Chronic venous insufficiency (CVI): Symptoms and stages

As you get older, you may start to notice veins in your legs become more visible or puffy. These vein changes usually don’t have a big impact on your health, but they can start to affect how blood moves through your body.

Chronic venous insufficiency (CVI) is a vein condition that can cause symptoms that get worse over time and affect your quality of life. Early signs of venous disorders can include varicose veins, swelling and discomfort. More advanced symptoms may include discolored skin and venous ulcers, which are open sores that can be slow-healing or nonhealing, and at a higher risk of infection.

Read on for more about the symptoms of chronic venous insufficiency, what you can do to keep it from getting worse and when to seek treatment.

What is chronic venous insufficiency?

The meaning of chronic venous insufficiency is right in the name:

  • Chronic, as you may know, means it doesn’t go away.
  • Venous means that it’s related to your veins.
  • Insufficiency means there isn’t enough of something. In this case, the valves in your veins are weakened and don’t have enough power to push your blood up toward the heart.

If you have CVI, blood pools in one area, increasing pressure on your veins and skin, and making injuries more likely. Since your blood follows the path of gravity, CVI mostly occurs in your legs, but it’s possible to get it in your arms as well. Other names for this condition include chronic venous stasis and peripheral venous disease.

CVI is most often diagnosed and treated by vein and vascular specialists in partnership with a primary care doctor. Wound healing specialists treat the venous ulcers that can develop when CVI reaches more advanced stages.

Is venous insufficiency similar to arterial insufficiency?

Both conditions are caused by insufficient blood flow. But venous insufficiency usually just affects blood flow in your extremities, while atrial insufficiency affects your entire body. People with venous insufficiency often have arterial insufficiency in their legs – a condition commonly referred to as peripheral artery disease.

Spot early signs of vein changes

Changes in the appearance of leg veins are very common, especially as you get older. While these changes do not mean you have or will get a venous disorder like CVI, it’s good to know about possible symptoms, in case you start to notice additional changes.

There are seven stages of venous disorders, based on what the affected area looks like.

Early stages of venous disorders

Spider veins and varicose veins are some of the earliest visible signs of a potential venous disorder. For many people, these vein changes don’t go on to cause major health problems or a more serious vein condition. But for others, they can be a warning sign of conditions like CVI.

Stage Visible symptoms
Stage 0 No visible symptoms
Stage 1 Visible blood vessels, such as spider veins
Stage 2 Varicose veins that are at least 3 millimeters (about 1/8 inch) wide

If you notice any early stages of vein changes, it’s a good idea to let your primary care doctor know. They’ll be able to recommend self-care and home treatment methods, as well as refer you to a vein and vascular specialist if needed.

Stages of chronic venous insufficiency

A CVI diagnosis generally means that your symptoms are at stage 3 or above. In the early stages of venous insufficiency, symptoms are generally mild. You might feel a dull ache in your legs or start to notice a few spider veins.

But as venous insufficiency becomes more advanced, you’ll likely notice more changes in your skin and an increase in discomfort or pain. In the most advanced stages of CVI, venous ulcers can appear.

Stage Visible symptoms
Stage 3 Leg swelling
Stage 4 Changes to skin color or texture
Stage 5 Healed leg wound (venous ulcer)
Stage 6 Open leg wound (venous ulcer)

Chronic venous insufficiency symptoms to watch for

So how do you know if your varicose veins are something more? If vein problems are affecting blood flow, there will be other changes in how your legs look and feel.

How your legs feel when you have chronic venous insufficiency

Painful legs are a common symptom of CVI – you may feel dull aching, heaviness, pain, burning, tingling, itchiness and cramping. Symptoms are usually worse at night or after standing for a while. Your legs will likely feel better when you put your feet up.

How your legs look can be signs of venous insufficiency

Changes in skin texture and color are often among the earliest signs of CVI. Here are things to watch for:

  • Swelling (edema): You may have swollen ankles or legs. This is usually most noticeable at the end of the day or after standing for a while.
  • Changes in skin color: In the beginning, you may notice darker or reddish-brown skin on the inside of your ankles or on your shins and feet. Scarring from a healed wound may have less color than the surrounding skin.
  • Leathery skin: Thick or hard skin on your legs or ankles can also be a sign of CVI.
  • Dry or irritated skin: You may have skin that’s itchy, flaky or cracking. It may also be red, crusty or weeping.

