Chronic Venous Insufficiency: What to Know (2024)

The veins in your legs carry blood back to your heart. They have one-way valves that keep blood from flowing backward. If you have chronic venous insufficiency (CVI), the valves don’t work the way they should and some of the blood may go back down into your legs. That causes blood to pool or collect in the veins.

CVI can affect all the types of veins in your legs. This includes:

  • Deep veins. They are large veins that are deep in your body.
  • Superficial veins. They are close to your skin’s surface. You can often see superficial veins.
  • Perforating veins. These veins connect deep and superficial veins.

Over time, CVI can cause pain, swelling, and skin changes in your legs. It may also lead to open sores called ulcers on your legs.

How common is chronic venous insufficiency?

About 150,000 people are diagnosed with CVI each year. Research shows CVI affects about 1 in 20 adults. Your risk for CVI goes up as you age.

Chronic venous insufficiency vs. post-thrombotic syndrome

CVI and post-thrombotic syndrome both refer to damaged leg veins. But post-thrombotic syndrome is a specific type of CVI. It’s caused by deep vein thrombosis (DVT), which is a blood clot that develops in a deep vein. Even after the clot is gone, it can leave behind scar tissue that damages your vein.

Chronic Venous Insufficiency Causes

A blood clot in a deep vein in your leg can damage a valve. If you don’t exercise, that can cause CVI, too. So can sitting or standing for long stretches of time. That raises pressure in your veins and may weaken the valves.

Causes for valve damage can be:

  • Congenital. This means that you’re born with problems in your leg veins.
  • Primary. Your leg veins change, and they don’t work the way they should.
  • Secondary. Medical conditions, such as DVT, damage your leg veins.

Chronic Venous Insufficiency Risk Factors

Women are more likely than men to get CVIand have vein problems. In fact, those assigned female at birth (AFAB) are nearly twice as likely to have varicose veins (twisted, enlarged veins close to the surface of the skin). Some research suggests that the higher rates of CVI in people AFAB may be due to changes that happen in pregnancy.

Your chances also might be higher if you are:

  • Obese
  • Over age 50
  • Pregnant or have been pregnant more than once
  • From a family with a history of CVI
  • Someone with history of blood clots
  • A smoker

Chronic Venous Insufficiency Symptoms

You may notice these in your legs:

  • Swelling or heaviness, especially in the lower leg and ankle
  • A dull ache or cramping in the legs
  • Tingling or burning in your legs
  • Pain that gets worse when you stand or gets better when you put your legs up
  • Itchiness
  • Varicose veins
  • Chronic venous insufficiency skin changes, which may include skin that is irritated, cracked, discolored, flaky, weepy, or looks like leather

Without treatment, the pressure and swelling will burst the tiny blood vessels in your legs called capillaries. That could turn your skin reddish-brown, especially near the ankles. This can lead to swelling and ulcers. These ulcers are tough to heal. They are also more likely to get infected, which can cause more problems.

If you have any of the symptoms of CVI, talk to your doctor. The sooner you treat it, the less likely you’ll get ulcers.

Stages of Chronic Venous Insufficiency

To classify venous disorders, doctors use these stages:

  • Stage 0. You have no signs that can be seen or felt. But you may have some symptoms, such as achy or tired legs.
  • Stage 1. You have visible blood vessels, including spider veins.
  • Stage 2. You have varicose veins that are at least 3 millimeters wide.
  • Stage 3. You have swelling but no skin changes.
  • Stage 4. You notice changes to your skin’s color or texture.
  • Stage 5. You have a healed ulcer.
  • Stage 6. You have an active ulcer.

Early stages of chronic venous insufficiency

To be diagnosed with CVI, you must be at stage 3 or higher. That means you can have varicose or spider veins, but not full-blown CVI. In the beginning stages of a venous disorder, you might also notice tired or achy legs. These early signs could get worse over time, so it’s important to tell your doctor about them.

Chronic Venous Insufficiency Diagnosis

Your doctor will take your medical history. They then will check the blood flow in your legs with a test called a vascular or duplex ultrasound. Your doctor will place a small device on your skin over the vein. Using sound waves, they can see the blood vessel and check how quickly and in what direction the blood flows.

Sometimes, you may need X-rays or specific scans to check for other causes of your leg swelling. Specific imaging tests such as MRA or CT can show blockages or narrowed veins.

