The report was intended to provide a distillation of the evidence on the current status of surgical techniques for deep venous incompetence in order to inform Health Ministry decisions regarding the reimbursement policy for such surgery within the province of Alberta. [...] Pathogenesis of chronic venous insufficiency The venous system of the lower limb comprises the parallel networks of the superficial venous system, which drains the microcirculation of the skin, and the deep venous system, which drains the muscles and muscular venous sinuses 9, 10. [...] Movement of blood up the leg veins toward the heart is achieved via the action of the calf muscle pump and, to a lesser extent, the thigh and foot pumps 1, 3. Valves positioned along the length of the veins prevent the backward flow of blood during muscle relaxation 10. [...] In primary CVI, abnormalities of the venous wall and the valves, in the absence of previous thrombosis, are the cause of valvular incompetence. [...] For patients with primary CVI and reflux or incompetence in the superficial, deep and perforating systems, ligation of the superficial and perforating veins improves the hemodynamics of the limb 18 by interrupting the transmission of the high pressure in the deep venous to the skin and subcutaneous tissues 16, 18, 26.