Varicose veins are a common problem, and yet there is divergent opinion as to whether surgery or sclerotherapy is the preferred method of treatment. After establishing a reliable injection technique, the method was compared with standard surgical procedures in a random trial. The results showed that after one year 82% of unselected patients were cured by injection, but after six years the cure rate was only 7%. The surgical result was not as good at one year, but much better than injection after six years. When the results were considered for three distinct clinical groups, the analysis showed that the best primary treatment for dilated superficial veins and for incompetent perforating veins in the lower part of the legs was injection-compression. However, surgery was much more successful and long-lasting when there was involvement of the saphenous systems with proximal incompetence.