Chronic venous insufficiency occurs when the veins in the legs have difficulty returning blood back toward the heart. This causes blood to pool in the legs, increasing pressure within the veins. Over time, this increased pressure can cause swelling, discomfort, varicose veins, skin changes, and potentially venous ulcers.

What Causes Venous Insufficiency?
 

Veins contain one-way valves that help move blood upward toward the heart and prevent it from flowing backward. The muscles of the legs, particularly the calf muscles, also help pump blood upward when you walk. Venous insufficiency can develop when these valves become damaged or do not close properly, allowing blood to flow backward (venous reflux). It can also occur when blood flow through a vein is partially obstructed.

Venous disease may involve the superficial veins, deep veins, or both.

Common causes and risk factors include:
 

• Increasing age

• Family history of venous disease

• Varicose veins

• Previous blood clot (deep vein thrombosis/DVT)

• Obesity

• Pregnancy

• Prolonged standing or sitting

• Limited mobility

• Previous leg injury or surgery

Symptoms
 

• Leg or ankle swelling

• Aching or heaviness

• Tired or uncomfortable legs

• Throbbing or cramping

• Itching or burning

• Varicose veins

• Symptoms that worsen after prolonged standing

• Symptoms that improve with leg elevation

• Symptoms that are worse towards end of day

• Brown or reddish-brown discoloration, particularly around the ankles (The characteristic brown discoloration can occur when red blood cells leak from small blood vessels and break down, leaving iron-containing hemosiderin deposits in the tissues)

• Dry, itchy, or irritated skin

• Stasis dermatitis — inflammation caused by chronic venous disease

• Thickening or hardening of the skin and underlying tissues

• Persistent swelling

• Slow-healing wounds and venous ulcers (shallow, moist, irregular, usually by ankles)

How Is Venous Insufficiency Diagnosed?
 

-Diagnosis begins with a medical history and examination of the legs.

Your healthcare provider may evaluate:
 

• Swelling

• Varicose veins

• Skin discoloration or inflammation

• Ulcers

• Leg pulses

• Differences between the two legs

-Venous Duplex Ultrasound: may be used to evaluate blood flow and determine which veins are affected. Importantly, ultrasound can help determine whether the problem involves:
 

• Superficial or deep venous reflux, or both

• Internal or external venous compression/obstruction

• Nonvenous etiology (lymphedema, HF, etc.)

Treatment
 

Treatment depends on the severity of symptoms and which veins are affected.

​

-Compression stockings are an important treatment for many people with chronic venous insufficiency. Compression helps reduce venous pooling and swelling and assists blood in returning toward the heart. The appropriate amount of compression depends on the patient's condition. People with suspected significant peripheral arterial disease may require additional evaluation before stronger compression is used.

-Leg Elevation. Elevating the legs, preferably above the level of the heart when practical, can reduce venous pressure and swelling.

-Exercise and Movement. Walking activates the calf-muscle pump, which helps push blood upward through the veins. Regular activity and avoiding long periods of uninterrupted sitting or standing can improve venous circulation.

-Weight Management. When appropriate, weight loss may reduce pressure on the veins and improve symptoms.

-Skin and Wound Care. Dry or irritated skin should be protected and moisturized. Stasis dermatitis and venous ulcers may require additional treatment or specialized wound care.

-Procedures for Superficial Venous Insufficiency. Some people have significant reflux involving the superficial veins of the legs. When appropriate, abnormal superficial veins can be closed or removed so blood is redirected through healthier veins.

Depending on which veins are affected, treatment may include:

• Endovenous laser ablation

• Radiofrequency ablation

• Sclerotherapy, in which medication is injected into selected abnormal superficial veins to close them

• Ambulatory phlebectomy, in which symptomatic superficial varicose veins are removed through very small incisions

These procedures do not treat every form of chronic venous insufficiency. For example, treating superficial varicose veins does not directly repair damaged valves within the deep venous system. For this reason, the location and pattern of venous disease should be evaluated before deciding whether a procedure is appropriate.