Chronic Venous Insufficiency: Symptoms, Causes & Treatment

Chronic venous insufficiency (CVI) affects millions of adults, yet many don’t fully understand this progressive vascular condition. When your leg veins can’t effectively pump blood back to your heart, you may experience uncomfortable symptoms like swelling, pain, and visible skin changes.

This comprehensive guide explores everything you need to know about chronic venous insufficiency, from recognizing early warning signs to understanding available treatment options that can help you manage this condition and, in turn, improve your quality of life.

Key Takeaways

• Chronic venous insufficiency develops when leg veins can’t return blood efficiently enough back to the heart, causing blood to pool in the lower extremities.
• Watch for symptoms such as persistent leg swelling, heaviness, fatigue, varicose veins, and skin discoloration that worsen throughout the day.
• Effective management involves combining lifestyle changes, compression therapy, and medical procedures as needed.
• Prompt diagnosis and treatment can prevent progression to more serious complications like venous ulcers.

What Is Chronic Venous Insufficiency?

Chronic venous insufficiency is a condition that describes when the veins in your legs can’t efficiently return blood to your heart. Under normal circumstances, your leg veins work against gravity with the help of one-way valves and muscle contractions to push blood upward and back to the heart for recirculation. However, for individuals living with chronic venous insufficiency, the valves become weakened or damaged, causing blood to flow backward and pool in the lower legs.¹

This condition affects approximately 10% to 35% of adults, with prevalence increasing significantly with age.² Women experience chronic venous insufficiency more frequently than men, particularly after pregnancy or during hormonal changes. The condition becomes more common after the age of 50, although it can develop at any age, depending on individual risk factors.¹

Understanding how chronic venous insufficiency differs from other swelling conditions helps clarify the diagnosis and treatment. Lymphedema is a chronic, progressive condition that involves the lymphatic system’s inability to drain fluid properly. While venous disease impacts venous circulation, lymphatic insufficiency presents when chronic venous insufficiency progresses, requiring both the veins and lymphatics to be treated.

Lipedema is another chronic and progressive condition, characterized by symmetrical fat distribution in the legs and arms. For lipedema patients, chronic venous insufficiency is a common comorbidity, as the increased pressure and inflammation caused by abnormal fat accumulation can overwhelm the lymphatic and venous systems.

Stages of chronic venous insufficiency

Chronic venous insufficiency progresses through seven distinct stages. Healthcare providers use this staging system to determine the most appropriate treatment approaches and monitor progression.^1,2

• Stage 0: No visible signs of or symptoms of venous disease.
• Stage 1: Spider veins or small varicose veins appear, typically measuring less than 3mm in diameter.
• Stage 2: Larger varicose veins become visible, usually exceeding 3mm in diameter and appearing rope-like or bulging.
• Stage 3: Swelling (edema) develops in the legs and ankles, often worsening throughout the day.
• Stage 4: Skin changes occur, including darkening, thickening, or inflammation around the ankles and lower legs.
• Stage 5: Skin changes progress with a healed venous ulcer present, indicating previous tissue breakdown.
• Stage 6: Open non-healing venous ulcers develop, representing the most severe stage, that are painful and prone to infection.

What Causes Chronic Venous Insufficiency?

Multiple factors can contribute to chronic venous insufficiency, often working in combination to weaken the vein walls and damage the delicate valves that prevent blood from backing up. Common chronic venous insufficiency causes include:^1,3

• Age: As we get older, our vein walls naturally lose elasticity and strength, while the valves inside veins may become less effective at preventing backward blood flow.
• Deep vein thrombosis (DVT): Also known as a blood clot, DVT can cause lasting damage to the vein valves even after the blood clot dissolves. The inflammatory process and pressure from the clot can permanently impair valve function, leading to chronic venous insufficiency in the affected leg.
• Prolonged sitting or standing: This puts continuous pressure on leg veins without the benefit of muscle contractions that normally help pump blood upward. People in occupations requiring extended periods in one position face higher risks of developing venous problems.
• Family history: This plays a crucial role, as genetic factors influence vein wall strength and valve development. If your parents or siblings have chronic venous insufficiency or varicose veins, your likelihood of developing the condition may be higher.
• Obesity: This adds extra pressure to leg veins, while potentially reducing physical activity levels that help maintain healthy circulation. Excess weight also increases inflammation throughout the body, which can contribute to damage to the vein walls.
• Pregnancy: This increases blood volume and hormone levels that relax vein walls, while the growing uterus puts pressure on pelvic veins.
• Smoking: This damages blood vessels throughout the body, including the delicate structures within veins. The chemicals in tobacco reduce oxygen delivery to tissues and promote inflammation that weakens vein walls over time.
• Damage to vein valves: Injury, surgery, or medical procedures can directly cause chronic venous insufficiency. Any trauma that affects the intricate valve mechanisms may result in permanent impairment of venous return.

What Are the Symptoms of Chronic Venous Insufficiency?

Chronic venous insufficiency symptoms typically develop gradually and may initially be subtle enough to be overlooked or attributed to other causes. Recognizing these symptoms early can help you get the necessary treatment before the condition progresses.^1,2

• Swelling: This usually begins around the ankles and feet, then gradually extends up the legs. The swelling may initially be mild and intermittent, but becomes more persistent and pronounced as the condition advances.
• Heaviness and tightness: These sensations in the legs create a feeling that many people describe as having their legs weighted down or feeling as if they are wrapped tightly.
• Fatigue: This develops in the legs as the circulatory system works harder to overcome the impaired venous return. Many people with chronic venous insufficiency report that their legs feel tired or weak, especially later in the day or after physical activity.
• Pain and discomfort: Pain and discomfort can range from mild aching to sharp, burning sensations. The pain typically worsens with prolonged standing and improves with leg elevation or walking.
• Varicose veins: These appear as enlarged, twisted, rope-like veins visible beneath the skin surface. These damaged veins often feel tender to the touch and may cause localized discomfort or throbbing sensations.
• Skin changes: These develop as chronic venous insufficiency progresses. The skin may appear brown, red, or purple due to blood pooling and iron deposits from broken-down red blood cells. The affected skin may also become thick, dry, or leathery in texture.
• Ulcers: These are the most serious complication of untreated chronic venous insufficiency. Without proper treatment, these ulcers can become infected and significantly impact quality of life.

