Abstract OBJECTIVE: To study the changes of dorsalis pedis venous pressure before and after saphenous varicose vein surgery by dorsalis pedis venous puncture and catheterization. METHODS: Preoperative and postoperative pressures in the dorsalis pedis vein lumen were obtained and compared with those in 48 lower limbs of 32 patients operated for saphenous varicose vein combined with deep vein valvular insufficiency in the lower limbs by using dorsalis pedis venous puncture catheterization in the standing position. RESULTS: In patients with saphenous varicose vein combined with lower limb deep vein valve kinetic insufficiency, the postoperative dorsalis pedis venous venous venous venous venous pressure decreased significantly compared with the preoperative period, and there was a statistically significant difference (P<0.05< span="">), which indicated that in patients with saphenous varicose vein, the dorsalis pedis venous venous reflux pressure was alleviated to a certain extent after performing saphenous vein ligature high ligature stripping surgery. CONCLUSION: In patients with saphenous varicose veins combined with lower extremity deep vein valve kinetic insufficiency, the pressure of the dorsal foot vein was significantly reduced after saphenous vein varicose vein stripping, and the hemodynamics of lower extremity deep vein hemodynamics were obtained. Varicose saphenous vein is a common peripheral vascular disease, and patients diagnosed with simple varicose saphenous vein should all undergo surgical treatment if they can tolerate surgery [1]. As it is a superficial venous lesion, closely related to the deep veins, through the study of saphenous varicose vein pressure changes in the dorsal foot after surgery, to understand the changes in the function of the deep vein valves, and to provide a basis for the evaluation of surgical efficacy. 1, data and methods 1.1 General information 32 cases (48 lower limbs) were surgical patients in our hospital, 14 male cases (21), 18 female cases (27). The age was 37-74 years old, with a mean age of 52 years, and the disease duration was 5-28 years. By vascular Doppler ultrasound examination, it was confirmed that the deep veins of the lower limbs were patent, and all deep vein valves had different degrees of regurgitation. Diagnosis: varicose veins of the great saphenous veins combined with some degree of lower extremity deep vein valve insufficiency (grade 0-3). The patients all had superficial varicose veins and different degrees of swelling of the lower limbs after activity, and 14 of them had skin pigmentation and thickening in the boot area, of which 5 cases were accompanied by ulcers. 1.2 Apparatus and methods The composition of the dorsal foot venous puncture catheterization pressure measurement device, including the strictly calibrated portable sphygmomanometer head, sterile intravenous infusion device (Figure). Patients take parallel feet standing position, with ordinary superficial venous puncture technique of the dorsal vein of the foot anterior ankle vein branch of the successful puncture, indwelling needle connected to a sterile intravenous infusion device, the distal end of the sterile intravenous infusion device is connected to the portable sphygmomanometer meter head interface, will be placed in the same plane with the dorsal vein of the foot puncture point of sphygmomanometer meter head; observation of the pressure needle stabilized for 10 seconds after the pressure as a target value of the measurement (mmHg). The same limb and the same puncture point were tested once 1 day before and 10 days after the operation. The surgical method was high saphenous vein ligation and stripping + varicose vein rotary cutting of the lower leg, during the operation, the high saphenous vein ligation was strictly carried out throughout the stripping and ligation of the saphenous vein root of the genus branch, and the varicose veins of the lower limb were cleanly rotated using the rotary cutting system. 1.3 Statistical methods SPSS13.0 statistical analysis software was used for data processing. The measured values of each index were expressed in ± s, the information obeyed normal distribution, and the t-test was used for the measurement data. The difference was considered statistically significant at p<0.05< span="">. 2, the results of standing position dorsalis pedis venous puncture tube pressure detection, saphenous varicose vein after surgery dorsalis pedis venous pressure compared with the preoperative have significantly decreased, the difference is statistically significant. Table Dorsalis pedis venosus intraluminal pressure measurement (mmHg) Group Number of articles Dorsalis pedis venosus intraluminal pressure (mmHg) Preoperative group 48 89.523±0.761 Postoperative group 48 81.220±0.263 3. Discussion Saphenous varicose vein is a common peripheral vascular disease with a high incidence rate. a survey in 1969 in the UK[2] showed that 56.5% of standing working workers suffered from superficial lower extremity varicose veins.In 1980, Kistner[3] firstly proposed the concept of primary lower extremity deep vein valve insufficiency, and many domestic and foreign