Chronic Venous Insufficiency

What Is Chronic Venous Insufficiency (CVI)?

Chronic venous insufficiency, or CVI, is a condition in which veins have problems moving blood back to the heart. It’s also known as chronic venous stasis, phlebitis or post-thrombotic syndrome. It most often affects veins in the legs, although it sometimes occurs in the arms.

What Causes Chronic Venous Insufficiency?

Chronic venous insufficiency can develop from common conditions such as varicose veins. It can also occur if something, such as a deep vein thrombosis or other clot, damages the valves inside the veins.

Over time, as the veins become increasingly weak, they have more trouble sending blood to the heart. Tiny valves in the veins can fail. As a result, blood pools in the lower limbs, causing pain, leg swelling and other circulation problems.

Not everyone with varicose veins develops chronic venous insufficiency. It is more common in people who have risk factors such as:

Being female, tall or carrying extra weight (obesity)
Family history of CVI
History of deep vein thrombosis in the legs
Middle age or older
Pregnancy
Standing or sitting for long periods

Chronic Venous Insufficiency Symptoms

Symptoms of chronic venous insufficiency are similar to signs of varicose veins. But as CVI worsens, many people also notice skin changes and more severe pain and discomfort.

Symptoms of chronic venous insufficiency include:

Dull aching, cramping or heavy feeling in the legs
Leg swelling
Pain that worsens when you stand and improves when you put your legs up
Tingling sensation in the legs
Visible varicose veins on the surface

With CVI, you may notice skin changes on the legs. You may have wounds that don’t easily heal, and skin may appear:

Irritated or cracked, especially if you scratch
Red, crusty or weepy (stasis dermatitis)
Swollen
Thick or hard on the legs and ankles (lipodermatosclerosis)

How Is Chronic Venous Insufficiency Diagnosed?

We diagnose chronic venous insufficiency by performing a physical exam. We ask about your symptoms and lifestyle and look at the appearance of your legs. Your doctor will specifically look at your leg veins when you stand up and when you sit with your legs dangling.

Your doctor may order imaging tests. You may have these tests in the Penn Medicine vascular testing and diagnosis labs:

Duplex ultrasound: This noninvasive test uses sound waves to show blood flow in your veins and help rule out other problems, such as a blood clot.
CT or MRA scan: For severe swelling that is difficult to treat, your doctor may order a CT or MRA scan to show blockages or narrowed veins in your abdomen and legs.

CVI Treatment at Penn Medicine

If you notice signs of CVI, it’s wise to see a Penn Medicine doctor for treatment. Without treatment, chronic venous insufficiency tends to get worse. But lifestyle changes and medication can slow the progression. If noninvasive care doesn’t help, we offer many procedures and surgical options.

Medical Management

For many people, noninvasive care can reduce symptoms of CVI. Your provider may recommend:

Achieve or maintain a healthy weight: Your doctor can recommend a weight loss plan if you need to reduce your weight. Exercise improves circulation and can help you lose weight or prevent weight gain.
Avoid putting pressure on leg veins: Try not to sit or stand for long periods during the day. Instead, move around frequently. Sit with your feet flat on the floor instead of crossing your legs.
Get wound care for leg wounds: If you develop sores (ulcers) on your feet or legs, treat them carefully. Your doctor can suggest appropriate creams, lotions or medication for cracked or dry skin. For nonhealing wounds, your doctor may suggest treatment at the Penn Advanced Limb Preservation Program.
Try compression stockings: Compression stockings are tight-fitting socks. They gently squeeze your legs, helping blood to move toward your heart and reducing swelling.

Procedures and Surgeries

If you have more severe symptoms of CVI that don’t respond to medical management, your doctor may recommend a minimally invasive procedure or surgery. Penn’s Vascular Surgery and Endovascular Therapy Program offers expertise in many procedures to treat chronic venous insufficiency.

These procedures close off the problematic vein. Your body reroutes blood flow through other blood vessels. Your options include:

Phlebectomy: In a phlebectomy procedure, a vascular surgeon makes tiny incisions in your leg and removes the damaged vein. After the procedure, you’ll wear compression stockings for a few weeks, but you can soon return to your usual activities.
Laser therapy and radiofrequency ablation (RFA): These minimally invasive procedures use a narrow tube (catheter). Your physician threads a tiny laser or RFA (heat) device into the vein. The heat seals the vein closed.
Sclerotherapy: This procedure involves injections of saltwater or a chemical solution into your vein. The solution causes the vein to harden and disappear after some time. Your vascular surgeon may perform several treatments to eliminate the problematic vein.
Vein stripping: Vein stripping is an outpatient surgical procedure to remove the saphenous vein, a large vein near the surface of your leg. Through small incisions, your vascular surgeon ties off the vein and removes it. Vein stripping may be an option if other treatments don’t work.
Angioplasty and stents: Occasionally, a blocked or collapsed vein causes CVI. A vascular surgeon can use a tiny balloon on the end of a catheter (narrow tube) to reopen blood vessels. A stent (a small mesh tube) stays in place permanently to hold open the vein.
Bypass surgery: Rarely, when the problem is severe, your surgeon may perform bypass surgery. This open surgery uses an artificial vein or a vein from elsewhere in your body to redirect blood flow around the failing vein.