Minimally invasive stripping combined with electrocoagulation offers patients with varicose veins in the lower extremities a minimally invasive and safe procedure with smaller incisions and better healing compared to traditional surgery. However, many patients still have some fears and doubts about the procedure: Am I suitable for this procedure? What preparations do I need to make before the surgery? Will there be scars after surgery? Do I need to make an appointment to have the surgery? Today, we will answer these questions one by one. Is Minimally Invasive Peel Combined Electrocoagulation suitable for all patients? Minimally invasive stripping combined with electrocoagulation is a modified version of the traditional procedure and can be chosen by most patients with varicose veins in the lower extremities, except for those with thrombophlebitis. The less severe the patient’s symptoms, the better the results of the procedure. It is also effective in patients who already have skin ulcers on their lower extremities. The ulcers are caused by poor blood return due to varicose veins in the lower extremities, causing blood to pool in the lower extremities where it cannot participate in normal metabolism, and the accumulation of toxins stimulates the surrounding skin to produce ulcers. After ligating the saphenous vein and the two branches, the ulcer can be healed slowly by electrifying the small blood vessels around the skin of the ulcer and “scalding” them with electrocoagulation to remove the toxins accumulated there, together with local medication changes, bandages and elastic stockings. However, for patients who already have skin color changes, the post-operative period can stop the development of skin pigmentation, but it is impossible to restore the skin color and condition to normal. Some patients ask: Can this procedure be done for patients who have had previous sclerotherapy or who have relapsed after surgery? The answer is yes. First, the patient now has the need for another surgery, which means that the previous treatment was unsuccessful; second, usually the injection sclerotherapy only targets the tiny branch veins, not to the main vein, so it does not affect the re-operation. What does the patient need to do before surgery? As with other surgeries, patients should have routine preoperative tests, such as an electrocardiogram, chest X-ray and blood tests. Of course, the most important thing is to have ultrasound of the deep and superficial veins of both lower extremities, even if only one leg has lesions, because it is necessary to compare with the normal lower extremity to determine the severity of the lesions in the affected extremity. In addition, for patients with particularly severe varicose veins in the lower extremities and suspected deep venous valve insufficiency, in addition to ultrasound, CTV or venogram is required to determine the degree of valve insufficiency. If the valve insufficiency is grade III and above (i.e., blood regurgitation to the knee joint and below, as shown in the figure below.) Minimally invasive surgery is not possible if you have to do deep vein valve reconstruction in addition to varicose vein surgery. For patients with other comorbid diseases, such as hypertension and diabetes, they may take anti-platelet drugs, which can generally continue to be taken regularly before surgery without stopping them. Because the surgery is to strip a superficial vein, the bleeding is relatively small and can be stopped by applying pressure and bandages, so patients do not have to worry too much. However, in the case of patients receiving dual antiplatelet therapy for coronary artery disease, or patients taking warfarin medication for atrial fibrillation, it is recommended to stop the medication for about a week. In case the bleeding during the surgery is not well controlled. What is the type of anesthesia used for the procedure? The procedure takes about half an hour, and the anesthesia used is intravenous general anesthesia with a laryngeal mask. This type of anesthesia is administered intravenously, which means that the patient falls asleep after a single injection. The advantage of intravenous general anesthesia is that the anesthetic effect is rapid, and the patient wakes up quickly and can move around on his own. In traditional surgery, lumbar anesthesia (i.e., subarachnoid anesthesia) is often used, and patients are not allowed to move around until six hours after surgery, and they are not allowed to raise their heads during the recovery process. Many female patients also suffer from post-anesthetic sequelae such as headache. Therefore, the laryngeal mask intravenous general anesthesia is more conducive to the patient’s recovery. However, there are some patients who are older and have poor cardiopulmonary function, so local anesthesia is used, and the pain relief is also very effective. Will there be scars on the incision after the surgery? There will be scars after the incision is healed, but the surgeon will cut along the skin texture when making the incision, which will produce the smallest scars and the best healing effect. As long as the patient is not scarred, the wound will slowly heal into a line through the body’s repair mechanism. Secondly, the incisions are relatively hidden and are usually not easily visible. Do I need to make an appointment for the surgery? Can both legs be operated on at the same time? To have surgery at Peking University First Hospital, you need to make an appointment and have a checkup in advance, and you usually have to wait from one month to six months. Whether the surgery is done on one leg or both legs at the same time is determined by the results of the ultrasound. If a patient has a problem with only one leg, only a single leg surgery is required. If the varicosities are severe in both legs, and the ultrasound reports that both lower extremities have an incomplete saphenous vein, then both legs can be operated on, solving all the problems at once. The post-operative recovery is the same for both legs and single leg surgery, and does not affect the patient’s daily life, and the patient can be discharged from the hospital two to three days after surgery, or two days later on weekends.