Health care must be sustainable; a correct use of available resources entails careful and shared planning of what is really appropriate. Guidelines are often viewed as a defense mechanism for physicians because they are supported by national and international scientific consensus. There is a need for other instruments to support clinical decision making, especially in the Italian health system with limited resources and the need to implement services that really benefit the population. In order to create this list we gathered a Commission made up of Hospital and University based Vascular Surgeons. Other scientific societies that endorsed the list were the SICVE (Italian Society of Vascular and Endovascular Surgery), the SIAPV (Italian Society of Angiology and Vascular Pathology) and FNOMCEO (Italian Federation of Physicians, Surgeons and Dentist). Finally, the Board of the College of Directors of Vascular Surgery presented at the EXPOSALUTE meeting in Milan the fourth of October 2015 a list of nine procedures considered at risk of being inappropriate. Five of those were voted and listed herein.