Primary varicose veins are considered a common ailment in Western industrialized countries; only 20-50% of the population has healthy veins. In Germany, spending on venous diseases has nearly doubled in the last decade. The introduction of imaging techniques has fundamentally expanded diagnostic and, consequently, therapeutic options. The chances of success, particularly with surgical therapy, can now be assessed on an individual basis. A universally applicable foundation has been established with the theoretical concept of recirculation circuits. By classifying a specific disease pattern within the corresponding recirculation circuit, the minima and maxima of the surgical strategy are determined. The rich illustrations in the text clarify the concept.