Varicose veins of the lower extremities with severe varicose syndrome are the most unfavorable course of disease, and surgeons face many challenges. Traditional miniphlebectomy in combined treatment of such patients is technically complex and not always justified. Total endovascular laser ablation in patients with «giant vein syndrome» avoids traumatic manipulations and minimizes intraoperative blood loss and postoperative complications. Modern laser equipment and positive available experience allow us to recommend this technique for wider practice.