Abstract: Objective To investigate the safety and efficacy of different surgical sequences in the ultrasound-guided endovenous microwave ablation combined with foam sclerotherapy for the treatment of primary great saphenous varicose veins.Method A total of 80 patients with great saphenous varicose vein admitted in the affiliated hospital of Jiangsu University，from January 2022 to January 2023 were selected.Patients were divided into observation group and control group according to different operation order, with 40 cases in each group.The control group was treated with ultrasound-guided microwave ablation of the main saphenous vein was performed first,followed by superficial calf vein foam sclerotherapy injection and local small incision point extraction,and the observation group was treated with superficial calf vein foam sclerotherapy injection and local small incision point extraction first,followed by ultrasound-guided microwave ablation of the main saphenous vein was performed.Perioperative relevant indicators at the 1st week of the two groups were counted,and the incidence of hematoma,ecchymosis,induration,skin burn,thrombotic superficial phlebitis,and endovenous heat induced thrombosis at the 1st week after surgery.The venous clinical severity score and chronic venous insufficiency quality of life at the 3rd and 6th month after surgery were compared between the two groups.VCSS and CIVIQ were used to evaluate the postoperative recovery of patients with varicose veins.Six months after the operation,the recurrence rate of great saphenous vein was compared by color Doppler ultrasonography.Result The operation time of the two groups was (68.13±3.34）min and（66.83±3.19）min,respectively.The intraoperative blood loss was (15.35±2.63) ml and (14.83±2.66) ml, respectively.The underground activity time was (14.35±3.34) hours and (13.60±2.63) hours, respectively.The length of hospitalization was (2.93±0.52) days and (3.15±0.61) days, respectively.There was statistical significance between the two groups (P<0.05).The preoperative VCSS of the two groups were 4.08±1.37 and 4.23±1.33, respectively,3 months after surgery were 3.00±0.59 and 3.03±0.61, respectively,and 6 months after surgery were 2.20±1.17 and 2.35±0.96, respectively.The preoperative CIVIQ of the two groups were 79.63±5.41 and 80.03±7.44,respectively,3 months after operation was 69.90±2.98 and 70.43±3.55, respectively,the 6-month CIVIQ was 59.05±3.79 and 58.00±4.66, respectively.There was no statistical significance between the two groups (P>0.05).The incidence of adverse events [hematoma (0 vs 0),ecchymosis (12.5% vs 15.0%),sclerosis (10.0% vs 7.5%),skin burns (0 vs 0),thrombosed superficial phlebitis (12.5% vs 17.5%),and thermal ablation-induced thrombosis (10.0% vs 5.0%)] in the patients of the two groups in the 1-week period after the procedure were compared,and the difference were statistically non-significant (P>0.05).Comparison of trunk recanalisation rate (5.0% vs 2.5%) at 6 months after surgery,the difference was not statistically significant (P>0.05).Conclusion There is no significant difference in the efficacy of the two procedures in the treatment of primary saphenous varicose veins,with a high degree of safety,both of which are worthy of clinical promotion.

Key words: microwave ablation；ultrasound；foam sclerotherapy；great saphenous varicose veins