Venous leg ulceration (VLU) is the endpoint of the continuum of chronic venous disease. Traditional management of these ulcers has been conservative with the use of compression therapy, in the absence of good research evidence to support interventional management of the underlying superficial venous disease. This article provides a narrative literature review of the evidence from contemporary research to evaluate the effectiveness and efficacy of intervention for venous ulceration. It explains the link between varicose veins and leg ulceration and advocates the need for a more timely and assertive approach with regard to the management of patients with venous leg ulcers, to ensure that patients have access to timely, equitable and efficient care.