What Is Chronic Venous Insufficiency?

Written by Teresa Dumain, Julie Marks
Medically Reviewed by Brunilda Nazario, MD on July 17, 2025
9 min read

The veins in your legs carry blood back up to your heart. They have one-way valves that keep blood from flowing back downward. When you have chronic venous insufficiency (CVI), these valves can't close completely. As a result, some of the blood goes back down into your legs and pools in the veins there. CVI can also keep your leg muscles from pumping enough blood back toward your heart. It sometimes results in vein blockages, too. 

CVI can affect all the types of veins in your legs. This includes:

  • Deep veins. These are the large veins found deep in your body.
  • Superficial veins. They're close to your skin’s surface. You can often see these veins.
  • Perforating veins. These veins connect deep and superficial veins.

Over time, CVI can cause pain, swelling, varicose veins, and skin changes in your legs. It may also lead to open sores called ulcers on your legs.

How common is chronic venous insufficiency?

It's a fairly common condition in older people. In the U.S., more than 11 million men and 22 million women ages 40- 80 have varicose veins, while over 2 million people have advanced CVI. More than 20,000 people are diagnosed with ulcers due to CVI each year.

Chronic venous insufficiency vs. post-thrombotic syndrome

CVI and post-thrombotic syndromeboth involve damage to your leg veins. But post-thrombotic syndrome is a specific type of CVI. It’s caused by deep vein thrombosis (DVT), which is a blood clot that develops in one of your deep veins. Even after the clot goes away, it can leave behind scar tissue that harms the vein.

A blood clot in a deep vein in your leg can damage a valve there. Lack of exercise can cause CVI, too. So can sitting or standing for long stretches of time. That raises blood pressure in your veins and may weaken the valves.

The causes of valve damage can be:

  • Congenital. This means you’re born with problems in your leg veins.
  • Primary. Your leg veins change, and they don’t work the way they should.
  • Secondary. Medical conditions, such as DVT, damage your leg veins.

 

Women are more likely than men to get CVI and have vein problems. In fact, those assigned female at birth (AFAB) are nearly twice as likely to have varicose veins (twisted, enlarged veins close to the surface of the skin). Some research suggests that the higher rates of CVI in people AFAB may be due to changes that happen in pregnancy. 

CVI can run in families, so you're more likely to get it if other close family members have had it. Your chances are also higher if you:

  • Have obesity
  • Are over 50
  • Are pregnant, or have been pregnant more than once
  • Previously had a deep vein blood clot 
  • Smoke
  • Have a job that keeps you on your feet for long stretches of time

You may notice these symptoms in your legs:

  • Swelling or heaviness, especially in the lower leg and ankle
  • A dull ache or cramping in the legs
  • Tingling or burning in your legs
  • Painthat gets worse when you stand or gets better when you put your legs up
  • Itchiness
  • Varicose veins
  • Chronic venous insufficiency skin changes, which may include skin that's irritated, cracked, discolored, flaky, or weepy, or that looks like leather 

Without treatment, the pressure and swelling will burst the tiny blood vessels in your legs called capillaries. That could turn fair skin reddish-brown, especially near the ankles. This can lead to swelling and ulcers. It's hard for these ulcers to heal. They are also likely to get infected, which can cause more problems.

If you have any symptoms of CVI, talk to your doctor. The sooner you treat it, the less likely you are to get ulcers.

To classify venous disorders, doctors use these stages:

Stage 0. You have no signs that can be seen or felt. But you may have some symptoms, such as achy or tired legs.

Stage 1. You have visible blood vessels, including spider veins. 

Stage 2. You have varicose veins, twisted and enlarged superficial veins that are at least 3 millimeters wide when you're standing up.

Stage 3. You have swelling but no skin changes.

Stage 4. You notice changes to your skin’s color or texture.

Stage 5. You have a healed ulcer.

Stage 6. You have an active ulcer. 

Early stages of chronic venous insufficiency 

In the beginning stages of a venous disorder, you might notice tired or achy legs. These early signs could get worse over time, so it’s important to tell your doctor about them. 

 

Your doctor will take your medical history. They'll also check the blood flow in your legs with a test called a vascular or duplex ultrasound. For this test, they will place a small device on your skin in the affected area. Using sound waves, they can see the vessels in your lower leg and to what extent blood is flowing backward.

Sometimes, you may need X-rays or specific scans to check for other possible causes of your leg swelling. Specific imaging tests, such as magnetic resonance angiography (MRA) or computed tomography (CT) scans, can show blockages or narrowed veins.

Venous insufficiency test 

Doctors can use the results of several tests, including a physical exam, duplex ultrasound, and other scans, to diagnose venous insufficiency.  They'll also consider whether you have a history of leg ulcers and if there's evidence of a blockage in a vein.  

