The venous surgery was born at the beginning of the last century and is still practiced today even if only rarely and in very special cases. It passed through various stages: from total and radical saphenectomy and under general anesthesia and hospitalization of a week of the 1960s to crossectomy and short stripping surgery for invagination under local anesthesia and surgery of 2000 when the more delicate mini-invasive, endovascular methods and in any case of equal if not better result have marked its slow decline.
The surgery of the sapheno-femoral has represented the first surgical time of saphenectomy for more than a century with a rate of relapse upwards (20-50%) for non-closure of the saphenous vein near the femoral vein. The persistence of a stump of saphenous veins is probably the biggest source of inguinal relapse and its treatment is still the object of discussion. The various tested methods (liquid sclerotherapy or with foam, laser, direct surgery) does not give satisfactory results (only 60-80%) and the method with side access according A.K.Li represents the safest choice.
The endovascular methods begin in 1999 and are currently very numerous, but those more experienced and with an observation period of more than fifteen years are: the laser and radio-frequency named thermal treatments since they act within the vein by creating intense heat. They represent the modern evolution of the now obsolete "open" surgery and are recommended by the national and international guidelines as a first choice in the treatment of superficial chronic venous insufficiency. The laser acts by means of a fiber of 400-600 micron which is inserted into the saphenous vein to the height of the knee under ultrasound guide and guided up to the groin. By withdrawing the fiber, the laser light which is emitted develops energy- heat which closes quickly and safely the vein in the predetermined length. It is appreciated for the lack of surgical wounds for its simplicity and because it is minimally invasive.
