Background: Endovenous laser ablation (EVLA) is a well-established alternative to surgery in the treatment of truncal and perforating vein insufficiency. After the refluxing truncal or perforating vein is ablated, the remaining varicosities are removed with phlebectomy or alternatively treated with sclerotherapy. Sclerotherapy is traditionally performed with liquid agents, but foam sclerotherapy is becoming more popular. EVLA and concomitant ultrasound (US)-guided foam sclerotherapy are recent treatment methods alternative to surgery in the treatment of Lower Limbs Varicose Veins. Objective: To evaluate safety and efficacy of Concomitant endo venous LASER ablation of truncal veins and foam sclerotherapy in extratruncal veins in treatment of lower limbs varicose veins. Patients and Methods: This prospective randomized controlled study was conducted in the vascular surgery department at Al-Azhar university hospital-Damietta, in the period from septemper 2019 to May 2021 (20 months). The study included 50 patients, males were 22(44%) while females were 28(56%), Presented by primary varicose veins. In these 50 patients (60 legs; (bilateral in 10 patients), the incompetent veins were great saphenous vein, small saphenous vein, perforating veins, and a combination of these.  In all patients, after EVLA of the incompetent veins, foam sclerotherapy of extra truncal veins was performed for the remaining varicosities. We use foam sclerotherapy by lauromacrogol 400 (polidocanol) 3% by direct puncture or duplex guided. Results: Endovenous laser ablation was technically successful in all cases. Concomitant direct puncture foam sclerotherapy was also technically successful in all cases. During the follow-up, recanalization of the laser-ablated refluxing veins occurred in (8 %) and was treated with repeat EVLA or ultrasound-guided foam sclerotherapy (USGFS). Major complications occurred in 1-2 % of the treated legs and included skin necrosis and calf vein thrombosis. Conclusions: Endovenous laser ablation and concomitant foam sclerotherapy is feasible and effective. The procedures are associated with a low complication rate and can be performed in both legs in the same session. Concomitant use of laser and foam may potentially decrease the recanalization rate of laser-ablated vessels.