Chronic Venous Insufficiency

Basic Facts

As people age, the veins located inside their legs may weaken and stretch.
When veins weaken and lose the ability to pump blood effectively, the condition is called chronic venous insufficiency (CVI).
Symptoms of CVI include varicose veins, skin problems such as sores, leg and ankle swelling, tight calves, and legs that feel heavy, tired, restless, or achy.

When veins in the legs weaken and lose the ability to pump adequate amounts of blood, the condition is called chronic venous insufficiency, or CVI.

Veins return blood to the heart in two ways. Either the force of the heart pumping fresh blood pushes blood back to the heart, or blood flows to the heart from the force of gravity. When blood has to fight gravity and flow upstream back to the heart, as it does through the deep veins in the legs, the leg muscles contract to pump blood back toward the heart.

The venous pump in action.

Vein walls are elastic, and many veins have small valves that only allow blood to flow in one direction. When leg muscles contract, they push inward against the elastic vein walls. This squeezes blood upward, opens the valves, and moves blood toward the heart. When leg muscles relax, the vein wall also relaxes and the valves inside the vein close to prevent blood from flowing backward. This method of pumping blood out of the legs is called the venous pump.

The venous pump is most effective when a person is walking and leg muscles are contracting. But when a person sits or stands, blood pressures in leg veins can build. Deep veins are usually able to withstand short periods of inactivity, but extended periods of increased pressure can stretch and weaken vein walls.

Increased blood pressure can stretch and damage vein walls. The veins may no longer be able to pump blood back to the heart.


Symptoms of CVI may include:

  • Varicose veins;
  • Ulceration or skin breakdown;
  • Lipodermatosclerosis, which may appear as a rash on the skin of the calves or ankles;
  • Reddened or discolored skin on the leg; and
  • Edema or swelling.


Venous hypertension, or high blood pressure inside veins that persists over time, is a primary cause of CVI. CVI can also be caused by:

  • A thrombus, or blood clot, that blocks blood flow in a vein, called deep vein thrombosis; or
  • Phlebitis, an inflammation of a superficial vein that causes a blood clot to form.

Risk factors may include:

  • Heredity;
  • Obesity;
  • Pregnancy;
  • Sedentary lifestyle;
  • Smoking;
  • Jobs requiring long periods of standing or sitting in one place; and
  • Age and sex (women in their 50s are more prone to developing CVI).


Physicians can diagnose CVI after performing a careful medical history and physical examination. To confirm a diagnosis of CVI, the physician may also order one or more of the following:

  • Duplex ultrasound;
  • Plethysmography; and
  • Venograms.


The goals of treatment for CVI are to restore a person to an active life and to minimize pain or disability. Typically, CVI does not pose a serious threat to life or limb, and with proper treatment most people with this condition can continue to lead active lives. In most cases, mild CVI can be treated on an outpatient basis with simple procedures. Treatment methods include:

  • Elastic compression therapy;
  • Sclerotherapy;
  • Vein stripping;
  • Deep vein surgery; or
  • Valve repair.