Objective: To assess the clinical efficacy of endovenous laser therapy plus transilluminated powered phlebectomy (Trivex system) in treatment of severe varicose veins of lower limbs. Methods: The clinical data of 20 patients with severe primary varicose veins of the lower extremities (26 legs) treated from July 2012 to October 2013 were retrospectively analyzed. All patients underwent endovenous laser therapy combined with transilluminated powered phlebectomy. Results: Operation was successfully completed in all patients. After operation, the lower extremity varicose veins disappeared, the complications such as pigmentation, itching, eczema and skin ulcer were attenuated in different degrees; 4 cases developed subcutaneous ecchymosis and local swelling which in all cases disappeared within one month and one cases had the lateral crus swelling, which was eliminated by puncture aspiration of fluid and elastic bandage compression; 2 cases had numbness of extremity, which disappeared after 2 months, and in 2 cases funicular callus appeared along the main trunk of the great saphenous vein and the burning sites of varicose veins, accompanied by local mild-to-moderate pain, which gradually disappeared in 2 to 3 weeks. The average postoperative follow-up was 8 months, and no recurrence of varicose veins or evident scars in the legs was noted. Conclusion: Endovenous laser therapy in combination with transilluminated powered phlebectomy is effective in treatment of severe varicose veins of lower limbs, and meanwhile it has minimal invasiveness and better cosmetic results.