Venous ulcers (open sores) are serious signs of chronic venous insufficiency

About 20% of people with CVI have venous ulcers, which most often develop near the ankles. These open sores don’t heal easily because good blood flow is important for wound healing – and blood flow is restricted when you have CVI. Also, because venous ulcers are an open wound that can be hard to heal, they’re at a higher risk of infection.

So if you think a venous ulcer is beginning to form or you have been managing an open sore on your legs that doesn’t seem to be getting better, it’s important to get care quickly.

Making an appointment with a wound healing clinic like Amery Hospital & Clinic’s Wound Healing Center is the ideal next step. Their care team specializes in treating slow-healing and nonhealing chronic wounds caused by a range of conditions. If you’re not sure where your closest wound clinic is, make an appointment with your primary care doctor and they can help connect you with more advanced care if needed.

If you have an open wound and are noticing signs of a potential infection – such as fever, increasing redness around the wound, or the skin near the wound is hot to the touch – it’s a good idea to go to your nearest emergency room as a precaution.

Risk factors that can cause chronic venous insufficiency

Different factors can increase the chance that you’ll get CVI.

  • Varicose veins: About 20% of adults have varicose veins. Of those with varicose veins, about 1 in 50 will develop CVI.
  • Being middle age or older: People over the age of 65 are more likely to have worse CVI symptoms.
  • Being female or assigned female at birth: Female hormones and physical factors can make it more likely you’ll develop CVI. A previous pregnancy also increases your risk, with more pregnancies being linked to more risk.
  • Low levels of physical activity: A sedentary lifestyle can increase your risk of CVI and make your symptoms worse.
  • Standing or sitting for long periods: Sitting and standing can allow blood to pool in your lower legs, increasing your chance of CVI. Even sleeping in a chair or recliner can increase your risk.
  • Being overweight: There are different reasons why extra weight can increase your risk of CVI, including increased vein diameter and venous pressure.
  • Smoking and tobacco use: Tobacco products can cause swelling and inflammation throughout your body, making it harder for your body to move blood.
  • Family history: You’re more likely to develop CVI if someone in your family had it.
  • Certain medical conditions: If you have May-Thurner syndrome or another condition that affects blood flow, you’re more likely to develop CVI.
  • Blood clot (deep vein thrombosis) in your leg: If you’ve had a blood clot in your leg, there’s a high chance that you’ll develop CVI within a couple of years.

Ways to help prevent Chronic venous insufficiency

People often wonder if they can prevent CVI. It’s not always possible, but you can lower your risks if you make changes to your lifestyle.

  • Elevate your legs: Raising your legs above the level of your heart can help blood move towards your heart, instead of pooling in your legs. When lying down, put a pillow or two under your legs and stay that way for about 30 minutes. Repeat throughout the day as needed.
  • Exercise: Moving your body helps to keep your blood moving. Plus, it can help with weight control. If you’re not sure how to begin exercising, taking short walks is a good place to start. Try to work up to at least 30 minutes of activity, most days.
  • Change your position: Since you want to reduce the pressure on your leg veins, try not to stand or sit in one place for too long. When sitting, avoid crossing your legs. Instead, put both feet flat on the floor.
  • Pay attention to your weight: If you’re overweight, losing weight can reduce your chance of getting CVI. Losing weight is a challenge for most people, so talk to your doctor if you’d like some help.
  • Eat a balanced diet: Try to eat a heart-healthy diet filled with fruits, veggies, lean proteins and healthy fats. It’s especially important to watch the amount of salt in your diet – too much salt can cause your body to retain water. This may cause swelling in your legs, putting pressure on your veins and making them weaker.
  • Drink more water: Even though one of the symptoms of CVI is swelling caused by water retention, drinking more water does help with venous insufficiency. That’s because water helps thin your blood, making it flow more easily.
  • Wear comfortable clothing and shoes: Tight clothing, girdles, belts and high-heel shoes can make it harder for blood to flow through your body. It’s best to wear loose clothing and shoes with a low heel.
  • Take good care of your skin: Try to wash and moisturize your legs every day. If you see changes in your skin or signs of an ulcer, make an appointment with your primary care doctor.
  • Avoid smoking and other tobacco products: Quitting smoking is one of the best things you can do to improve your overall health. Talk to your doctor if you’d like help quitting.
  • Take your recommended medications: For example, if you have deep vein thrombosis, your doctor may recommend anticoagulants.

