Introduction: Venous Leg Ulcers (VLUs) account for 69% of all leg ulcers and estimates 1% of the population with a prevalence that increases with age according Edinburgh study, which was a cross-sectional study of a random sample Objective: To compare the efficacy of compression +duplex guided injection sclerotherapy of incompetent perforators opposite compression alone in management of chronic VLUs. Methods: Patients (older than 18 years) attending at outpatient clinic of Vascular Surgery Department, Faculty of Medicine-Zagazig University, were invited to participate in our study. Conclusion: The compression therapy is important line in management of venous ulcers. This synergistic approach can improve quality of life through shortening time needed for compression therapy and rapid recovery for normal daily activity. Duplex-guided sclerotherapy is a minimal invasive procedure, compared to surgery, it avoids the need for general anesthesia, hospital admission and long recovery times and may be done in outpatienvt clinic. As absence of serious complications and its evident success, make this the first line managment for venous ulcer beside compression but we need larger number of patient and longer time for follow up to obtain good result.