Lower extremity primary varicose veins (PVVs) can manifest as distended and tortuous veins as well as limb heaviness and swelling, and can be associated with skin changes and refractory ulcers at an advanced stage. PVVs is a multifactorial disease, and although valvular incompetence and venous hypertension are regarded to be the most common causes, the exact pathogenesis remains unclear. Various studies have suggested a potential genetic contribution. Recently, vascular remodeling has been recognized as a trigger factor for PVVs. The authors address the research progress of genes associated with vascular remodeling in PVVs.