Can chronic venous insufficiency be reversed? No, but symptoms can be managed

While there’s no way to reverse CVI, the good news is that lifestyle changes and treatments can help you manage the condition. For example, treatment can’t fix damaged veins, but removing or blocking off those veins can help ease or eliminate symptoms, so you feel better.

Options for treating chronic venous insufficiency

Those diagnosed with CVI often experience worsening symptoms over time, especially if they’re not following a treatment plan designed for them by their care team. Your care team may include your primary care doctor and vein and vascular specialist, as well as a wound healing expert if needed.

Compression therapy is one of the best treatments for chronic venous insufficiency

Compression therapy uses controlled pressure to improve the flow of blood in your legs and make it easier for blood to move from your legs up toward your heart.

  • Compression stockings: The simplest form of compression therapy is wearing tight-fitting socks that gently squeeze your legs. You can buy compression stockings at retail stores or online. There are also prescription stockings that provide more compression than those you buy at a store.
  • Compression pumps for venous insufficiency: If your CVI is in a later stage, your doctor may recommend an intermittent pneumatic compression (IPC) pump if other treatments aren’t working. This pump has inflatable sleeves you wear on your legs that help blood flow through your veins. But IPC therapy may not be appropriate for all people. For example, you’ll need to be extra careful with IPC therapy if you also have peripheral artery disease (PAD). So, always be sure to follow your doctor’s recommendations.

Medications can address some causes and symptoms of chronic venous insufficiency

Your doctor may prescribe medications to help improve how blood flows through your body. If you have infected ulcers caused by CVI, your doctor will prescribe antibiotics.

Procedures and surgeries for chronic venous insufficiencies are usually minimally invasive

Your doctor will work with you to determine which procedure makes sense, based on the stage of your CVI and other factors:

  • Sclerotherapy: Your doctor injects a foam or liquid solution into your vein. This causes the vein to collapse or disappear after some time. You may need multiple treatments.
  • Radiofrequency ablation (RFA): This treatment for larger veins uses high-frequency radio waves to seal the vein. Since the vein is left in place, there is minimal bleeding and bruising.
  • Avulsion: Your doctor may recommend avulsion for varicose veins near the surface of your skin. During the procedure, your doctor will make small incisions in the skin over your veins. Then, they’ll use a special hook to remove the damaged vein.
  • Vein ligation and stripping: Vein ligation is a procedure where your doctor cuts and ties off the veins that are causing you problems. Vein stripping is a procedure that may be used for larger veins when other treatments don’t work – it involves removing the vein through two small incisions that your doctor makes in the skin.
  • 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: If nothing else works, your doctor may use an artificial vein or healthy vein from somewhere in your body to redirect blood flow around the damage vein.

Venous ulcers need specialized wound care

As mentioned earlier, venous ulcers can be a complication of more advanced CVI. They can be difficult to heal on their own, so working with a wound healing specialist – like those at our Wound Healing Center – can be an important part of the treatment plan. Wound healing centers offer a range of advanced treatment options, including hyperbaric oxygen therapy, skin grafts and cellular implants.

When to see a doctor about chronic venous insufficiency symptoms

If you’ve noticed a new spider vein or varicose vein, it doesn’t mean you have or will have a chronic vein condition. But if you have varicose veins and are noticing additional symptoms such as swelling, cramping, aching or a heavy feeling in your legs, or irritated or cracked skin, it’s a good idea to see a primary care doctor. If needed, they’ll refer you to a vein and vascular specialist for more advanced care.

Make an appointment at a wound healing center if you have an open sore on your leg, especially if it doesn’t seem to be healing.