Understanding Chronic Venous Insufficiency: Symptoms, Causes, Treatment & Prevention

A form of peripheral vein disease (PVD), chronic venous insufficiency occurs when valves in the leg veins become damaged or blocked. Normally, these veins carry oxygen-poor blood from the legs back to the heart, and the valves keep the blood flowing in the proper direction. When a vein valve malfunctions, however, blood can sometimes flow backward (venous reflux) and pool in the legs. This causes high pressure in the veins and can eventually lead to serious complications if left untreated.

What are the Causes & Risk Factors of Chronic Venous Insufficiency?

Chronic venous insufficiency (CVI) can develop as a result of damage to any of the leg veins, from the superficial veins closest to the surface of the skin to the deep veins running through the muscles further inside the leg—as well as the perforating veins that connect them. This condition has been linked to causes such as:

• High blood pressure in the legs due to prolonged sitting
• Carrying excess body weight
• A sedentary lifestyle
• Smoking
• A blood clot in a deep vein in a thigh or calf (deep vein thrombosis)
• Inflammation of a vein close to the skin (phlebitis)

In some instances, chronic venous insufficiency could be the result of a congenital condition. A patient may have been born with abnormal leg veins that did not develop properly, leading to blood flow issues that cause venous reflux and, eventually, the development of this condition.

How Rare is Chronic Venous Insufficiency?

Chronic venous insufficiency is common, affecting an estimated 1 in 20 adults. It is most often found in adults age 50 and older. Deep vein thrombosis is the most common cause of this condition. It is also frequently found in people living with peripheral artery disease (PAD), or a buildup of plaque (atherosclerosis) inside the arteries that narrows them, which can lead to poor blood flow and even blood clotting. And while chronic venous insufficiency almost always affects the legs, it has been observed in the arms.

Risk Factors for Chronic Venous Insufficiency

Some of the most prominent risk factors for chronic venous insufficiency include a history of deep vein thrombosis and having varicose veins (and/or having a family history of varicose veins). People over 50 years old, especially women, are also more likely to develop CVI. Other risk factors are:

• Lack of exercise
• May-Thurner syndrome
• Obesity
• Pregnancy
• Sitting or standing for extended periods
• Tobacco use

Risk Prevention

Because chronic venous insufficiency has so many possible causes, it’s not considered to be a truly preventable condition. But patients are able to reduce their risk of developing it—along with other venous disorders—in numerous ways such as:

• Adopting a consistent exercise routine
• Maintaining a healthy weight
• Making time to get up and move around frequently
• Not smoking or using tobacco in any form
• Reducing sodium intake and switching to a heart-healthy diet
• Taking blood thinners if prescribed by a doctor after having had deep vein thrombosis
• Wearing looser, less restrictive clothing

What are the Symptoms & Warning Signs of Chronic Venous Insufficiency?

Those living with chronic venous insufficiency may experience symptoms such as:

• Swelling in the legs and ankles (edema)
• Tightness in the calves
• Leg pain while walking that resolves with rest
• Darkened skin, often near the ankles
• Varicose veins
• Open leg sores that do not heal (ulcers)
• A constant urge to move the legs (restless legs syndrome)
• Painful leg cramps or muscle spasms (charley horse) at night
• “Pins and needles” feelings in the legs
• Leathery, itchy, cracked or flaky skin

The onset of chronic venous insufficiency may not cause severe symptoms that cannot be ignored or mistaken for something else. In fact, those with the condition in its early stages may experience as few as one symptom for a while, making it far less obvious that CVI is the cause of said issue. Varicose veins, for example, are very common and can occur for many reasons unrelated to chronic venous insufficiency.

When to See a Medical Care Provider

It’s recommended for patients to visit a primary care provider to discuss chronic venous insufficiency when they are exhibiting several of the above symptoms, especially edema and varicose veins. Patients with any of the aforementioned risk factors for CVI should speak with their provider if they are concerned about possibly developing this condition. Without proper treatment, mild symptoms will worsen over time and negatively affect a patient’s quality of life.

Diagnosis & Tests for Chronic Venous Insufficiency

Typically, a physician will begin by reviewing the patient’s symptoms and medical history and performing a physical examination. As part of the diagnostic process, the physician may order a duplex ultrasound to evaluate the structure of the patient’s leg veins and the speed and direction of the blood flowing within them. Medical care providers may sometimes order additional tests such as a CT or MRA scan in instances where a patient’s edema is severe, and an MRI can be used rule out other conditions that can cause similar symptoms.

