In vein centers that are staffed by surgeons that have the skill, ambulatory phlebectomy is a common procedure. In my practice, it is the preferred treatment for most varicose veins. “Ambulatory”, means that the patient walks to and from the procedure (i.e. no general anesthesia, no hospital admission). “Phlebectomy” means excision of veins. At VEINatlanta, ambulatory phlebectomy is performed in an office setting under local anesthesia. Tiny 1/8 inch slits are made in the skin to remove the vein. The patient can resume normal daily activity immediately. Usually there is no post-procedure discomfort. Ambulatory phlebectomy is not vein stripping. EVLT (endovenous laser therapy) and RF ablation (Venefit, Closure) have made vein stripping obsolete. In my practice, sclerotherapy is not used for bulging varicose veins, as it will cause the varicose vein to turn into a hard bulging cord. In most cases, EVLT or RF ablation is necessary to close the underlying “feeder” vein prior to performing ambulatory phlebectomy.