Last week, I returned to my hometown to spend a few days with my mother. It also gave me a rare chance to step back from the intensity of daily clinical work and slow down a little.
During that break, I reviewed a large number of second-opinion teleconsultation cases from both China and overseas. As I looked back over them, I became aware of a striking pattern that kept repeating itself across countries: most patients assumed, without exception, that the bulging, twisted veins they could actually see on their legs—the visible tributary varicosities—would be directly “removed” by the laser, radiofrequency, or medical glue their doctors had proposed.
With a bit more time than usual, I also began systematically reviewing the websites of varicose vein clinics and hospitals in the countries where these patients were being treated. I compared not only their treatment pathways, but also the way they explained those treatments to the public. As I connected these pieces, one long-standing but rarely confronted problem became increasingly clear. And frankly, it was more serious than I had expected.
If you read the websites of many well-known vein centers abroad, you will almost never find a clear statement telling patients something like this: laser treats the saphenous trunk, but the bulging veins you care about most are often not the direct target of that technology. That silence may not always be accidental. It is hard not to wonder whether, at least in part, it reflects a marketing logic. Many institutions understand that patients are buying the promise of “minimally invasive” and “high-tech” treatment. If they openly explained that visible tributary veins may still need manual phlebectomy, multiple tiny incisions, or sclerotherapy injections, the premium aura of these so-called advanced technologies would immediately lose some of its shine.
Most patients do not come to consultation with a detailed understanding of venous anatomy. Endovenous laser ablation, radiofrequency ablation, and medical adhesive closure do have a real role, but their true arena is the relatively straight saphenous trunk hidden beneath the skin—not the superficial, tortuous, bulging varicose branches that patients see every day in the mirror. These technologies depend on catheters or fibers passing smoothly through a vein. They are designed for deeper, more linear trunks, not for twisted superficial tributaries. The visible varicosities on the lower leg are often too tortuous for a catheter to navigate and too close to the skin for heat-based treatment to be ideal. For those obvious surface veins, treatment still often relies on the oldest methods in the field: sclerotherapy or phlebectomy through small incisions.
So why are these details so often softened or blurred in consultation? The answer likely lies in a mixture of commercial incentives, procedural efficiency, and the limitations of medical communication itself. This is not just a phenomenon in mainland China. It can also be seen across Europe, North America, and Australia. Laser, radiofrequency, and glue are often presented as if they were one elegant puncture-based solution to the entire problem of varicose veins. In reality, some physicians may worry that if they openly explain that, after treating the trunk, they still need hooks, mini-incisions, manual removal, or chemical injections to deal with the visible branches, the futuristic image of the procedure will collapse instantly.
In some settings, that vagueness may also help preserve the high commercial value of expensive disposables. Patients are encouraged to feel they are paying for a sophisticated, one-step technological solution, rather than for a combined treatment in which traditional methods still play a major role. That is precisely why this issue deserves to be discussed more openly.
The reality we need to face is simple: in the vast majority of real-world cases, if the great saphenous vein trunk is closed with laser, radiofrequency, or glue, the bulging tributary varicosities still need to be managed separately, usually with sclerotherapy or phlebectomy. This has never been a secret at the professional level. It is present in guidelines, and it is present in the literature. What is missing is not knowledge, but transparency in how that knowledge is presented to patients.
This simplification does not happen only in doctor-patient communication. A similar distortion can also be found in many published studies. Strictly speaking, many papers on the “safety and efficacy” of laser, radiofrequency, or glue closure do not fully present the fact that multiple interventions are often used in the same treatment course. In real practice, while the saphenous trunk is being treated endovenously, the tributary veins may already be undergoing sclerotherapy or microphlebectomy, either during the same session or in a staged manner. Yet in many papers, these tributary procedures are not analyzed as core variables. As a result, what is really a combined treatment outcome is often described as if it were the outcome of a single technology.
This is not just a minor wording issue. It is a methodological attribution problem. Tributary treatment contributes to the result, but is often absent from the explanation of that result. Over time, this creates a misleading impression: readers may come to believe that the improvement comes mainly from the endovenous technology itself, while the real contribution of the additional steps is left in the background.
Patients have a right to know what is actually being done to their bodies. Technology can continue to advance, and that is welcome. But one principle should not change: if a treatment is carried out through multiple steps, those steps should be explained honestly and completely. Patients do not need to master every anatomical detail. But they do deserve to know what is really treating the veins they can see, what is treating the refluxing trunk they cannot see, and how the final result is actually being achieved.
That is not a matter of marketing. It is a matter of informed consent.
