What is chronic venous insufficiency (CVI)?

Chronic venous insufficiency (CVI) is a disorder where vein walls and valves in the legs stop working properly. This condition makes it difficult for the veins to carry blood back to the heart from the legs. Blood tends to “pool” or collect in these veins. This venous pooling is referred to as stasis.

CVI affects an estimated 40% of Americans. More often noted in the medical history of people above the age of 50. The illness is seen more often in women than in men.

Symptoms of Chronic Venous Insufficiency

Seriousness and symptoms of CVI can increase the longer you have the disease. It is very important to see a doctor as quickly as possible if you think you have vein issues like this. If you aren’t sure, have a specialist take a look at the legs. The earliest sign of this issue is spider veins. This is a good time to get your legs checked and remedied by a vascular specialist.

The earlier you begin treatments, the better your chances of preventing serious problems.

Symptoms of CVI include:

  •         Swelling of the legs and/or ankles
  •         Pain when moving, especially while standing
  •         cramping, aching, heaviness, and throbbing in the legs
  •         Itchy, flaky skin
  •         Weakness in the legs
  •         Thickening of the skin, usually on lower legs and ankles
  •         Discoloration of the skin
  •         Leg ulcers and slow to heal wounds
  •         Varicose veins
  •         Skin tightness in the legs
  •          The relief when elevating the legs

As the disease progresses, there is a risk for the bursting of capillaries in the legs. When this happens, the skin will change to a reddish color. The skin will also become very sensitive to bleeding and can break with a slight bump or prick.

Chronic venous insufficiency stages

There are six different stages of chronic venous disease (CVD), the latter of which are referred to as CVI, ranging from small spider veins to open ulcers. The early stages provide an opportunity to seek treatment with relative ease.

In its earliest stages, Chronic Venous Insufficiency takes the form of spider veins. These look like small red or blue tree branches just under the surface of the skin. From there, spider veins can develop into varicose veins, which are much larger and more noticeable, but still very treatable. The main difference from spider veins is their protrusion from the skin.

Moving on from the issue of varicose veins, legs can begin to swell and change in color due to the broken blood vessels that lie below. This is a sign that the issue is becoming more serious. At this stage, treatment is necessary to maintain good health. In this stage, you may sometimes see a sore with a scab on the leg.

As CVD becomes CVI in the later stages, open ulcer sores with oozing fluid can be seen.

What causes chronic venous insufficiency?

The purpose of the veins is to return deoxygenated blood back to the heart. To reach the heart, the blood needs to flow upward from the legs. Calf muscles and the muscles in the feet need to contract with each step to squeeze the veins and push the blood upward. Veins contain special one-way valves to make sure the blood is always flowing in the right direction.

Chronic venous insufficiency starts to happen when these valves become damaged. Damaged venous valves can allow blood to leak backward. There are many factors that can cause valve damage; such as aging, extending sitting or standing, or a combination of both.

When it becomes harder for blood to flow back up to the heart, blood pressure can stay at dangerously high levels for long periods of time, leading to long-term health problems.

Blood clotting in the deep veins of the legs is the most common cause of CVI. These clots are also known as deep vein thrombosis (DVT). In rarer cases, CVI can result from pelvic tumors and vascular malformations.

The swollen legs that are frequently seen as a result are caused by the blood pooling in the legs when the veins are unable to transport it back to the heart.

If you have some or all of the risk factors for chronic venous insufficiency, you will be more likely than other people to develop CVI. The most important risk factors include:

  •         Blood clots (DVT)
  •         Varicose veins
  •         Obesity
  •         Tall height
  •         Pregnancy
  •         Smoking
  •         Certain Cancers
  •         Age
  •         Family history
  •         Inactivity such as sitting or standing for long periods of time
  •         Progesterone hormone levels (women)
  •         Muscle injury
  •         Phlebitis (swelling of a superficial vein)

How we find this illness

Generally, the discovery of venous insufficiency comes by means of duplex ultrasound. This is a non-invasive imaging procedure that scans the calf muscles, vein valves, and leg veins. These are the most common places that insufficiency is found.

Most vein diseases are visible and found using ultrasound technology very similar to that used during pregnancy to check the status of the baby.

How do we treat chronic venous insufficiency?

The treatment we use generally depends on the stage of CVI that our patients are experiencing. Complexity increases as the disease progresses and non-surgical options become fewer.

When treating spider and varicose veins, there are non-surgical options available that offer little to no downtime, allowing you to return to everyday life instantly. These generally take the form of injections that will collapse the damaged veins, removing them from view.

Ulcers are also cleaned and wrapped using wet and dry dressings. Ulcers will heal much faster when they are covered. Dressings are changed at least once a week. If the dressing stays on too long, there is a risk of removing new cells that are growing to replace the damaged ones.

Aside from dressings, we also commonly use antibiotic ointments in treatment to avoid infections as the healing process goes on. Prescription or oral antibiotics are also sometimes used depending on the level of infection risk.

To remove the dead skin at this stage, surgery is required. The dead skin is cut away and we promote the regeneration of new cells to repair damage to the leg.


Chronic venous insufficiency can cause many problems later on in life. The best way to combat it is to get to it early and identify the warning signs. If you feel strange feelings in your legs, you could have an issue with your veins. Consult with a doctor immediately. Getting to the problem as soon as you can is the best thing you can do for your recovery.

If you want to know for sure whether you have vein issues developing or present is to have a vein screening at Chicago Vein Institute. With a simple 15 minute screening, we can assess your vein health.

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Chicago Vein Institute is a practice solely dedicated to the diagnosis and treatment of vein diseases. The experts at CVI perform the latest and most effective treatments for painful varicose veins, spider veins, and other vein-related disorders. CVI offers minimally invasive treatment options, including Endovenous Laser Ablation (EVLA), Ambulatory Phlebectomy, Ultrasound-Guided Sclerotherapy, Surface Sclerotherapy, Elastic Compression Stockings and wound care for venous ulcers, performing more than 11,000 vein-related procedures annually. Same-Day appointments and multi-lingual team members standing by to assist.