Ligation (lye-GAY-shuhn) and stripping is a surgical procedure that's typically used on larger varicose veins. An upper incision is made, usually just below the groin, and a thin, wire-like instrument is inserted into the vein and threaded downward. Depending on the location and length of the vein to be removed, the lower incision may be made in the ankle or behind the knee. Ligation means tying. The unwanted vein is tied off at a point above the swollen section, then severed. The wire, along with the vein, is pulled out through the bottom incision. Sutures are used to close the incisions. Vein stripping may be performed with either local or general anesthesia and is often done as an outpatient surgery. Circulation isn't impaired by removal of the vein, because the blood shifts to other, healthier veins. In fact, because varicose veins have sluggish blood flow, such operations may actually improve circulation in the legs. While an effective treatment for advanced varicose veins, stripping results in more scarring than techniques like sclerotherapy (sklair-oh-THAIR-uh-pee), or injection, and phlebectomy (fluh-BEHK-toh-mee), in which a series of micro-incisions are used.