Objective: To compare conventional surgery and ultrasound guided foam sclerotherapy for primary superficial venous insufficiency(SVI) with respect to obliteration of superficial venous system, clinical outcome and cost. Methods: The study was conducted between September 2005 and March 2006, in Surgery department of Christian Medical College Hospital, Vellore. All patients with symptomatic primary venous insufficiency of lower limbs requiring definitive management were randomized to conventional surgery (n = 30) or ultrasound guided foam scleretherapy (n = 30). Obliteration of superficial venous system at 3 months, clinical outcome and costs were registered. Results: Superficial venous system was obliterated in all the patients of both the groups at 3 months. Improvement in clinical scores and complication rates was similar in both the groups. The foam scleretherapy group had less analgesic requirement, earlier return to work and lower cost. Conclusion: Foam sclerotherapy is a cheaper alternative to surgery for primary venous insufficiency with respect to early measures of clinical outcome.