Post-Thrombotic Syndrome

If a doctor finds that a patient’s chronic venous insufficiency was caused by deep vein thrombosis (DVT), that will lead to a diagnosis of post-thrombotic syndrome. This is to designate the fact that the condition was brought on by a blood clot (thrombus) deep within the leg that created scar tissue throughout the vein when it was removed. This scar tissue damages the vein. Nearly half of all patients who have had DVT develop post-thrombotic syndrome and will often develop it within the first two years after the thrombus is gone.

Stages of Chronic Venous Insufficiency

As with many venous disorders, the severity of one’s chronic venous insufficiency is diagnosed through a numbered staging system, ranging from 0-6. Medical care providers will diagnose a patient if their condition is observed at stage 3 and above. The stages are observed as follows:

• Stage 0: At most, the patient has achy legs. But there is otherwise no obvious sign of chronic venous insufficiency.
• Stage 1: The patient’s blood vessels are visible on the skin’s surface, and spider veins can sometimes be present as well. However, this is not an indicator of chronic venous insufficiency.
• Stage 2: The patient has varicose veins that are three or more millimeters wide. Because varicose veins can occur for a variety of reasons, chronic venous insufficiency is not singled out as the cause at this time.
• Stage 3: While there are no changes to the skin color and texture, the patient presents with edema. This indicates that the patient likely has chronic venous insufficiency.
• Stage 4: The skin at the affected area of the patient’s leg(s) has begun to change in color and texture.
• Stage 5: The patient has developed an ulcer, but it has visibly healed.
• Stage 6: The patient has an open (acute) ulcer that has not healed.

How Is Chronic Venous Insufficiency Treated?

Medical treatment can vary based on the severity of the symptoms and other factors. Most often, the first steps will involve conservative, non-invasive treatment methods. Surgery will be recommended if the patient’s condition doesn’t respond well to these treatments.

Non-Surgical Treatment of Chronic Venous Insufficiency

Medical care providers will typically start treatment by recommending lifestyle changes and compression therapy. Other non-surgical treatment methods may be introduced to improve blood flow, reduce leg pain and swelling, improve the appearance of the skin and encourage the healing of ulcers.

Lifestyle Changes

Conservative measures to improve blood flow in the leg veins most often begin with a focus on physical activity. Patients will be asked to:

• Elevate their legs several times a day for 30 or more minutes at a time to ease the pressure in the leg veins
• Exercise the legs regularly in an effort to strengthen the calves, which can help pump blood up from the legs to the heart.
• Reach a healthier weight (if being overweight is a possible cause of one’s chronic venous insufficiency) to reduce pressure on the leg veins and their valves
• Take regular walks or perform similar activities to improve blood flow in the legs as well as cardiovascular health

Compression Therapy

Compression therapy is another commonly recommended form of treatment for chronic venous insufficiency. Compression stockings, sleeves and bandages can help encourage better blood flow from the legs to the heart, which in turn can reduce swelling and ease other symptoms.

There is no one-size-fits-all approach to compression therapy, however. These products come in many different sizes and shapes, from consistently straight fits to graduated (tapered) fits, and certain products are tight enough that a patient cannot buy and use them without a prescription. It is important for patients to consult with their medical care provider before beginning compression therapy with any of these products, and if their compression garments are bunching and do not fit properly.

Medications

Various medications can be combined with other forms of treatment to achieve several goals, such as improving blood flow, clearing infections and healing open sores. These can include antibiotics or blood thinners (anticoagulants). Patients may also be given a medicated wrap designed to both cover a wound and create compression in the affected area.

Non-Surgical Procedures

Before invasive surgery is recommended, medical care providers may recommend certain non-surgical procedures for treatment. Endovenous laser ablation, or radiofrequency ablation (RFA), will close off a damaged vein with minimal bleeding or bruising. Alternatively, sclerotherapy uses an injected solution to create scar tissue within a damaged vein in order to prevent it from carrying blood.

Surgical Procedures Used to Treat Chronic Venous Insufficiency

Many of the endovascular surgical procedures that can treat chronic venous insufficiency are minimally invasive. These include:

• Ligation surgery to tie off a damaged vein
• Vein stripping to remove a damaged vein
• Phlebectomy surgery using a series of microincisions and a special hook to remove damaged veins
• Subfascial endoscopic perforator surgery (SEPS) to block off damaged veins in the ankle to prevent blood flow

If a blocked vein causes chronic venous insufficiency, a vascular surgeon may install a stent or use a small balloon to reopen the blood vessels. More severe cases of chronic venous insufficiency may need to be treated with an invasive procedure called a vein bypass. Due to the nature of this surgery, it is recommended only as a last resort for patients.

