ConditionHeart & circulation
Venous Insufficiency (Chronic Venous Insufficiency)
Chronic venous insufficiency (CVI) happens when the veins in the legs cannot return blood to the heart efficiently, usually because their one-way valves are damaged or a past blood clot has scarred them. Blood pools in the lower legs, causing swelling, heaviness, aching, varicose veins, itchy discolored skin and eventually leg ulcers. It is common, especially with age, pregnancy and obesity. Compression, leg elevation, exercise and minimally invasive vein procedures relieve symptoms and help ulcers heal.
Also called: Chronic venous insufficiency, CVI, chronic venous disease, venous reflux, venous stasis
At a glance
- What it is
- Poor blood return from the leg veins due to faulty valves or blocked veins.
- Symptoms
- Swelling, heaviness, aching, cramps, itching, varicose veins, brown skin, ulcers near the ankle.
- Risk factors
- Age, female sex, pregnancy, obesity, prolonged standing, previous DVT, family history.
- Diagnosis
- Examination and duplex ultrasound.
- Treatment
- Compression, elevation, walking, weight loss; vein ablation, sclerotherapy, stents.
- Complications
- Venous ulcers, cellulitis, superficial clots, bleeding varicose veins.
When to get help
Call 911 or go to the ER
- Sudden shortness of breath or chest pain, especially with leg swelling (possible pulmonary embolism)
- A varicose vein that is bleeding heavily: lie down, raise the leg and press firmly, and call 911 if it does not stop
See a doctor within a day or two
- One leg suddenly swollen, painful, warm or red (possible deep vein thrombosis)
- Spreading redness, warmth and fever in a swollen leg (possible cellulitis)
- A painful, hard, red cord along a vein
Book a routine appointment
- Leg swelling, heaviness or aching that worsens through the day and improves overnight
- Brown or reddish skin discoloration, itching or thickened skin around the ankles
- A sore near the ankle that is not healing within 2 weeks
- Bulging, twisted veins causing discomfort
Usually safe to manage at home
- Mild ankle swelling after long standing or travel that settles overnight with leg elevation
How leg veins normally work
Blood in the leg veins has to travel upward against gravity. Calf muscles squeeze the deep veins with each step (the "calf muscle pump"), and one-way valves keep blood from falling back. In CVI, valves leak (reflux) or veins are blocked (obstruction), so pressure in the leg veins stays high. This high pressure stretches veins, pushes fluid into tissues, and over years damages the skin.
Causes and risk factors
- primary valve weakness: often inherited, worsens with age
- previous deep vein thrombosis: clots damage valves, causing post-thrombotic syndrome
- pregnancy, especially multiple pregnancies
- obesity
- prolonged standing or sitting
- inactivity and a weak calf muscle pump (for example with arthritis or paralysis)
- female sex and older age
- family history of varicose veins
- pelvic vein compression (such as May-Thurner syndrome)
Symptoms
- swelling of the ankles and lower legs, worse at the end of the day
- heaviness, tiredness, aching or throbbing legs
- leg cramps, especially at night
- itching or burning skin
- restless legs
- varicose veins and spider veins
- skin changes: reddish-brown discoloration, dry scaly skin (stasis dermatitis), thickened hard skin (lipodermatosclerosis), white scar-like patches (atrophie blanche)
- venous ulcers: shallow, often weeping sores, usually above the inner ankle
Stages (CEAP classification)
| Class | Findings |
|---|---|
| C0 | No visible signs |
| C1 | Spider veins or reticular veins |
| C2 | Varicose veins |
| C3 | Swelling (edema) |
| C4 | Skin changes: pigmentation, eczema, lipodermatosclerosis |
| C5 | Healed venous ulcer |
| C6 | Active venous ulcer |
Venous insufficiency vs other causes of leg swelling
| Condition | Clues |
|---|---|
| Venous insufficiency | Swelling worse with standing, better with elevation; varicose veins; brown skin |
| Deep vein thrombosis | Sudden one-sided swelling, pain, warmth |
| Lymphedema | Firm swelling including the foot and toes; less improvement with elevation |
| Heart, kidney or liver disease | Swelling of both legs, often with breathlessness or other signs |
| Medicines | Calcium channel blockers (amlodipine), steroids |
| Peripheral artery disease | Calf pain on walking, cool pale feet, weak pulses (important to check before compression) |
Diagnosis
- examination of the legs, skin and pulses
- duplex ultrasound: the key test, showing valve reflux, blockages and old clots
- ankle-brachial index: checks arterial circulation before strong compression
- CT or MR venography or intravascular ultrasound if pelvic vein blockage is suspected
Treatment
Self-care and conservative treatment
- compression stockings (typically 20 to 30 or 30 to 40 mm Hg), put on in the morning; the cornerstone of treatment and ulcer prevention
- leg elevation above heart level for 30 minutes several times a day
- walking and calf exercises to strengthen the calf pump
- weight loss
- avoid long periods of sitting or standing; flex ankles regularly
- skin care: moisturize daily, treat stasis dermatitis with steroid creams as prescribed
- some medicines (such as micronized purified flavonoid fraction or horse chestnut extract) may reduce symptoms; discuss with your doctor
Procedures
- endovenous thermal ablation (laser or radiofrequency) to close leaking superficial veins
- non-thermal ablation: medical adhesive (cyanoacrylate) or mechanochemical ablation
- sclerotherapy: injections to close smaller veins
- ambulatory phlebectomy: removal of bulging veins through tiny incisions
- venous stenting for blocked iliac veins
- ulcer care: compression bandaging, wound care, and treating reflux to speed healing and reduce recurrence
Complications
- venous leg ulcers, which can be slow to heal and often recur
- cellulitis and skin infections
- superficial thrombophlebitis
- bleeding from fragile varicose veins
- reduced mobility and quality of life
Frequently asked questions
What are the symptoms of venous insufficiency?
Common symptoms include swollen ankles and legs that worsen during the day, heavy, tired or aching legs, cramps at night, itching, varicose veins, brownish skin discoloration around the ankles, and in advanced cases, slow-healing ulcers.
What causes chronic venous insufficiency?
It is caused by damaged or weak valves in the leg veins, or by blocked veins after a blood clot. Risk factors include age, pregnancy, obesity, prolonged standing, inactivity, family history and previous deep vein thrombosis.
Is venous insufficiency serious?
It is not usually life-threatening, but it is progressive and can cause painful skin changes, leg ulcers and infections. Early treatment with compression, exercise and vein procedures prevents complications and improves symptoms.
Do compression stockings help venous insufficiency?
Yes. Compression stockings support the veins, reduce swelling and aching, and are essential to healing and preventing venous ulcers. Have your arterial circulation checked before using strong compression if you have poor foot pulses or diabetes.
Can venous insufficiency be cured?
The underlying vein damage cannot be fully reversed, but procedures such as endovenous ablation can close faulty veins and greatly improve symptoms. Ongoing compression, exercise and weight management help keep the condition under control.
Sources
This guide was written from current patient and clinical guidance, including:
- Society for Vascular Surgery and American Venous Forum: Clinical practice guidelines for varicose veins and chronic venous disease
- American Venous Forum: CEAP classification
- NHLBI: Venous disease information
- MedlinePlus: Venous insufficiency
- Society of Interventional Radiology: Chronic venous insufficiency