Chronic venous insufficiency 

What is the most common cause of chronic venous insufficiency?
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Chronic venous insufficiency occurs when the valves in the veins in the legs are damaged, preventing them from functioning properly.

This leads to the accumulation of blood in the legs because the valves fail to keep the blood flowing back to the heart as they normally do.

The pooling of blood in the legs due to chronic venous insufficiency results in increased pressure in the leg veins, leading to symptoms such as swelling and ulcers.

What is chronic venous insufficiency?

It is a venous disease that occurs when the leg veins fail to facilitate the return flow of blood to the heart, and chronic venous insufficiency arises.

In usual circumstances, the valves in the veins ensure the blood moves in the direction of the heart. However, if these are not functioning properly, blood may reflux. Consequently, there can be an accumulation of blood in the lower extremities.

What veins chronic venous insufficiency disease can affect?

  1. Deep veins: located deep within your body, known as deep veins, traverse through your muscles.
  2. Superficial veins: situated near the surface of your skin.
  3. Perforating veins: where your deep and superficial veins are connected.

How common is chronic venous insufficiency?

Chronic venous insufficiency is fairly common, affecting up to 20% of adults, particularly those over the age of 50.

It becomes more prevalent with age and is more common in women than in men.

What are the causes of chronic venous insufficiency?

The heart sends oxygen-rich blood and nutrients to the entire body through the arteries, while the veins carry the blood back to the heart.

To return from the legs, flows through both superficial and deep veins.

Contractions in the leg muscles help push the blood through the deep veins, with valves in the veins ensuring that flows in the right direction towards the heart and prevents any backflow.

Chronic venous insufficiency occurs when factors cause the leg veins to dilate or damage the valves.

These alterations result in reduced flow and increased pressure in the veins.

The rise in pressure, along with the decreased blood circulation, causes a buildup of fluid in the legs and various other symptoms.

The most common cause of chronic venous insufficiency is deep vein thrombosis (DVT), which is the blood clot that forms in the legs.

A blood clot can lead to chronic venous insufficiency because the tissue damage resulting from the clot can damage the valves in the veins.

Sometimes referred to as phlebitis, deep vein thrombosis can also be called postphlebitic syndrome as a sequel to vein inflammation.

What are the causes of chronic venous insufficiency?

  • Congenital absence or damage to venous valves in the superficial and communicating systems can lead to chronic venous insufficiency (CVI).
  • Venous incompetence may result from thrombus formation, as indicated by the Virchow triad (venous stasis, hypercoagulability, and endothelial trauma).
  • Varicose veins are rarely linked to CVI development; most cases of venous insufficiency are associated with reflux through the superficial veins.
  • Chronic non-healing wounds on the lower extremities can stem from various causes, with venous etiology being the most common for chronic lower-extremity ulcers.
  • Venous ulcers are predominantly triggered by venous reflux primarily confined to the superficial venous system, with only a minority attributed to chronic deep vein thrombosis or valvular insufficiency in the deep veins.

Klippel-Trénaunay-Weber syndrome:

– A less frequent contributor to venous insufficiency

– Manifests through:

– Port-wine stains

– Varicose veins

– Hypertrophy in bones or soft tissues

– Pure Klippel-Trénaunay syndrome:

– Solely venous engagement

– Parkes Weber variation:

– Exhibits arteriovenous malformations

– Port-wine stains:

– Medically called capillary hemangiomas in KTW syndrome

– Can trigger:

– Local skin disintegration

– Ulcers

– Hemorrhaging

– Infections

– Complications can arise in any system within the body

– Sciatic vein:

– Notably large superficial vessel

– Typically diminishes during fetal development

– Observable at birth or in adulthood in KTW syndrome

– Runs along the back and side of the leg, from foot to gluteal area

– In KTW syndrome, serves as a reflux route instead of facilitating normal flow

– Irregular venous pathways:

– Present in individuals with KTW syndrome

– Affect both deep and superficial venous systems

– Can induce severe venous insufficiency

– May lead to secondary lymphedema due to excessive lymph production

Surgical challenges:

– Efforts to address anomalous refluxing veins in KTW syndrome are challenging

– Frequent postoperative exacerbation of venous irregularities occurs

What is stage 3 of chronic venous insufficiency?

What are risk factors of chronic venous insufficiency?

Research indicates that individuals assigned female at birth (AFAB) are nearly twice as prone to developing varicose veins compared to their male counterparts, making them more susceptible to chronic venous insufficiency and vein disorders.

It is believed, based on certain studies, that the elevated occurrence of CVI in AFAB individuals may be linked to physiological transformations occurring during pregnancy.

  • A family history of illness increases the likelihood of developing chronic venous insufficiency in individuals with such a background.
  • Blood clots or thrombosis within the veins hinder the flow, leading to its accumulation and stagnation within the veins.
  • Vein dilation.
  • Pregnancy.
  • Obesity.
  • Smoking.
  • Venous inflammation or superficial vein swelling.
  • Individuals in occupations requiring prolonged standing or sitting.
  • Muscle weakness in the legs.
  • Cancer.
  • Women are more prone to chronic venous insufficiency compared to men.
  • Individuals over fifty years of age.

What are symptoms of chronic venous insufficiency?

