Is surgery or conservative treatment better for early varicose veins of the lower extremities?

The incidence of varicose veins in the lower extremities is about 7% in the population. The main mechanism of varicose veins in the lower limbs is the incomplete closure of the valves of the great saphenous vein into the deep veins, which leads to the backflow of blood and increases the pressure in the veins, and this results in the dilatation and distortion of the veins, which is known as varicose veins. Varicose veins tend to occur first in low lying areas such as the calves. Varicose veins can develop for several years or even more than a decade without any obvious clinical symptoms. But this does not mean that varicose veins are harmless. When the disease progresses to a certain level, complications such as thrombosis in the veins, aseptic inflammation (phlebitis), hyperpigmentation, ulceration, stasis dermatitis, rupture and hemorrhage can occur. In the past, the idea was that asymptomatic varicose veins or elderly patients could be treated first with conservative treatment, including medication or compression stockings. This view is somewhat universal and is based on the considerations of high trauma of surgery, heavy economic burden, and the risk of surgery for patients of advanced age, which is also somewhat justified. However, medicine has evolved to the point where the answer to the question, "Is it better to treat varicose veins early with surgery or first with conservative treatment?" has changed dramatically. The answer to this question has changed subtly. More and more patients with varicose veins are opting for early minimally invasive surgery. First of all, medications and compression stockings, as the mainstay of conservative treatment of varicose veins, can only slow down the progression of the disease but cannot treat the root cause of varicose veins. Therefore, drugs can only be used as an adjunctive treatment after surgery for varicose veins of the lower extremities. Although compression stockings are effective, they need to be worn for life and are cumbersome and costly. Most patients who initially wear compression stockings eventually opt for surgery. Then. Since surgery is still needed, the time and effort spent on conservative treatment is wasted. Advances in medicine have also made surgery for varicose veins of the lower limbs increasingly minimally invasive. The use of minimally invasive surgery has reduced what used to be a week-long hospital stay to less than two days, and even a few hours at WorldPathClinic International in Shanghai. However, minimally invasive surgery is only suitable for early varicose veins. One of the consequences of the development of varicose veins is that, as blood from the deep veins flows back into the opening of the diseased saphenous vein and then backs up into the superficial venous system, an ineffective circulation is formed, aggravating the burden on the deep veins, which over time leads to, or exacerbates, the degree of deep vein valvulopathy. The severity of the lesions in the deep veins is an important factor in the chance of recurrence after varicose vein surgery. Once the condition reaches the point of venous thrombophlebitis, edema, hyperpigmentation, stasis dermatitis, or ulcers, the effectiveness of the surgery is greatly diminished. For example, surgery does not eliminate the darkening of the skin, surgery is very ineffective for edema, and surgery is less than 80% effective for stasis dermatitis. Phlebitis also takes a long time to subside. In elderly patients, the general condition of the body deteriorates with age. If minimally invasive surgery is not performed at an early stage and complications from varicose veins occur later, they are often untreatable because they cannot tolerate surgery. Therefore, in order to avoid these complications, the best option is to have early surgery to resolve varicose veins before complications arise. To summarize, the drawbacks of conservative treatment of varicose veins are: (1) side effects of medications; (2) the use of compression stockings reduces the quality of life (e.g., too hot in summer, laborious to wear, need to buy new stockings every 6 months) (3) there is a risk of progression of the disease and loss of the opportunity to opt for minimally invasive surgery. (4) Significantly higher rates of surgical recurrence and failure in the event of complications. (4) Loss of the purpose of post-surgical leg aesthetics. Although varicose vein surgery has a certain recurrence rate, even if recurrence occurs, it is much better than having complications without surgery. However, most recurrences are related to the clinical experience and skill of the surgeon. Therefore, it is a prerequisite to choose an experienced vascular surgeon to perform the procedure.