Chronic Venous Insufficiency: Signs and Treatment

What is chronic venous insufficiency?

Chronic venous insufficiency (CVI) is what happens when leg veins have failed to work properly for a long time. Normally, one-way valves and the calf-muscle pump move blood upward to the heart. When valves leak ( reflux ) or veins are partly blocked, pressure builds up in the lower leg — a state called venous hypertension . Over months and years, that pressure pushes fluid and blood components into the surrounding tissue, causing swelling, inflammation and damage to the skin.

In the CEAP classification , CVI covers stages C3 (swelling), C4 (skin changes), C5 (healed ulcer) and C6 (active ulcer). Many people with CVI also have visible varicose veins , but some do not.

What are the signs of chronic venous insufficiency?

• Swelling of the ankle and lower leg, worse by evening and better after a night's rest.
• Heaviness, aching and tightness , especially after standing.
• Skin darkening — brown or reddish-brown patches near the ankle.
• Venous eczema — itchy, red, flaky or weeping skin.
• Lipodermatosclerosis — hard, tight, sometimes painful skin that can make the lower leg look like an upside-down bottle.
• Atrophie blanche — smooth white scar-like patches.
• Ulcers — open sores, usually above the inner ankle, that heal slowly. See venous leg ulcers .

What causes chronic venous insufficiency?

Primary reflux

Most often, CVI develops from long-standing varicose veins whose valves have gradually failed. Risk factors include family history, standing or sitting work, pregnancy, ageing and excess weight. See causes of varicose veins .

After a deep vein thrombosis

A previous blood clot in a deep vein can damage its valves or leave it partly blocked. This is called post-thrombotic disease and can lead to CVI even without obvious varicose veins.

Weak calf pump

Reduced ankle movement, for example from arthritis, injury or long periods of immobility, weakens the calf pump and adds to the problem.

How is CVI diagnosed?

A duplex ultrasound is the key test. It shows which veins leak, whether perforator veins near damaged skin are involved, and whether the deep veins are open or scarred from a past clot. At LEDAS, Dr. Kim Byoung Joon scans you standing, using Philips EPIQ Elite ultrasound, and explains the findings on screen. Other causes of leg swelling, such as heart, kidney or lymphatic problems, may need to be considered.

How is chronic venous insufficiency treated?

The goal is to lower pressure in the leg so the skin can recover and ulcers can heal and stay healed.

1. Treat the reflux. Closing leaking veins reduces venous hypertension. Where skin is already damaged or ulcerated, surgery becomes harder, so LEDAS recommends non-surgical ultrasound-guided sclerotherapy first, including for refluxing veins beneath damaged skin. EVLT is used for refluxing trunk veins when suitable.
2. Compression. Medical compression stockings or bandages reduce swelling and support healing. They help symptoms but do not replace treatment of the cause.
3. Skin and wound care. Moisturize dry skin, avoid scratching and keep ulcers clean as advised.
4. Daily habits. Walk regularly, do ankle exercises and raise your legs above heart level when resting.
5. Follow-up. Regular ultrasound every 1–2 years helps catch new reflux early.

All LEDAS treatments use local anesthesia only, with no incision and same-day discharge.

When is CVI urgent?

Seek prompt care if an ulcer becomes very painful, spreads, smells or is surrounded by spreading redness and fever, which can indicate infection. Call emergency services for sudden severe leg swelling with pain, or sudden breathlessness or chest pain, which can signal a blood clot.

CVI treatment options compared

Chronic venous insufficiency – frequently asked questions