Venous insufficiency test

Doctors may rely on the results of several tests, including a physical exam, duplex ultrasound, and other scans, to diagnose venous insufficiency.

Chronic Venous Insufficiency Treatment

The main goal is to stop swelling and prevent leg ulcers. Your doctor may suggest a combination of treatments based on your age, symptoms, and other things. Some options to help manage CVI include:

Chronic venous insufficiency medications

Your doctor may prescribe an antibiotic to treat infections or leg ulcers. Sometimes, they’ll give you medicine to help prevent blood clots.These are called blood thinners.

You may also receive a medicated wrap. It consists of compression materials and a zinc oxide ointment.

Chronic venous insufficiency medical procedures

If your CVI is further along, you may need a nonsurgical treatment.

  • Sclerotherapy. Your doctor will inject a solution into the problem vein. It scars the vein, forcing blood to flow through healthier veins. Over time, your body absorbs the scarred vein.
  • Endovenous thermal ablation. This newer method uses high-frequency radio waves or a laser to heat and close the problem vein.

Surgery for chronic venous insufficiency

Fewer than 1 in 10 people need surgery for CVI.

Here are your options:

  • Ligation. The vein is cut and tied off so blood can’t flow through. Your doctor may also remove a vein that is very damaged. You usually will go home on the same day.
  • Microincision/ambulatory phlebectomy. This technique uses much smaller cuts, punctures, and small hooks to remove damaged veins.
  • Vein repair. Your doctor fixes the vein or the valves. This can be done through an open cut on your leg or through a smaller opening by using a long, hollow catheter or tube.
  • Vein transplant. Your doctor replaces the problem vein with a healthy one from somewhere else in your body.
  • Vein bypass. This is done on veins in the upper thigh and only in the most severe cases. Your doctor takes part of a healthy vein from another part of your body. They’ll use that to reroute blood around the affected vein. You’ll usually stay in the hospital for 2-5 days.

Living With Chronic Venous Insufficiency

You can help blood flow better in your leg veins. Steps include:

Compression stockings. These elastic socks put pressure on your legs to help blood move. They come in different tightnesses, lengths, and styles. Your doctor can suggest which might work best for you.

Movement. Try not to sit or stand for a long time. If you have to sit for a while, stretch or wiggle your legs, feet, and ankles often to help your blood flow. If you stand a lot, take breaks to sit and put your feet up. This helps lower pressure in your leg veins.

Exercise. Working outhelps pump your blood, too. Walking is a good, simple way to make your legs stronger and boost blood flow.

Diet for venous insufficiency

Doctors typically suggest a heart-healthy diet for venous insufficiency. This includes lots of vegetables, fruits, and whole grains.

Also, you should limit your salt intake. Salt can cause too much fluid to build up in your legs, which may put pressure on your veins and worsen CVI.

Chronic Venous Insufficiency Prevention

You may not be able to prevent CVI completely, but you can lower your risk with these lifestyle changes:

  • Avoid smoking or other tobacco use.
  • Don’t wear tight clothing.
  • Eat a healthy, low-salt diet.
  • Exercise regularly.
  • Maintain a healthy weight.
  • Don’t stand or sit for too long at a time.

Chronic Venous Insufficiency Prognosis

CVI can be managed if you're treated in the early stages. The condition usually isn’t life-threatening. But it can get worse over time and affect your quality of life.


CVI is a venous disease that happens when veins in your legs are damaged. Though the damage can’t be reversed, treatments and lifestyle changes can keep your symptoms at bay. It’s important to see your doctor if you have any signs of CVI.

Chronic Venous Insufficiency FAQs

How serious is chronic venous insufficiency?

CVI is generally not considered a serious health threat. But it can be painful and affect your quality of life.

What are the signs of CVI?

Some common signs of CVI are:

  • Achy, heavy, or crampy legs
  • Pain that gets worse when you stand or better when your feet are raised
  • Itching and tingling in the legs
  • Swelling of the legs
  • Irritated, cracked, flaky, or thickened skin
  • Varicose veins
  • Wounds that are slow to heal

Is CVI a developmental disability?

CVI is not a developmental disability. Another condition with the same abbreviation, called cortical visual impairment (CVI), is a leading cause of vision problems in children and can come with developmental disabilities.

Chronic Venous Insufficiency: What to Know (2024)
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