Venous leg ulcers (VLUs) are common and costly to both the healthcare system and patients. They form a significant part of the burden of wounds within the UK. Strong compression promptly applied will heal the VLU but treating the superficial venous reflux may lead to faster healing. Patients with a VLU should be considered for referral to vascular services for assessment and intervention of the underlying problem. Venous intervention is a low risk, minimally invasive procedure performed under local anaesthetic that should be suitable for most patients. However, some groups of patients require special consideration and may be deferred instead of referred. For these patients, it may be more appropriate to optimise conservative treatment.