How Is Chronic Venous Insufficiency Diagnosed?

Diagnosing chronic venous insufficiency begins with a comprehensive medical evaluation that combines your symptom history with physical examination findings. Your healthcare provider will ask about when symptoms occur, what makes them better or worse, and whether you have risk factors for venous disease.

During the physical examination, your doctor will carefully inspect your legs for visible signs of chronic venous insufficiency, including varicose veins, swelling, skin discoloration, and any open wounds. They may also feel for areas of tenderness or check how quickly swelling rebounds when pressed.

The most important diagnostic tool for chronic venous insufficiency is ultrasound, a painless imaging study that evaluates blood flow patterns and vein structure. This test uses sound waves to create detailed images of your leg veins, measuring both the direction and speed of blood flow.¹

How Do You Treat Chronic Venous Insufficiency?

Chronic venous insufficiency treatments aim to improve blood flow, reduce symptoms, prevent complications, and enhance quality of life. The most effective approach typically combines multiple treatment strategies tailored to your specific situation and disease severity. Options include:¹

• Lifestyle modifications: Regular exercise, particularly walking, swimming, and calf-strengthening activities, helps activate the muscle pump that assists venous return. Leg elevation several times daily reduces swelling and improves circulation. Meanwhile, weight management reduces pressure on leg veins while improving overall cardiovascular health.
• Compression therapy: This is one of the most effective chronic venous insufficiency treatments. Graduated compression garments apply controlled pressure, helping push blood upward toward the heart.
• Pneumatic compression devices: Pneumatic compression devices like Tactile Medical’s Flexitouch Plus and Nimbl systems provide intermittent compression that can significantly improve symptoms and circulation.
• Medications: These may help manage chronic venous insufficiency symptoms, though they don’t cure the underlying condition. For example, blood thinners can help treat and prevent blood clots, while antibiotics are used to treat skin infections.
• Endovenous laser ablation or radiofrequency ablation (RFA): This treatment uses heat energy to close damaged veins, forcing blood to redirect through healthier vessels.
• Sclerotherapy: This therapy involves injecting a solution into varicose and spider veins, which causes them to close and eventually disappear. This treatment works well for cosmetic improvements and symptom relief in less severe cases.
• Surgery: This becomes necessary for advanced chronic venous insufficiency that doesn’t respond to conservative treatments. Procedures include ligation (tying off problem veins), and vein bypass surgery for severe cases with extensive damage.

Chronic Venous Insufficiency FAQs

What is the life expectancy for someone living with chronic venous insufficiency?

Chronic venous insufficiency isn’t a life-threatening condition, and people with this diagnosis can expect normal life expectancy with proper management. However, the condition is progressive, meaning symptoms typically worsen over time without appropriate treatment. With consistent care that includes compression therapy, lifestyle modifications, and medical treatments when needed, most people maintain an excellent quality of life.

Can chronic venous insufficiency be reversed?

Unfortunately, chronic venous insufficiency cannot be completely reversed because the underlying valve damage is permanent. However, this doesn’t mean you’re without options for feeling better. The condition is indeed progressive, but following a comprehensive treatment protocol can significantly slow its advancement and dramatically reduce symptoms.

How can you manage chronic venous insufficiency at home?

Several home management strategies can significantly improve chronic venous insufficiency symptoms and slow disease progression. The treatments for swelling include:

• Maintaining a healthy weight to reduce the amount of pressure on your leg veins and improve overall venous and lymphatic circulation throughout your body
• Regularly exercising, partaking in activities that work your calf muscles to activate the natural muscle pump that assists blood return to your heart, such as walking, biking, or swimming
• Practicing good skin hygiene to help prevent infections like cellulitis
• Avoiding sitting or standing for long periods to prevent blood pooling
• Elevating your legs above heart level several times daily for immediate symptom relief
• Wearing prescribed compression garments consistently, as it’s one of the best ways to manage chronic swelling
• Using pneumatic compression devices, such as Tactile Medical’s Flexitouch Plus or Nimbl systems, for clinically effective lifelong management
• Learning how to do a lymphatic massage to help improve circulation and reduce swelling when performed correctly
  

Wrapping Up: Understanding Chronic Venous Insufficiency

Early detection and proactive treatment of CVI can make a significant difference in your life. If you’re experiencing symptoms that might indicate chronic venous insufficiency, don’t wait to consult with a healthcare provider. They can perform the necessary evaluations to confirm the diagnosis and work with you to develop a personalized treatment plan.

For those requiring advanced compression therapy, Tactile Medical’s Flexitouch Plus and Nimbl systems offer doctor-prescribed pneumatic compression devices that can significantly improve symptom management as part of a comprehensive treatment approach.

References
1. “Chronic Venous Insufficiency: Causes, Symptoms & Treatment.” Cleveland Clinic, Jul 22 2025, my.clevelandclinic.org/health/diseases/16872-chronic-venous-insufficiency-cvi.
2. Patel SK, Surowiec SM. Venous Insufficiency. [Updated 2024 Feb 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430975/
3. “Chronic Venous Insufficiency.” Johns Hopkins Medicine, Aug 8 2021, www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-venous-insufficiency.