Venous surgery prescribed to the patients receiving anticoagulation therapy for the treatment of atrial fibrillation especially with the use of warfarin is considered to constitute a serious challenge due to the increased risk of the development of venous thromboembolism and other hemorrhagic complications in case of withdrawal of the anticoagulant. A clinical case of successful perioperative management of the patient with varicose veins with the use of long-term warfarin therapy for the management of atrial fibrillation is presented. Several surgical clinics refused to treat the patient on a regular basis on the ground of impracticability of any invasive procedures because of the patient’s condition taking into consideration the involuntary intake of the anticoagulation agent and the concomitant cardiac pathology. We performed the primary clinical examination and duplex ultrasound study of the patient who was found to have varicose veins in right lower extremity (C2, 3S, Ep, As, p, Pr2,18, LII) with the international normalized ratio (INR) being 3,64. We confirmed the indication for the surgical treatment and offered the patient high ligation, stripping and phlebectomy. Prior to surgery, the patient was switched to a subcutaneous injection of enoxaparin. After reducing INR down to less the 2.0, we performed surgery under spinal anesthesia. The anticoagulation treatment was restarted 12 hours after the operation. No complications was documented within the first weeks after the intervention. The patient was switched back to warfarin therapy.