Chronic Venous Insufficiency (CVI)
What is chronic venous insufficiency?
Chronic venous insufficiency (CVI) is a long-standing condition where the leg veins fail to return blood effectively to the heart. This occurs due to failure of the one-way valves within the veins, leading to blood pooling in the lower limbs. Over time, this increased venous pressure causes symptoms such as swelling, skin changes, and visible veins, and may progress if left untreated.
Why does chronic venous insufficiency occur?
CVI develops when venous valves become weakened or damaged. Common contributing factors include genetics, prolonged standing or sitting, pregnancy, obesity, ageing, and a history of blood clots in the legs. In climates like Dubai, prolonged standing and heat-related venous dilation may further worsen venous pressure and symptoms.
What symptoms does CVI cause?
Symptoms of chronic venous insufficiency can range from mild to severe and often worsen as the day progresses. Patients may experience leg heaviness, aching, swelling around the ankles, skin itching, night cramps, and visible veins. In advanced cases, skin discoloration, hardening of the skin, and open wounds (venous ulcers) may develop.
How is CVI related to varicose veins?
Varicose veins are a common visible manifestation of underlying chronic venous insufficiency. While not all patients with CVI have prominent varicose veins, most varicose veins are caused by venous valve failure. Treating varicose veins without addressing the underlying venous reflux may lead to recurrence or progression of disease.
How does CVI cause leg swelling (edema)?
In CVI, prolonged venous pressure forces fluid out of the veins into the surrounding tissues, particularly around the ankles and lower legs. This results in chronic leg swelling, which may improve overnight and worsen during the day. Persistent edema can eventually lead to skin inflammation and tissue damage if not treated.
Skin changes caused by chronic venous insufficiency
Long-standing venous hypertension can cause characteristic skin changes, including venous eczema, brown discoloration from iron deposition, skin thickening (lipodermatosclerosis), and increased fragility. These changes indicate progressive disease and increase the risk of skin breakdown and venous ulcers.
How is chronic venous insufficiency diagnosed?
Diagnosis of CVI is based on clinical examination and confirmed using duplex ultrasound. Ultrasound assessment evaluates the superficial and deep venous systems, identifies valve failure, and maps reflux patterns. Accurate duplex mapping is essential for guiding effective treatment planning.
How Doppler Findings Affect Treatment
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If Doppler confirms reflux in a main vein (GSV/SSV), treatment may include EVLA or RFA.
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If side-branch veins are the main issue, foam sclerotherapy or phlebectomy may be used.
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If deep venous disease is present, treatment focuses more on compression and long-term management.
Modern treatment options for CVI
Treatment depends on disease severity and reflux patterns. Options may include compression therapy, lifestyle modification, and minimally invasive procedures such as endovenous laser ablation (EVLA), radiofrequency ablation (RFA), mechanochemical ablation, adhesive closure, or ultrasound-guided sclerotherapy. The goal is to reduce venous pressure, relieve symptoms, and prevent progression.
Treating venous reflux addresses the root cause of symptoms rather than providing temporary relief.
Conditions Related to Chronic Venous Insufficiency
Link to Leg Edema
Chronic venous insufficiency is one of the most common causes of persistent leg edema, especially swelling that worsens by evening and improves with elevation.
Link to Varicose Veins
Many patients with chronic venous insufficiency develop visible varicose veins, which represent surface manifestations of underlying valve failure.
Link to Skin Changes
Long-standing venous pressure can cause skin changes, including discoloration, eczema, and hardening around the ankles.
Link to Venous Leg Ulcers
In advanced stages, untreated chronic venous insufficiency may progress to venous leg ulcers, particularly around the ankle region.
Link To Spider Veins
While spider veins are often cosmetic, symptoms such as heaviness or swelling may indicate underlying venous insufficiency.
Frequently Asked Questions About Chronic Venous Insufficiency (CVI)
Is chronic venous insufficiency the same as varicose veins?
Not exactly. Varicose veins are a visible manifestation of venous valve failure, while chronic venous insufficiency refers to the underlying condition in which veins fail to return blood efficiently to the heart. Some patients have CVI without prominent varicose veins.
Can chronic venous insufficiency cause leg swelling?
Yes. Chronic venous insufficiency is one of the most common causes of leg swelling. Swelling typically worsens by the end of the day and improves with leg elevation or overnight rest.
Does chronic venous insufficiency get worse over time?
It can. Without appropriate treatment, CVI may progress from mild symptoms such as heaviness and swelling to skin changes, inflammation, and venous leg ulcers. Early assessment helps prevent long-term complications.
Can chronic venous insufficiency cause skin discoloration or eczema?
Yes. Long-standing venous pressure can lead to skin pigmentation, venous eczema, lipodermatosclerosis, and fragile skin around the ankles. These changes indicate advanced venous disease and should be assessed by a vascular specialist.
How is chronic venous insufficiency diagnosed?
Diagnosis requires a duplex ultrasound, which maps the superficial, deep, and perforator veins and identifies valve failure and reflux patterns. A physical examination while standing helps confirm the presence and severity of visible varicosities.
Is chronic venous insufficiency dangerous?
CVI is usually not life-threatening, but it can significantly affect quality of life. In advanced cases, untreated disease may lead to recurrent infections, non-healing ulcers, and chronic skin damage.
Can chronic venous insufficiency be treated without surgery?
Yes. Many patients benefit from conservative measures such as compression therapy and lifestyle modification. When indicated, minimally invasive endovenous treatments can effectively correct venous reflux with minimal downtime.
When should I see a vascular surgeon for CVI?
You should seek specialist assessment if you have persistent leg swelling, skin changes, varicose veins, or symptoms that interfere with daily activities. Early evaluation helps prevent disease progression.
When should you see a vascular surgeon?
You should seek specialist assessment if you experience persistent leg swelling, aching, skin itching, discoloration, visible varicose veins, or skin breakdown. Early evaluation by a consultant vascular surgeon allows accurate diagnosis, timely treatment, and prevention of long-term complications.
Clinical insight from Dr. Soroush Sohrabi
As a UK-trained consultant vascular and endovascular surgeon, Dr. Soroush Sohrabi regularly assesses and treats patients with chronic venous insufficiency, ranging from early venous reflux to advanced skin changes and ulcers. Accurate duplex ultrasound mapping and individualized treatment planning are essential to achieving durable results and preventing recurrence.
Medical Review & Clinical Oversight
This page is written and reviewed by Dr. Soroush Sohrabi, Consultant Vascular & Endovascular Surgeon. Clinical content is based on current vascular guidelines, duplex ultrasound assessment, and evidence-based treatment principles.
