Chronic Venous Insufficiency (CVI): Symptoms, Causes, and More

Chronic venous insufficiency (CVI) is a long-term condition where the veins in your legs have trouble sending blood back to your heart. Unlike arteries, which have muscular walls to help move blood, veins rely on tiny, one-way valves that help push blood upward. When these valves become damaged or weakened, blood can pool in your legs.

Chronic venous insufficiency often starts with mild symptoms, such as swelling or a dull aching in your legs. As blood continues to pool in your veins over time, symptoms can become more noticeable and may affect your daily activities. 

Common symptoms may include:

• Leg swelling (edema): Swelling tends to occur in the ankles and legs, especially at the end of the day or after standing for long periods. 
• Heavy or achy legs: Your legs might feel heavy, tired, or achy, usually due to the increased pressure from pooled blood in the veins.
• Leg pain or cramping: Pain or cramping in your legs can occur, especially at night. 
• Varicose veins: These appear as swollen, twisted veins just under your skin’s surface. 
• Skin changes: The skin on your legs and ankles may become dry and itchy. It may also darken over time.
• Leg ulcers: As CVI progresses, you might develop open sores on your legs, usually around your ankles.

Chronic venous insufficiency occurs when the valves in your leg veins don’t work properly. Healthy valves act like one-way doors. They help blood flow upward against gravity toward your heart. When the valves in your veins become damaged, though, blood can leak backward and pool in your leg veins, leading to CVI.

Several things can damage your vein valves or affect blood flow in your legs. These include:

• Problems with the structure or function of the vein walls or valves
• Deep vein thrombosis (DVT), when blood clots form in the deep veins of your legs and cause the valves to become thick, stiff, and unable to close properly
• Leg injuries
• Long periods of inactivity
• Surgery
• Some inherited conditions that affect how veins develop

Risk Factors

CVI affects about 25 million adults in the United States. Certain factors can increase your risk. These include:

• Female sex
• Age 55 or older
• Family history of vein conditions
• Pregnancy
• Obesity or carrying extra weight
• Smoking
• Standing or sitting for long periods
• Previous blood clots or leg injuries
• Not enough physical activity

A healthcare provider will review your medical history and symptoms. They will likely order tests to check for chronic venous insufficiency. These may include:

• Duplex ultrasound: This imaging test uses sound waves to create pictures of your veins and show how blood flows through them. It can reveal blocked or damaged veins and help identify blood clots.
• Other imaging tests: These may include computed tomography (CT) scan, magnetic resonance imaging (MRI), or magnetic resonance venography (MRV). These tests give a more detailed view of your blood vessels and surrounding tissues.

Stages of Chronic Venous Insufficiency

Healthcare may diagnose CVI and determine the most appropriate treatment based on the stage, which ranges from 0 to 6:

• Stage 0: No visible signs of vein disease, but you might have some symptoms like aching or heaviness
• Stage 1: Spider veins or reticular veins (small, dilated veins visible under the skin)
• Stage 2: Varicose veins are present
• Stage 3: Swelling in the legs and ankles, but no skin changes
• Stage 4: Skin changes such as darkening, redness, or hardening of the skin
• Stage 5: Skin changes with a healed ulcer
• Stage 6: Skin changes with an active ulcer

The main goals of treatment are to reduce swelling, improve blood flow, and prevent complications. In some cases, lifestyle changes and compression therapy may be enough. But people with more serious symptoms may need additional treatments or surgery.

Treatments may include:

• Leg elevation: Raising your legs above heart level, such as by propping them on pillows or against a wall, can help blood flow back to your heart.
• Compression stockings: These special socks gently squeeze your legs to help push blood upward. Your healthcare provider can recommend the right type and fit for you.
• Other lifestyle changes: Get regular physical exercise, maintain a healthy weight for you, and avoid sitting or standing without moving your legs often.
• Medication: Your treatment might include blood thinners. These medications help treat and prevent blood clots and keep blood flowing properly through your veins.
• Minimally invasive procedures: These treatments work by closing off affected veins, allowing your body to redirect blood through healthy veins nearby. Examples include sclerotherapy and endovenous laser treatment.
• Surgery: For severe cases, you may need surgery to remove or repair the affected veins.

It’s not always possible to prevent chronic venous insufficiency, but taking some steps may help lower your risk and maintain healthy blood flow in your legs. For example, it may help to maintain a weight that reduces pressure on your leg’s veins. Try to get enough regular exercise to improve circulation and help with weight management, too. 

Blood pooling in your legs can damage your skin, tissues, and blood vessels over time. Possible conditions related to chronic venous insufficiency include:

• Chronic leg pain
• Leg ulcers that are slow to heal and can become infected
• Blood clots in the deep veins of your legs, which can be dangerous if they travel to other parts of your body
• Recurring skin infections (cellulitis) due to poor circulation and breaks in the skin
• Hardening and darkening of the skin on your legs from long-term inflammation
• Severe swelling that affects your lymph vessels (lymphedema), making it harder for fluid to drain from your legs
• Ongoing skin problems like itching, redness, and scaling caused by poor circulation

The severity of chronic venous insufficiency can vary from person to person. Some people have mild symptoms that are manageable with lifestyle changes, while others might need more intensive treatment. Working closely with your healthcare provider can help you manage your symptoms effectively.

If you notice changes in your legs or develop new symptoms, let a healthcare provider know. Early treatment may offer the best chance of managing CVI successfully.