Saphenous vein disconnection improves venous function and heals venous ulcers without compression bandaging if the deep veins are normal. This procedure under local anaesthetic may be particularly suitable for elderly patients, but long saphenous vein stripping should be added in young patients.

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We conclude that there is substantial agreement between colour-coded Duplex and arteriography of the lower limbs, and that the ability of colour-coded Duplex to plan and guide lower limb vascular interventions requires investigation.

Ambulatory venous pressure should be used to quantify venous insufficiency and remains the reference standard test of the venous calf muscle pump. The tourniquet test should not be used to select patients for surgery since it cannot distinguish deep from superficial venous incompetence. Venous reflux is best localised using Duplex ultrasound.