Patient: My sister has a history of varicose veins in her right lower extremity for more than ten years, and the surface is lumpy and prominent. On the 27th of the waxing moon a year ago, probably due to overexertion, a thrombus appeared in the right lower limb, which was about three centimeters long and 2 or 3 centimeters wide. At first it was above the ankle, but now it has wandered about 3 cm toward the calf with pain and no significant pain elsewhere. The local hospital diagnosed the mass at the right calf as a varicose superficial vein with luminal thrombus on ultrasound on the 27th of Ramadan. What is this disease and how can it be treated? The Department of Peripheral Vascular Surgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China Jusang: According to your description, the preliminary judgment is thrombosed superficial phlebitis, which is one of the most common comorbidities of varicose veins. It is not difficult to treat this disease, mainly rest, in recent days you should reduce walking, bed elevation of the affected limb, and then apply some Chinese medicine, such as “Ru Yi Jin Huang San”, which is cheap and should be available in common pharmacies in the market. From your description, the patient is from Henan, so it is not worth coming to Beijing for such a mild disease. Otherwise, the patient will get better faster with some oral Chinese medicine, and there is no way to take the medicine because you cannot see the patient in person. In addition, it should be clear whether it is really “wandering”, “wandering” means that a place first got this kind of phlebitis, a few days later got well, and other unrelated parts of the same phlebitis, if so, the situation is complicated, may be some other complicated disease. From your description, it should not be “wandering”. Patient: Dr. Ju, after reading your diagnosis, our family is relieved and we would like to express our most sincere thanks to you. Okay, we plan to go to the local Chinese medicine hospital for further treatment, and apply some of your recommended herbs externally first, and then consult and consult you again when we have good results. Once again, I would like to express my gratitude to Dr. Ju for your kindness and virtue. I wish you happy work and good health for your family. Beijing Dongzhimen Hospital Peripheral Vascular Department, Dr. Ju: Wish you a speedy recovery Patient: Hello Dr. Ju, I had a “right lower extremity venogram” done at the local hospital this morning. The contrast was seen: the superficial veins of the lower limb were blocked with a hemostatic bag, and the examination table was placed at 30 degrees after pushing 50ml of Osu through the right dorsal foot vein, and the right tibial and peroneal veins were seen to be filled, and the superficial veins were seen to have increased tortuosity, and the contrast was returned through the widened saphenous vein. The right femoral vein valve was poorly visualized in the Wachs test, and the contrast medium regurgitated through the femoral vein and saphenous vein. Right skeletal vein reflux is possible. Opinion: 1. right lower extremity venous varices 2. right lower extremity deep venous valve insufficiency. After taking that imaging test and looking for a doctor, the doctor diagnosed the following: superficial venous tortuosity below the right lower knee, 1 square meter of gangrene in the inner third of the right leg in the form of a gangrenous area of the superficial veins of the lower leg with tortuosity and dilatation. 1 m venous valve insufficiency. Diagnosis of the disease was: superficial phlebitis. Boundary vein valvulopathy in the right leg. Conclusion: control of infection and surgical treatment. The doctor said about 15-20 days from surgery to discharge. I hope you will take a look at how we are doing at the moment and I look forward to your reply and thank you for your hard work. Beijing Dongzhimen Hospital, Peripheral Vascular Department, Ju Shang: I wonder what kind of surgery is to be done? According to my experience, if the surgery is done, it is better to deal with the femoral vein valve at the same time, if the saphenous vein surgery alone is not effective. Of course this is just a personal opinion. Patient: Hi Dr. Joo, we don’t know what kind of surgery, and the local doctor didn’t say anything about it. I have sent you the pictures (two) of the patient’s angiogram. I would like to ask you to take a look at them in your busy schedule to see if it is necessary to operate, if it is necessary to go to your hospital for the operation, and if so, when is the right time to go to Beijing? Thank you very much for your help again. I don’t know if the ankle band is not tied tightly or not. If it is tied tightly, the superficial veins of the calf should not be shown. In your angiogram, there are 2 possibilities: 1) the band is not tied tightly; 2) there is a traffic branch on the ankle. If the band is not tied tightly, you need to redo the imaging; if there is a traffic branch, you need to connect the traffic branch surgically, otherwise it will recur. So the procedure I recommend is: high saphenous vein ligation + traffic branch ligation + femoral vein annuloplasty + saphenous vein stripping (we use laser instead of stripping here). The surgery sounds complicated, but it is not difficult and you don’t need to come to Beijing to have it done. Before doing the surgery, you should talk to your local doctor in detail and give your full trust, because after all, I have not seen the patient here, so without first-hand information, I do not have enough say, and the specific operation should be based on the recommendation of the local doctor. Thank you for your trust and feel free to contact me if you have any questions. If there are no special circumstances, I will take a little time every night to answer questions online. Beijing Dongzhimen Hospital Peripheral Vascular Department: I don’t know why I lost my reply a few days ago, so I have to write it again: Normally, you can’t see the tortuous vein mass in the calf with this imaging because the ankle is tied with a tourniquet (from the film you sent me, it looks like it is indeed tied with a tourniquet), so you should only see the deep veins. But on your film, all the superficial varicose veins in the calf are visible, which means there are two possibilities: 1) the tourniquet is loosely tied; 2) there is a diseased traffic branch in the calf. So my recommended surgery is: high saphenous vein ligation + traffic branch ligation + saphenous vein stripping + femoral vein annuloplasty. This is only my personal opinion, the specific procedure should be based on the recommendation of the local receiving doctor, because after all, I have not seen the patient in person, so I have no say without first-hand information. The surgery is not very difficult and does not have to be done in Beijing. If you are willing to come to me, you are welcome. Patient: Hello, Dr. Ju, I would like to thank you again for your reply. I have a question for you: If I come to your hospital for this surgery, how much will the surgery and hospitalization cost in total? How long will it take in Beijing? Thank you very much. Beijing Dongzhimen Hospital Peripheral Vascular Department: The total hospitalization cost is about 8,000 RMB, and if you need to redo the imaging, it will cost an additional 1,000 RMB. The hospital stay is about 7-10 days. If you are coming to Beijing, be sure to bring as many previous test results as possible to reduce the number of duplicate tests.