OBJECTIVE: To compare the acceptability and outcome of primary varicose vein (VV) surgery (saphenofemoral or saphenopopliteal ligation/excision) under local anaesthesia (LA) with that of general anaesthesia (GA). METHODS: A non-randomized controlled trial of consecutive patients treated between April 2004 and March 2006 was performed. After complete informed consent individual patients were asked to select their preferred form of anaesthesia (LA or GA). Preoperative disease status and co-morbidities were recorded. Outcomes were assessed perioperatively and at six weeks and six months postoperatively using patient scoring systems including the Aberdeen varicose veins severity score (AVVSS). RESULTS: Seventy-two (LA 46[62%] and GA 26[38%]) patients participated; median (range) age was 48 (21-74) years versus 36 (21-59) years (P = 0.0164), respectively. All procedures were performed as day cases. Median postoperative pain scores for LA and GA did not differ at 12 hours (4 versus 4; P = 0.48) and four days (5 versus 6; P = 0.44). Median improvement in the AVVSS at six weeks and six months for LA and GA cohorts were 5.7 versus 6.1 (P = 0.875) and 6.5 versus 8.3 (P = 0.131), respectively. Overall patient satisfaction did not show any intergroup difference at six weeks. CONCLUSIONS: Surgical treatment of VV under LA can be performed safely with comparable results to GA in self-selected patients.