scholars carried out a great deal of research work on this.Sun[4] found that among 105 patients with severe symptoms of superficial lower extremity varicose veins, there were 61 patients with lower extremity deep vein valve insufficiency. The relationship between superficial lower extremity varicose veins and deep vein valve insufficiency of the lower extremity has not been conclusively determined, of which the hemodynamic theory is highly recognized. The venous hypertension caused by deep venous regurgitation and obstruction of venous return not only destroys the valves of the deep vein trunk, but also destroys the valves of the saphenous-femoral vein, which in turn causes saphenous varicose vein, and the development of the disease further destroys the valves of the deep and superficial vein traffic branches of the calf, which puts the superficial veins in a high-pressure stagnant state, and produces a series of clinical symptoms and signs. Therefore, simple saphenous varicose vein is not necessarily accompanied by deep vein valvular insufficiency, and any person with primary deep vein valvular insufficiency is accompanied by saphenous varicose vein [5]. The treatment of varicose saphenous veins is mainly based on the traditional high saphenous vein ligation and stripping, and there are other methods such as suture ligation, point stripping, radiofrequency therapy, laser therapy, sclerotherapy, etc. The various methods have their own characteristics and limitations. Each method has its own characteristics and limitations. The traditional high saphenous vein ligation and stripping has a definite efficacy. In the anterior region of the ankle, anterior to the cruciate ligament, posterior to the dorsal venous arch of the foot, lateral to the tendon of the lesser toes of the extensor digitorum longus tendon, and medial to the 4th metatarsal bone, there are fewer cutaneous nerves, which is called the “lack of nerves area” [6]; the vein trunk of the anterior ankle vein network that appeared in this area is about 8.26 cm in length, with an external diameter of 0.1 cm, a straight course, good elasticity, thick lumen, and a relatively straight direction. good elasticity, thicker lumen, superficial and constant position, and easy to fill with blood. Therefore, it was identified as a puncture vein. On the one hand, it avoids the pain and subcutaneous bruising caused by the patient during manipulation and improves the success rate of puncture; on the other hand, it avoids the pain and damage caused by the needle piercing too deeply. In practice, try to avoid the intersection of nerves and blood vessels, or try to avoid the nerve side of the blood vessels, and choose the “lack of nerve area” with less distribution of skin nerves, which is helpful to reduce the patient’s pain and get good cooperation from the patient. The pressure in the lumen of the dorsal veins of the lower limbs is composed of two factors, including the reflux resistance of the superficial venous system (saphenous vein, small saphenous vein) and the reflux resistance of the deep venous system; in patients with saphenous varicose veins combined with deep venous valvular insufficiency, the resistance to reflux in the superficial venous system is elevated compared with the normal one, and the pressure is transmitted to the distal dorsal veins of the lower limbs, raising the pressure of the lower limbs and increasing the pressure. The pressure is transmitted to the distal dorsalis pedis vein, which increases the pressure in the lumen of the dorsalis pedis vein in these patients. After saphenous vein surgery, the resistance to blood return in the saphenous vein disappeared, and the removal of this part of the pressurizing factor reduced the pressure of venous return in the distal lower extremity, which was manifested as a decrease in the pressure in the lumen of the dorsalis pedis vein, and an improvement in the hemodynamics of distal venous flow in the lower extremity. Walsh et al [7] reported that 29 affected limbs with preoperative superficial femoral vein and saphenous vein reflux confirmed by two-way Doppler ultrasonography, did saphenous vein stripping of the thigh, and the reflux from the deep vein disappeared; this phenomenon was also confirmed by Sales et al [8], and the reflux from the deep vein was also confirmed to be significantly reduced after the saphenous vein stripping in our previous study [9]. When simply stripping the saphenous vein trunk and removing the varicose vein, the function of the deep vein valves of the lower limbs was improved, the reflux was reduced or disappeared, and the resistance to blood return in the deep veins was reduced, and according to the theory of intraluminal pressure conduction, the resistance to blood return in the distal lower limbs was reduced accordingly, so that the pressure measured by dorsal pedicle venous puncture placement in the standing position was significantly reduced compared with that of preoperative period. This indicates that the postoperative saphenous varicose vein surgery reduces the reflux pressure of the distal venous system and improves the blood supply and oxygenation of the tissues.