A vascular surgeon injects a liquid or foam into a vein. This causes the vein to close and forces blood to flow through other healthy veins. Eventually, the vein fades as your body absorbs it.
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What is chronic venous insufficiency?
Chronic venous insufficiency (CVI) occurs when veins have trouble carrying blood to the heart. It’s most common in leg veins. CVI is very common, affecting up to four in 10 people in the United States.
Usually, the valves in your leg veins open and close to push blood toward your heart. When these valves are damaged, blood can flow backward and pool in the leg veins.
CVI can affect any of the veins in your legs, including:
- Deep veins located within the muscles. These veins carry most of the blood back to the heart.
- Superficial veins found closer to the skin’s surface. These veins are more prone to varicose veins.
- Perforating veins that connect the superficial and deep veins.
The goal of chronic venous insufficiency treatment is to relieve symptoms, improve circulation, and prevent complications. Vascular specialists at Mass General Brigham Heart and Vascular offer a full range of treatments for CVI, including minimally invasive endovascular treatments and vascular surgery.
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Symptoms of chronic venous insufficiency
Chronic venous insufficiency affects circulation in the legs and feet, leading to symptoms such as:
- Aching or heaviness
- Cramping, especially at night
- Numbness or tingling
- Skin discoloration, flakiness, or itching
- Swelling due to fluid build-up (edema)
- Varicose veins (swollen, visible veins)
Chronic venous insufficiency symptoms are often mild at first, but they can worsen over time. If left untreated, they can become serious enough to disrupt your usual activities.
Stages of chronic venous insufficiency
Chronic venous insufficiency is a type of venous disorder (a problem affecting veins) that gets worse over time. Doctors categorize venous disorders into stages based on symptoms and severity:
- Stage 0: You may have some discomfort, such as leg aching or fatigue, but no visible signs of CVI.
- Stage 1: Small, visible spider veins begin to develop.
- Stage 2: Varicose veins three millimeters or larger form.
- Stage 3: Leg swelling appears due to fluid buildup.
- Stage 4: Skin changes such as discoloration, flakiness, or thickening develop.
- Stage 5: You had a venous ulcer that has healed.
- Stage 6: You have an active, non-healing ulcer.
Causes of chronic venous insufficiency
Chronic venous insufficiency develops because of damage to the valves in leg veins that make it harder for blood to flow back to the heart. This damage usually occurs from high blood pressure in the leg veins. Sitting or standing for long periods, not exercising, and smoking can all increase this pressure.
Some medical conditions can also damage valves in leg veins. The most common is deep vein thrombosis (DVT). DVT is a blood clot in one of your deep veins.
Risk factors for chronic venous insufficiency
You are more likely to develop chronic venous insufficiency if you:
- Are over 50
- Are pregnant
- Don’t exercise often or sit or stand for long periods
- Have a family history of CVI
- Have a history of blood clots or a leg injury, such as one you’d get in a car accident
- Have obesity
- Smoke
Diagnosis of chronic venous insufficiency
Diagnosing chronic venous insufficiency starts with a physical exam. Your provider checks your legs for signs of CVI, such as varicose veins, swelling, or discolored skin. They also ask about your symptoms, including:
- Do your symptoms disrupt your usual activities?
- Does anything relieve your symptoms?
- What makes your symptoms worse?
You usually get a Duplex ultrasound to confirm a CVI diagnosis. This painless, noninvasive test uses sound waves to create images of your veins. It shows the structure of your leg veins and how well blood flows through them.
Treatment for chronic venous insufficiency
Treating CVI usually starts with lifestyle changes. If these changes don’t reduce your symptoms, your doctor may recommend other therapies. The CVI treatment that’s right for you depends on multiple factors, including the severity of your symptoms and your overall health.
Many people manage CVI symptoms and improve blood flow with lifestyle changes alone. Your provider will likely recommend changes that include:
- Avoiding sitting or standing for long periods
- Caring for any wounds with appropriate lotions, creams, or medications
- Elevating your legs above your heart several times daily
- Exercising more frequently
- Managing your weight, if needed
- Sitting with your feet flat and avoiding crossed legs
- Wearing medical-grade compression stockings
Your provider may prescribe medicines to treat CVI. You may also take antibiotics to treat skin ulcers.
Endovenous ablation uses heat or laser energy. A vascular surgeon inserts a long, flexible tube (catheter) into the affected vein. They close the vein and blood flow redirects to healthier veins.
In rare cases, people need vascular surgery to treat chronic venous insufficiency. Surgical options may include:
- Phlebectomy: A surgeon makes very small incisions over affected veins. They use a hook-like device to pull out the damaged veins.
- Ligation and stripping: A surgeon may tie off the damaged veins (ligation) or remove them (stripping).
- Vein bypass: If other treatments don’t effectively manage CVI, we may form a new route for blood flow using a vein from elsewhere in your body.
Chronic venous insufficiency prevention
No single strategy can prevent chronic venous insufficiency. But you can lower your chances of getting the condition by:
- Avoiding sitting or standing for long periods
- Eating a heart-healthy, low-salt diet
- Exercising regularly
- Maintaining a healthy weight
- Quitting smoking, if you smoke
FAQs about chronic venous insufficiency
Chronic venous insufficiency isn’t curable. You can’t reverse valve damage in your leg veins. However, treatment can improve your symptoms and quality of life.
CVI occurs when blood pools in the legs. This increases the blood pressure in your legs and can cause varicose veins. Varicose veins are enlarged, visible veins. While varicose veins can be a sign of CVI, not everyone with varicose veins has CVI.
Untreated CVI can lead to rare complications such as open sores (ulcers) that don’t heal. These complications can become serious without proper management.
Doctors typically diagnose CVI at stage 2 or higher venous disease. This means it’s possble to have spider or varicose veins without having CVI. A CVI diagnosis is usually made when an ultrasound shows venous reflux (poor blood flow in the veins) along with symptoms like varicose veins at stage 2, or more advanced signs such as leg swelling (edema) at stage 3. These stages reflect increasing levels of vein dysfunction.
Yes! Walking helps improve circulation and manage chronic venous insufficiency. With each step, you squeeze your calf muscles. This contraction helps your veins send blood back to your heart.
Compression stockings can significantly reduce symptoms of CVI. Compression stockings are tight-fitting prescription socks that apply gentle pressure to your legs. This pressure helps your veins pump blood back to your heart.