What are the Complications & Long-Term Effects of Chronic Venous Insufficiency?

Chronic venous insufficiency can cause the smallest blood vessels (capillaries) in the affected leg(s) to burst due to the elevated vein pressure. This makes a patient vulnerable to:

• A higher likelihood of breaking the skin when bumping or scratching the affected area
• Tissue inflammation and damage
• Venous stasis ulcers on the skin, which may become infected
• Cellulitis, if the infection in a venous stasis ulcer spreads to nearby tissue

Prognosis

Chronic venous insufficiency is a progressive disease that isn’t inherently life-threatening, but can lead to serious complications if left untreated for too long. Due to the damage that is done within the veins, it cannot be cured. But with proper treatment and ongoing condition management, it is possible for patients to slow the progression of this condition, improve their quality of life and relieve many of their symptoms.

Living with Chronic Venous Insufficiency

No two patients are exactly the same, so no two at-home condition management methods will be exactly the same.  But no matter what a patient’s specific, provider-recommended management plan looks like, many of the practices will be simple to integrate into one’s daily life. These may include:

• Elevating the legs several times a day
• Getting up to move around after long periods of sitting
• Keeping a healthy weight (determined by a medical care provider)
• Moving the legs, feet and ankles frequently while on long flights or car rides
• Regularly checking the legs for concerning skin changes
• Taking more breaks from standing to sit and elevate the feet
• Washing and moisturizing the skin on a daily basis
• Wearing compression garments (if recommended by a medical care provider)

Chronic Venous Insufficiency: Frequently Asked Questions (FAQs)

If you have been diagnosed with chronic venous insufficiency or are interested in learning more about this condition, you may have plenty of questions about it. Frequently asked questions include:

• What causes chronic venous insufficiency? – Anything that damages the leg veins can cause chronic venous insufficiency. This is usually in the form of deep vein thrombosis (blood clots), but it can also be the result of a congenital condition.
• What are signs of chronic venous insufficiency? – Varicose veins can be a sign of many venous disorders but can signal chronic venous insufficiency when combined with swelling of the legs (edema) and ulcers.
• What are symptoms of chronic venous insufficiency? – Symptoms include changes in the legs’ skin color and texture, open ulcers, leg aches and pains, tingling sensations in the legs, nighttime cramping and varicose veins.
• How is chronic venous insufficiency diagnosed? – Providers will conduct a physical examination to diagnose the condition, and they can also order certain tests to learn more about the nature and severity of a patient’s condition. The nature of one’s condition is recorded in stages 0-6, with stages 3 and above indicating that a patient has chronic venous insufficiency.
• Can chronic venous insufficiency be treated? – Yes, this condition is a progressive disorder that can be treated and managed, allowing patients to enjoy a better quality of life. However, it cannot be reversed—only slowed.
• Can you live a normal life with chronic venous insufficiency? – While patients will have to make some lifestyle changes to manage their condition, proper treatment can allow for patients to live active lifestyles and do many of the things they enjoyed prior to developing chronic venous insufficiency.
• What happens if chronic venous insufficiency isn’t treated? – Because this is a progressive disorder, untreated and unmanaged chronic venous insufficiency can cause persistent pain and reduced mobility. Plus, if venous ulcers become infected and this spreads throughout the leg, this causes a dangerous condition called cellulitis that requires fast action and a full course of antibiotics.

The TGH Difference for Chronic Venous Insufficiency

Chronic venous insufficiency is a common venous disorder in which blood pools in the leg veins due to damaged or malfunctioning valves that allow blood to flow backward. It is typically caused by blood clots (deep vein thrombosis) and often present in adults age 50 and older. It is a progressive, incurable condition that can nevertheless be treated by doctors and managed at home. Patients with this condition can lead active, healthy lifestyles with proper treatment.

The experts at Tampa General Hospital’s Heart and Vascular Institute and Vascular Center of Excellence use innovative methods to diagnose and treat all types of heart and vascular conditions, including chronic venous insufficiency. At our ultrasound vascular laboratory, we utilize leading-edge technologies to perform advanced diagnostic tests, such as peripheral venous testing. For our patients who elect surgical treatment, our team of vascular surgeons, interventional radiologists and other specialists perform a wide range of complex surgeries. Contact us today at (813) 844-3900 to schedule an appointment with our heart and vascular team or email heart-vascular@tgh.org.