Surgery under local and/or general anesthesia is still utilized but in few cases only where other modalities of treatment are not feasible or appropriate.

The prior vein stripping surgeries under general anesthesia were replace d in large part by the availability of less invasive outpatient based modalities such as endovenous laser and radiofrequency type ablations. The stripping procedure in particular, was associated with significant post-operative risks of pain, bruising, bleeding and damage to nerves and lymphatic tissues leading to more morbidity than justifies the procedure any more. Phlebologists doo use a technique called micro-phlebectomy to extract large varicose veins through the skin under local anesthesia using a hook and forceps extraction technique (office based procedure). This is a very elegant adjunctive technique to complement laser or radiofrequency vein ablation.