Varicose veins have probably been around as man has walked the earth. Hippocrates observed the relationship between veins and leg ulceration more than 2000 years ago. He wrote about treating them with cauterization as early as 400 BC. There is a stone tablet from 400 BC,  in a museum in Greece depicting a leg with varicose veins.

Compression therapy dates back to the Romans. Soldiers wrapped their legs with leather straps to minimize fatigue during long marches.

The first known report of sclerotherapy was by a Swiss doctor in the late 1600's. However, injections did not become common until the invention of the hypodermic needle in 1845. Sclerotherapy of veins began to gain acceptance in the early 1900's. While initially popular especially in Europe, sclerotherapy's enthusiasm was starting to wane.  This was partly because sclerotherapy did not always effectively deal with the underlying valve failure that is such an important part of vein disease.  Also early sclerotherapy agents were prone to complications of skin ulceration and staining of the skin.

In 1947 the French Phlebology Society was founded. What was to become the American College of Phlebology was founded  in 1986. Surgical procedures of "modern day" had to await Harvey's description of the structure and function of venous valves in the circulatory system in his 1628 book De Moto Cordis. There were some early surgical procedures being carried out notably Trendelenberg who described ligation (tying off) the great saphenous vein, the but it wasn't until the early 1900s when Keller and Mayo did the first stripping of the great saphenous vein. By the 1930's incompetent perforator veins were being treated by ligation.

For over 50 years there was little progress in the diagnosis and treatment of  varicose veins. The last 10 years have been exciting for the field of phlebology. They have brought the use of ultrasound as a diagnostic tool. With ultrasound veins that are refluxing (incompetent) can be visualized. Thus the entire leg can be "mapped out" and the appropriate interventions carried out. Prior to ultrasound, vein surgery could be likened to doing orthopedic surgery without an x-ray. In fact, today an ultrasound exam is the standard of care prior to treating someone's varicose veins.

The last decade has seen the introduction of lasers to veins both on the skin and in the fat or subcutaneous tissues. We have also seen newer sclerosing agents and techniques such an microfoam injection which will explore in subsequent chapters. Treatment of vein disorders has become more "mainstream" thanks to organizations like the American College of Phlebology. Most recently the American Board of Phlebology was created and in 2008 the first Board Certification exam was held.