The aim of our study was to report our experience with endovenous laser treatment (EVLT), initiated with an exclusively US-guided approach, but then combined with a surgical approach. Over the period from September 2003 to December 2005 in the Sondrio Hospital General Surgery Unit 61 patients were submitted to EVLT. In the first 13 cases the procedure was performed under ultrasonographic guidance, whereas later we opted for a combined technique in which the use of the laser was preceded by high ligation of the saphenous vein ("crossectomy") together with complete sectioning of the venous collaterals (48 cases). We observed no complications related to the saphenous vein ligation, whilst EVLT proved safe and easy to perform. Considering successful EVLT as ultrasonographically documented absence of flow in the saphenous vein, a statistically significant difference (p < 0.01) was found between the patients treated using the combined strategy (absence of flow in 92.0% of cases) and those treated with EVLT alone (absence of flow in 54.6% of cases). If EVLT is combined with high ligation of the saphenous vein, it is easier to obtain complete sclerosis of the saphenous trunk, avoiding possible recurrences, amongst other things thanks to the ligation of all the collateral veins that flow into the cross. Moreover, particular selection of patients to be submitted to EVLT proves less necessary, thus substantially increasing the indications for the procedure.