Objective: To investigate the clinical efficacy and safety of ultrasound-guided local anesthesia for endovenous laser combined with sclerotherapy in the treatment of varicose great saphenous veins. Methods: A total of 53 patients with varicose great saphenous veins admitted to our hospital from December 2023 to June 2025 were selected and divided into a traditional surgery group (18 cases) and a laser combined with sclerotherapy group (35 cases) according to the surgical method. The venous clinical severity score (VCSS), chronic venous insufficiency quality of life questionnaire (CIVIQ) score, visual analog scale (VAS) score for pain, complication rate, surgical time, treatment cost, recovery time, and patient satisfaction were compared between the two groups at 1 week, 1 month, and 3 months postoperatively. Results: The VCSS scores of the laser group at each postoperative time point were lower than those of the traditional group, and the CIVIQ scores were higher than those of the traditional group (all p < 0.05). The incidence of complications in the laser group (8.57%), the VAS score at 24 hours postoperatively, the duration of pain, and the utilization rate of analgesic medications were all significantly lower than those in the conventional group (all p < 0.05). The laser group also demonstrated shorter operative and recovery times compared to the conventional group, along with higher patient satisfaction, albeit at a higher treatment cost (p < 0.05). Conclusion: Endovenous laser combined with sclerotherapy under ultrasound guidance for the treatment of great saphenous vein varicosis offers advantages such as minimal trauma, rapid recovery, mild pain, and fewer complications, demonstrating significant clinical efficacy and good safety, thus possessing high clinical application value.