Background: Endovenous procedures have been proven effective in treating axial vein reflux. This report describes a new application, namely endovenous laser therapy of the incompetent perforating vein of the leg. Objective: To explore an alternative option for treatment of incompetent perforating vein of the leg. Methods & materials: An 80-year-old male underwent ultrasound-guided sclerotherapy of the neovascularization vessels at the groin and the refluxing vein of the left thigh. Endovenous laser therapy of the incompetent perforating vein was then performed to treat a persisting incompetency of the posterior tibial perforating vein (Cockett's perforating vein). Results: Follow-up duplex scan showed that not only was the tributary vein (run-off vein) thrombosed, but the perforating vein itself was thrombosed with an intact posterior tibial vein at one-week, three-week, and 12-week follow-up examinations. The only complication was a slight erythematous change of the overlying skin, which subsided spontaneously. Conclusions: There are many options in the treatment of incompetent perforating vein of the leg. An endovenous procedure should be considered as one of the options, especially where tissue around the incompetent perforating vein of the leg is compromised.