Objective: The aim of the present study is to compare a mini-invasive (smaller than 2-cm incision) sapheno-femoral high-tie by clip apposition (HT group) with a traditional high-ligation by ligature (HL group). Methods: One hundred fifty chronic venous disease patients were included in group HT and compared with 150 cases constituting the group HL. The main outcome was the sonographic detection of saphenous trunk recurrences. Procedural pain, esthetic satisfaction, and disease specific quality of life were assessed. Results: At 4.5 ± 2.4 years follow-up, 8 cases (5.3%) of Great Saphenous Vein reflux reappearance were reported in group HT vs. 19 cases (12.6%) (odds ratio: 2.6; 95% confidence interval: 1.1–6.1; P = 0.04) of group HL. Esthetic satisfaction was scored as high and very high in group HT and HL, respectively (P <.0001). Conclusions: Proper high-ligation technique provides satisfying outcomes both in terms of recurrence rate and patient esthetic satisfaction. The different outcomes obtained by the two groups encourage further investigations regarding recurrence pathogenesis.