27 years ago I started my surgical internship at St. Luke's/Roosevelt Hospital Center at the St. Luke's site. Hard to believe how time flys! There have been so many changes in technology, procedures, training and how health care is delivered. In my specialty of Vascular Surgery, the greatest changes have been in the area of endovascular procedures which treats the abnormality of a blood vessel remotely using a catheter of some sort. In the world of vein care, the management of patients with varicose veins and chronic venous insufficiency has dramatically improved. There has been an increase in the understanding of the role of the venous valves of not only the deep veins of the leg but also the superficial and perforator veins in the causation of pain, swelling and even ulceration of the leg. 27 yrs ago, a patient was admitted the night before a painful stripping of the veins of the leg under general anesthesia through incisions from 1/4 of an inch to 3 inches and remained in the hospital overnight afterwards. People were often 6 weeks before they returned to normal function. Today, we achieve better results with an office based procedure in under 1 hr with local anesthesia and practically no pain. Patients return to work in a day or two. This procedure, known as the Venefit procedure has radically improved the quality of life of millions of patients around the world since its inception.