Until recently, vein ligation and stripping was the standard for treating venous reflux in larger varicose veins. These veins are treated by making an incision over the vein and tying off the vein. If the majority of the valves in the vein are healthy, ligation can be used to isolate the faulty valves and the remaining vein may be left in place to continue circulating blood. If the vein is heavily damaged it is usually removed, or stripped. To strip a vein, incisions are made at the groin and near the knee and the vein is grasped and removed. Most people are able to return to their normal daily and recreational activities within a few weeks.

Vein ligation and stripping is effective in producing positive long-term results in 85% of people. Some common side effects from vein stripping and ligation surgery may include temporary pain or discomfort, bruising, hematoma, numbness, and less frequently wound infection.

Vein stripping is an invasive procedure and should not be performed on older individuals for whom surgery poses a risk due to other medical conditions. It is also not an appropriate choice for people who have circulatory problems of the legs, skin infections, blood-clotting defects or an abnormal passageway between and artery and vein. Pregnant women are also inappropriate candidates for vein stripping.