Ambulatory Phlebectomy: sixty-year-old but still looking great

Ambulatory Phlebectomy (AP), conceived by Robert Muller starting from 1956, initially considered with great scepticism, became completely accepted and employed at the end of the XX century. AP may be employed in three strategic perspectives related to the Saphenous Veins (SV) situation: - In the course of SV stem incompetence treatment, either as a concomitant or a staged treatment of dilated tributaries. Both positions seem to have valid (different) reasons. - As a first step avoiding SV incompetence treatment, as in CHIVA or in ASVAL methods, although with different hemodynamic bases. - As an isolated procedure when SV is not involved. AP is a simple technique, easily office based, effective and safe, provided basic rules are followed (local anaesthesia, US assessment, correct mapping, small incisions, no sutures, post-op. compression); however, it is highly related to manual skill (together with patience, concentration and delicate touch), results depending heavily on details and less on routine.