Here’s what to know about chronic venous insufficiency

Chronic venous insufficiency (CVI) is a common vascular condition where the veins in the legs can’t efficiently return blood to the heart, resulting in blood pooling (also known as venous stasis) in the lower extremities12678. The underlying issue is most often damaged or weakened one-way valves inside the leg veins. These valves usually prevent blood from flowing backward, but when they malfunction, gravity causes blood to flow backwards and accumulate in the legs148.

Key facts about chronic venous insufficiency:

• Causes:
  • Most cases are due to valve dysfunction caused by:
    • Previous blood clots (deep vein thrombosis/DVT)257
    • Varicose veins or superficial venous reflux4
    • Congenital or primary valve weakness25
    • Other factors such as obesity, pregnancy, prolonged standing, and family history45
• Symptoms:
  • Swelling (especially ankles and feet)14568
  • Aching, heaviness, fatigue, or cramps in the legs568
  • Varicose veins (twisted, bulging veins visible under the skin)1478
  • Skin changes:
    • Hyperpigmentation (brownish discoloration, especially at the ankles)58
    • Itchiness, dryness, or scaling458
    • Thickened, hardened, or leathery skin (lipodermatosclerosis)58
  • Venous ulcers (open sores that are slow to heal, most often near the ankles)145678
  • In more advanced or severe cases, complications can include chronic inflammation, stasis dermatitis, and rarely, skin malignancy458.
• Who is at risk?
  • Older adults (increasing risk with age)67
  • Women (more common than in men)45
  • Those with a history of DVT, pregnancy, obesity, family history, and sedentary or standing occupations458
• Diagnosis:
  • Clinical evaluation (history and physical exam)256
  • Duplex ultrasound to assess venous reflux and valve function56
  • Additional tests to rule out other causes of leg swelling (such as heart or kidney conditions)68
• Complications:
  • Venous ulcers
  • Recurrent skin infections (cellulitis)4
  • Severe skin changes and sometimes bleeding58
• Treatment:
  • Lifestyle and conservative measures:
    • Compression stockings are first-line therapy2568
    • Leg elevation1268
    • Regular physical activity, especially walking68
    • Weight management and avoiding long periods of standing or sitting68
  • Medications to address inflammation or heal ulcers (when indicated)6
  • Procedures:
    • Minimally invasive techniques for varicose veins (such as endovenous laser treatment)45
    • Surgical or endovenous interventions for more severe cases25
• Prognosis:
  • CVI is usually not a direct threat to life but may be painful and disabling without treatment12.
  • Early recognition and treatment can prevent long-term complications.

If you notice persistent leg swelling, heaviness, skin changes, or non-healing wounds, it’s important to see a healthcare provider for evaluation and diagnosis—and to rule out other serious conditions that can cause similar symptoms68.