Background: The treatment of varicose veins is challenging, with public hospitals often facing long surgical wait times. Endovenous Microwave Ablation (EMA) and Radiofrequency Ablation (RFA) are outpatient options that can increase patient throughput without requiring inpatient admission. Purposes: This study aimed to compare the therapeutic efficacy and safety of EMA versus RFA in the treatment of primary varicose veins. Patients and methods: This prospective, randomized interventional study included 40 patients diagnosed with great saphenous vein (GSV) reflux. Patients were randomized into two groups (1:1) using a computer-generated randomization table: Group I (EMA, n=20) and Group II (RFA, n=20). Each patient underwent clinical assessment, hematological profiling, and duplex ultrasonography. Follow-up was conducted for 12 months post-procedure. Results: All patients had uneventful intraoperative courses. Spinal anesthesia was required by 85% in the EMA group and 75% in the RFA group. Mean operative times were 76.8 minutes for EMA and 69.1 minutes for RFA. No significant differences were observed in postoperative complications or recurrence rates between the groups over the 12-month follow-up period. Conclusions: Both EMA and RFA are safe and effective for treating primary varicose veins. EMA may offer advantages with fewer thermal-related complications and reduced short-term recurrence, indicating its potential as a preferred method in varicose vein management.