This a prospective study comparing subfascial endoscopic perforator surgery (SEPS) versus conservatie treatment in management of the clinical sequalae of CVI This study included 45 limbs in 39 patients (32 males and 7 females), 6 of them with bilateral diseases. All limbs were presented with active ulceration, C6 according to CEAP classification .The underlying pathophysiology was venous reflux affecting the superficial veins in 5 limbs , deep veins in 22 limbs ,both superficial and deep veins in 11 limbs and perforating veins in7 limbs .Patients were evaluated for their venous status by physical examination and duplex ultrasonography.Twelve limbs were treated conservatively, out of them 9 limbs (75%) showed initial ulcer healing, then ulcer recurrence was observed in 5 limbs (41%) while the remaining 4 ulcers showed complete healing. Non-healing of the ulcers was documented in 3 limbs (25%).Forty one limbs were treated surgically, 33 patients from the beginning plus 8 patients after failure of conservative treatment. SEPS were performed in all these limbs and additional surgery were performed in 18 limbs (stripping of great saphenous vein in 16 limbs and direct ligation of lateral perforators in 2 limbs). Ulcer healing was observed in 35 limb (85.4%), reduction in ulcer size by 50% in 2 limbs, non-healing of the ulcers in 3 ulcers (7.3%) and ulcer recurrence in one limb (2.4%). It is concluded that, SEPS is preferred to