  1. Experience Claudication when you feel pain, cramping, or fatigue in your legs or buttocks while being physically active, which typically subsides with rest.
  2. Encounter leg numbness or weakness that may manifest when you walk or ascend stairs.
  3. Feel coldness in your lower leg or foot as a result of decreased blood circulation that can cause your extremities to feel cold.
  4. Notice changes in skin color where your skin might appear pale or bluish.
  5. Witness slow wound healing because diminished flow can hinder the body’s ability to repair wounds.
  6. Detects weak or absent pulses in your legs that may be challenging for your doctor to locate in your feet or legs.
  7. Experience erectile dysfunction as reduced flow can impact sexual function in men which can occur in chronic venous disease.
  8. Observe hair loss or slower hair growth on your legs and feet due to a decrease in that particular area.
  9. See shiny skin on your legs that may look glossy and thin due to a reduction in blood supply.
  10. Notice thickened, opaque toenails that can occur as a result of poor circulation affecting nail health.
  11. Develop ulcers or sores on your legs or feet that fail to heal, as chronic wounds may arise from reduced flow.

How to diagnose chronic venous insufficiency?

A Comprehensive Guide to Identifying Chronic Venous Insufficiency

When facing the challenge of diagnosing chronic venous insufficiency, healthcare providers can navigate this condition effectively with the appropriate strategies.

Explore the following essential steps for diagnosing CVI:

1. The Importance of Physical Exam:

– An initial vital phase in diagnosing CVI is conducting a thorough physical examination.

Providers will delve into symptoms and lifestyle factors while closely observing the condition of the patient’s legs.

– Special attention is dedicated during the examination of chrito the state of leg veins, both when the patient stands and sits with legs hanging down.

This evaluation aids in understanding the flow dynamics and detecting any visible indications of venous insufficiency.

2. Evaluating Symptoms:

– Acquiring details about the patient’s symptoms is crucial for an accurate diagnosis. Symptoms commonly linked with CVI encompass leg discomfort, swelling, heaviness, and skin alterations like discoloration or ulcers.

– Grasping the duration, intensity, and impact of these symptoms on the patient’s daily life assists in confirming the presence of CVI and guiding treatment decisions.

3. Utilizing Imaging Techniques:

– Alongside the physical examination and symptom evaluation, healthcare professionals may employ imaging tests to further understand venous function and pinpoint underlying issues.

– Duplex ultrasound, a noninvasive imaging method utilizing sound waves to visualize blood flow in veins, supports confirming the diagnosis of CVI and ruling out alternative vascular conditions, such as blood clots.

– In situations of significant swelling or suspected abdominal vein involvement, healthcare providers may request a computed tomography (CT) or magnetic resonance angiography (MRA) scan.

These imaging tools offer intricate images of the veins in the abdomen and legs, aiding in the identification of blockages or narrowed areas contributing to CVI.

How to manage chronic venous insufficiency?

It is advisable to seek guidance from a specialist when symptoms of CVI manifest, to ensure effective treatment.

Neglecting CVI can lead to its aggravation, but a blend of lifestyle modifications and prescribed medication can help slow down its advancement. In cases where non-invasive interventions fall short, there are various procedures and surgical options that can be explored.

Managing the Condition:

Many individuals find relief from CVI symptoms through non-invasive methods.

Your healthcare provider may recommend the following approaches:

1. Weight Control: Maintaining a healthy weight is crucial. Your doctor can assist you in creating a weight loss plan, as physical activity aids in improving circulation and managing weight.

2. Reducing Vein Pressure: Limit extended periods of sitting or standing to ease pressure on leg veins. Incorporate regular movement into your routine and avoid crossing your legs while seated.

3. Caring for Wounds and avoiding them getting worse: Proper management of leg ulcers or sores is vital. Your physician might suggest appropriate creams, lotions, or medications for wound treatment.

Persistent wounds may require care at the Penn Advanced Limb Preservation Program.

4. Compression Garments: Wearing compression stockings can promote blood flow towards the heart, diminishing swelling.

Interventional Procedures and Surgical Solutions:

For individuals experiencing more severe CVI symptoms that do not respond to conservative treatments, minimally invasive procedures or surgical interventions may be recommended.

Vascular Surgery and Endovascular Therapy Program offers a breadth of expertise in dealing with chronic venous insufficiency, such as:

  1. Phlebectomy: This procedure involves minor incisions in the leg to eliminate the problematic vein, followed by wearing compression stockings during recovery.
  2. Laser Therapy and Radiofrequency Ablation (RFA): Minimally invasive techniques that use laser or RFA devices to seal off the affected vein.
  3. Sclerotherapy: Injection of a solution into the vein to induce hardening and eventual disappearance of the affected vein.
  4. Vein Stripping: Outpatient surgical removal of the saphenous vein, considered if other treatments are ineffective.
  5. Angioplasty and Stents: Interventional methods to address obstructed or collapsed veins using balloons and stents.
  6. Bypass Surgery: An uncommon but viable solution for severe cases, rerouting blood flow through artificial or alternate veins.


Chronic venous insufficiency (CVI) is a condition characterized by impaired blood flow from the legs back to the heart, leading to a range of symptoms such as varicose veins, leg swelling, and skin changes.

It can significantly impact quality of life and may lead to complications such as ulcers and infections if left untreated.

Management typically involves lifestyle modifications, compression therapy, and in some cases, surgical intervention.

Early detection and appropriate treatment can help alleviate symptoms and prevent complications associated with CVI.