Objective: To compare the efficacy of endovenous microwave ablation (EMA) and conventional stripping operation for primary lower limb varicosities. Methods: The clinical data of 170 patients with primary lower limb varicosities were retrospectively analyzed. Of the patients, 110 cases underwent high ligation of the great saphenous vein plus EMA treatment (EMA group), while, the other 60 cases were subjected to the conventional procedure (conventional group). The clinical variables that included operative time, intraoperative blood loss, time to ambulation, length of postoperative hospital stay, complications and clinical efficacy between the two groups were compared. Results: Compared with conventional group, the operative time, intraoperative blood loss, time to ambulation, length of postoperative hospital stay, and incidence of postoperative complications (skin burns, subcutaneous extravasation of blood, poor wound healing and localized paresthesia) in EMA group were reduced, and all differences had statistical significance (all P<0.05). There was no statistical difference with regard to the incidence of postoperative deep venous thrombosis and clinical efficacy (local recurrence, and pigmentation) between the two groups (all P>0.05). Conclusion: High ligation plus EMA for primary lower limb varicosities effectively combines the advantages of both conventional operation and microwave therapy. It is minimally invasive, safe, and effective.