Introduction: The ESCHAR study showed that superficial venous surgery reduced the recurrence rate compared with compression therapy only. Ulcer recurrence rates after endovenous laser (EVL) treatment for superficial venous insufficiency seem comparable, but so far only small groups and shorter follow up times have been reported. The aim of this study was to investigate long term treatment outcomes of patients with venous ulcers treated with EVL in a larger population, in ordinary clinical practice without dedicated ulcer care. Methods: One hundred and ninety seven consecutive patients previously treated with EVL for a healed or open venous ulcer were invited to follow up including clinical examination, quality of life score using EQ5D, Duplex, ankle brachial index, venous refilling time (RT) and pump volume measured with PPG. Risk factors for non-healing and/or recurrence were calculated using chi-square to compare proportions and logistic regression. Results: 197 patients have been examined after a mean follow up time of 41 months. After EVL further ulcer treatment and compression was carried out mostly in primary care. Details of post-operative treatment were not possible to retrieve. 165 patients had healed ulcers (Group 1) without recurrence during follow up, 32 patients never healed or had a recurrence after EVL (Group 2). The mean age was 62.7 years for group 1 and 64,2 for group 2 (NS). The number of women/men was 99/66 in group 1 and 14/18 in group 2 (NS). Significant risk factors for non-healing and or recurrence were reduced ankle mobility (p = .009), perforating vein insufficiency (PVI) in the ulcer area (p = .007), popliteal and crural vein insufficiency (p = .016 and .000 respectively) and shortened RT (p = .016). There was a greater proportion in group 2 with previous deep venous thrombosis, diabetes, remnant varicose veins (VV) in ulcer area, and they had lower QoL, but no significance was reached. Other non-significant risk factors were cardiovascular disease, previous VV surgery, smoking, C5 or C6 at EVL, skin disease and remnant VV outside ulcer area. Conclusion: Endovenous laser ablation treating patients with venous ulcers in ordinary clinical practice confers long-term healing in a majority. Non-healing and recurrence was associated with reduced ankle mobility, deep and perforating vein insufficiency and shortened RT. It may be speculated that healing rates can be further improved with a more dedicated ulcer care and follow up post-operatively.