Chronic Venous Insufficiency - Symptoms & Causes

What is chronic venous insufficiency?

Chronic venous insufficiency occurs when leg veins fail to efficiently return blood to the heart. Normally, vein valves prevent backward blood flow, but if they malfunction, blood can pool in the legs, leading to circulation issues.

Types of chronic venous insufficiency

• Superficial Venous Insufficiency – Affects veins near the skin’s surface and often leads to varicose veins.
• Deep Venous Insufficiency – Involves deeper veins and can be more severe, potentially causing conditions like deep vein thrombosis (DVT).
• Perforator Venous Insufficiency – Impacts the connecting veins between the superficial and deep venous systems.

Chronic venous insufficiency vs post-thrombotic syndrome

• Both terms refer to the same problem of damaged leg veins. Post-thrombotic syndrome is chronic venous insufficiency caused by deep vein thrombosis (DVT). DVT is a blood clot in a deep vein in your leg. “Post-thrombotic” means after a blood clot (which is also called a “thrombus”). After the blood clot is gone, it can leave scar tissue that damages your vein.

What are the symptoms of chronic venous insufficiency?

• Leg discomfort – Achiness, tiredness, or a heavy sensation.
• Burning or tingling – A "pins and needles" feeling in the legs.
• Nighttime leg cramps.
• Skin changes – Reddish-brown discoloration, flaking, itching, or a leathery appearance.
• Swelling (Edema) – Especially in the lower legs and ankles after prolonged standing.
• Varicose veins.
• Ulcers (open sores) – Typically near the ankles; painful sores may indicate infection.

What causes chronic venous insufficiency?

CVI occurs when leg vein valves fail, causing blood to flow backward (venous reflux) instead of toward the heart. This can result from:

• Congenital causes – Malformations present at birth, such as missing vein valves.
• Primary causes – Structural changes in veins, like widening, that prevent proper valve closure.
• Secondary causes – Damage from other medical conditions, most commonly deep vein thrombosis (DVT), where a blood clot leaves scar tissue that impairs valve function.

What are the risk factors for chronic venous insufficiency?

You are more likely to develop CVI if you:

• Are overweight
• Are pregnant
• Have a family history of the condition
• Have had damage to your leg from injury, surgery, or previous blood clots

Other contributing factors include:

• Prolonged high pressure in leg veins from sitting or standing for long periods
• Lack of exercise
• Smoking
• Deep vein thrombosis (DVT), often in the calf or thigh
• Phlebitis – Swelling and inflammation of veins close to the skin, usually in the legs.

What are the complications and related diseases of chronic venous insufficiency?

• Skin and tissue changes:

  • Stasis dermatitis: Irritated, cracked, discolored, flaky, or weepy skin due to poor circulation.
  • Lipodermatosclerosis: Hardened, thickened skin around the ankles.
  • Venous ulcers: Slow-healing sores prone to infection.
  • Pigmentation changes: Darkening of skin from iron deposits.

• Blood clot and circulation problems:

  • Deep vein thrombosis (DVT): Blood clots in deep veins, blocking blood flow.
  • Pulmonary embolism: Blood clot from DVT travels to the lungs, potentially life-threatening.
  • Superficial thrombophlebitis: Painful inflammation of superficial veins.

How do you prevent chronic venous insufficiency?

There is no proven way to prevent CVI. However, there are some things you can do to reduce your risk of CVI:

• Avoid smoking and tobacco use
• Avoid restrictive clothing, such as tight girdles or belts
• Don’t sit or stand for prolonged periods; get up and move around frequently
• Eat a heart-healthy diet, focusing on reducing sodium (salt) intake
• Exercise regularly to improve circulation
• Maintain a healthy weight to reduce pressure on your veins
• If you've had deep vein thrombosis (DVT), your healthcare provider may recommend anticoagulants to prevent further clotting