The main goal of CVI treatment is to ease your symptoms and prevent leg ulcers. Your doctor may suggest a combination of treatments based on your age, symptoms – including whether you have varicose veins – and other things. Some options to help manage CVI include:

Lifestyle changes

Most cases of CVI can be managed with conservative measures like leg elevation, compression stockings, and exercise 

Elevation. Keeping your legs raised above your heart helps boost blood flow and reduce swelling. You might do this at least three times a day for at least 30 minutes at a time. 

Compression stockings. These elastic socks put gentle pressure on your legs to help blood move. They come in different degrees of tightness, and different lengths and styles. Your doctor can suggest which might work best for you.

Exercise. Regular exercise aids circulation and blood flow. Your routine can be as simple as walking. When you move your calf muscles, this strengthens them and helps them pump blood up to your heart.Talk to your doctor about what kind of exercise and how much is best.

Weight control. If you weigh more than your doctor thinks is healthy for you, they may suggest losing weight. Excess weight adds pressure to your leg veins, which raises your risk of valve damage. Your doctor can let you know how to find a weight management plan that will work for you.

Chronic venous insufficiency medications

Your doctor may prescribe an antibiotic to treat infections or leg ulcers. Sometimes, they’ll give you medicine to help prevent blood clots. These are called blood thinners.

You may also receive a medicated wrap. It consists of compression materials and a zinc oxide ointment. 

Chronic venous insufficiency medical procedures 

If your CVI is further along, you may need a nonsurgical or minimally invasive treatment.

Endovenous thermal ablation. This newer method uses high-frequency radio waves or a laser to heat and close the problem vein.

Sclerotherapy. Your doctor will inject a solution into the problem vein. It scars the vein, forcing blood to flow through healthier veins. Over time, your body absorbs the scarred vein.

Stenting. Your doctor can insert a small mesh tube called a stent to open blocked veins in your pelvis or upper legs. They'll make a small cut in your groin area, then insert a tube with a tiny balloon on the end into the affected vein. They inflate the balloon to widen the vein. Then, they place the stent in the vein to keep it open and improve blood flow. 

Surgery for chronic venous insufficiency

Fewer than 1 in 10 people need surgery for CVI.

If you have lasting symptoms, significant backward blood flow, or complications like leg ulcers, you might have:

Ligation and stripping. The vein is cut and tied off so blood can’t flow through. Your doctor may also remove a vein that is very damaged. You usually will go home on the same day.

Ambulatory phlebectomy or microphlebectomy. This technique uses much smaller cuts, punctures, and small hooks to remove damaged veins.  You'll usually have this done after, or at the same time as, thermal ablation.

Some things you can do to care for yourself when you have CVI include:

Move. Try not to sit or stand for a long time, and avoid crossing your legs when you sit. If you have to sit for a while, stretch or wiggle your legs, feet, and ankles often to help your blood flow. If you stand a lot, take breaks to sit and put your feet up. This helps lower pressure in your leg veins. On long flights, flex your legs, feet, and ankles from time to time.

Care for your skin. Look for changes in your skin every time you bathe. Tell your doctor if you notice any ulcers, and follow their advice to treat them. Keep your legs and feet well-moisturized to prevent cracks that could turn into infected sores. Your doctor can recommend creams and lotions that can help.

Wear loose, comfortable clothing and shoes. Tight shoes or clothes can interfere with blood flow in your legs. So can shoes with high heels.

Follow your treatment plan. Wear compression stockings as your doctor recommends, exercise regularly, and take time to elevate your legs every day.  

Diet for venous insufficiency

Doctors typically suggest a heart-healthy diet for venous insufficiency. This includes lots of vegetables, fruits, and whole grains, and limited saturated fats and refined carbs. Also, limit your salt intake. Excess salt can cause fluid to build up in your legs, which may put pressure on your veins and worsen CVI.

You may not be able to prevent CVI completely, but you can lower your risk with these lifestyle changes:

  • Avoid smoking or other tobacco use.
  • Don’t wear tight clothing.
  • Eat a balanced, low-salt diet.
  • Exercise regularly.
  • Maintain a healthy weight.
  • Don’t stand or sit for too long at a time.

CVI can be managed if you're treated in the early stages. The condition usually isn’t life-threatening. But it can get worse over time and affect your quality of life.  

CVI is a venous disease that happens when veins in your legs are damaged or blocked, and your muscles don't work well to help push blood to your heart. Though the damage can’t be reversed, treatments and lifestyle changes can keep your symptoms at bay. See your doctor if you have any signs of CVI.

How serious is chronic venous insufficiency?

CVI is generally not considered a serious health threat. But it can be painful and affect your quality of life. 

What are the signs of CVI?

Some common signs of CVI are:

  • Achy, heavy, or crampy legs
  • Pain that gets worse when you stand or better when your feet are raised
  • Itching and tingling in the legs
  • Swelling of the legs
  • Irritated, cracked, flaky, or thickened skin
  • Varicose veins
  • Wounds that are slow to heal