent sodium ichthyate used in the past had strong corrosive properties, which easily caused skin pain, necrosis and other complications. In addition, in the past, sclerotherapy only targeted the varicose branch veins but not the main saphenous vein, which did not remove the root cause of the disease and therefore had a high recurrence rate. Nowadays, a new type of sclerosing agent with milder effect, polyglaucine, has been introduced and produced in China, which was historically used as a local anesthetic drug and rarely causes pain and skin damage when injected, making it safe to use. Sclerotherapy injection, when combined with high ligation of the saphenous vein and sclerotic occlusion of the trunk, can achieve results similar to those of traditional surgery, and the recurrence rate is much lower than simply treating varicose branches, and even if recurrence can be resolved by simple supplemental injection. The disadvantage is that postoperative phlebitis can easily occur in thick diseased veins if they are not well compressed, so this method is not recommended for very severe varicose cases. The advantages of scleroclastic closure are that it is less invasive, there is no incision in the visible part of the leg (only a small inguinal incision is possible), no semi-anesthesia is required, and you can live normally the day after the procedure. It is a good choice for cases that are not particularly severe and have cosmetic needs.