Our current knowledge of the natural history of venous disease suggests that congenital venous valve insufficiency and left iliac vein compression predispose to later deep vein thrombosis (DVT) and pulmonary embolism. Available longitudinal studies are, however, inadequate to justify prophylactic treatment of these conditions at the present time. Furthermore, our knowledge of the natural history of acute venous thrombosis, of which venous valves are critical, and of the sequelae of ileofemoral venous thrombosis is also inadequate. Finally, the long‐term results of venous reconstructive surgery are still not known. For this reason, long‐term studies of large patient cohorts for each of these areas will be necessary. Nevertheless, I believe future treatment of venous disease will include earlier widespread DVT prophylaxis using both medical and surgical methods, more effective and complete thrombolysis, earlier surgery, and the use of new reconstructive surgical methods. Early identification of patients at high risk prior to their disease, followed by selective diagnostic separation of patients with significant obstruction and/or insufficiency and the availability of long‐lasting surgical procedures that can be offered with low morbidity will justify earlier and more widespread prophylactic therapy.