Chronic Venous Insufficiency
Heavy legs at the end of the day. Ankles that swell, then settle overnight. Veins or skin changes that seem to creep in year after year. Many people put up with these symptoms for a long time, thinking they’re just part of getting older. Often, they’re signs of chronic venous insufficiency, a common and treatable condition in which leg veins struggle to send blood back to the heart. Our vein specialists confirm the diagnosis with ultrasound and offer minimally invasive treatment in the office.
Book a visit with a vein specialist near you at one of our clinics in Pennsylvania, New Jersey, Ohio and Arizona.
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At MVM Health — Movement. Vitality. Medicine. — we are committed to providing exceptional pain, vein, and wellness services that empower individuals to reclaim their health and well-being. With our team of Harvard-trained experts, we strive to deliver transformative outcomes that restore comfort, confidence, and quality of life. MVM Health’s mission is to help every patient relieve discomfort, restore motion, and renew life.
Vwaire Orhurhu, MD, MPH
Harvard Medical School
Mariam Salisu, MD, MPH
Harvard Medical School
Peter Isaac, DO
Philadelphia College of Osteopathic Medicine
Ali Amin, MD
Baylor College of Medicine
THOMAS KHOURY, MD
Harvard Medical School
ANTHONY TURNER, MD
Yale School of Medicine
KIRAN C. TAMIRISA
Baylor College of Medicine
TARIQ ALFARRA, DO
JOHNS HOPKINS HOSPITAL
Rishi Sheth, MD
University of Miami School of Medicine
Henry Onyeaka, MD, MPH
Harvard Medical School
Felicia Todd, CNP
Moravian College
Carrie Ward, CNP
Franklin University
Kruti Solanki, CNP
Drexel University
Christy Daniels, CNP
Chamberlain University
Heerina Kittel, CNP
Maryville University
Vic Urbano, CNP
Walden University
Jameela Azeem, CNP
Hofstra University
Vwaire Orhurhu, MD, MPH
Harvard Medical School
Mariam Salisu, MD, MPH
Harvard Medical School
Peter Isaac, DO
Philadelphia College of Osteopathic Medicine
Ali Amin, MD
Baylor College of Medicine
THOMAS KHOURY, MD
Harvard Medical School
ANTHONY TURNER, MD
Yale School of Medicine
KIRAN C. TAMIRISA
Baylor College of Medicine
Rishi Seth, MD
University of Miami School of Medicine
Henry Onyeaka, MD, MPH
Harvard Medical School
Felicia Todd, CNP
Moravian College
Vic Urbano, CNP
Walden University
Jameela Azeem, CNP
Hofstra University
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What Is Chronic Venous Insufficiency?
Your leg veins carry blood uphill, back to your heart. Small one-way valves inside them open as blood moves up and close to stop it from slipping back down. Your calf muscles help by squeezing the veins every time you walk.
In chronic venous insufficiency, some of those valves stop closing properly. Blood leaks backward (venous reflux) and pools in the lower legs, raising the pressure inside the veins. Over months and years, that pressure stretches the veins, pushes fluid into the tissue and can damage the skin.
CVI is one of the most common circulation problems in adults, especially after age 50. It usually develops slowly and doesn’t go away on its own, but treatment can ease symptoms and help keep it from getting worse.
Early Signs You Shouldn’t Ignore
CVI often starts with symptoms that are easy to brush off. Watch for:
- Legs that feel heavy, tired or achy, especially by evening
- Leg swelling around the ankles that improves overnight
- Night leg cramps or restless legs
- Itching or burning around the veins
- New spider veins or bulging varicose veins
- Symptoms that ease when you raise your legs
Some people with CVI have no visible veins at all. That’s why ongoing heaviness or aching on its own is worth checking.
Why Veins Start to Fail
Most CVI comes from valves and vein walls that weaken over time. This tends to run in families. It can also follow a deep vein blood clot (DVT), which can scar the valves it passes through.
Your risk is higher if you:
Have a parent or sibling with varicose veins or vein disease
Are over 50, when vein walls and valves naturally weaken
Have been pregnant, especially more than once
Stand or sit for long hours at work without moving
Carry extra body weight or get little regular exercise
Have had a deep vein blood clot or a serious leg injury
Smoke, which damages blood vessel walls and circulation
Take hormonal birth control or hormone therapy
Skin Changes and Venous Ulcers
When high vein pressure goes on for years, it starts to affect the skin around the ankles and lower legs. These changes usually appear slowly, and knowing what to look for helps you get care before they get worse.
Skin Discoloration
Reddish-brown or dark patches appear around the ankles and lower legs. They form when blood leaks out of stretched veins and stains the skin. The color often deepens over time and may not fully fade.
Venous Eczema
Skin becomes dry, itchy, scaly or weepy, often near the ankle. It’s sometimes mistaken for a simple rash or allergy, but it’s caused by pooled blood irritating the skin. Scratching can break the skin and raise the risk of infection.
Hardened, Tight Skin
The skin and the fat under it can become thick, firm and tender, sometimes making the lower leg look narrower near the ankle. This hardening is a sign of long-term vein pressure and inflammation.
Small Veins Around the Ankle
A fan of tiny blue or purple veins can appear around the inner ankle or along the foot. This “ankle flare” is often an early warning sign that the deeper veins aren’t working well.
Pale, Scar-Like Patches
Smooth, white, star-shaped patches with tiny red dots can form on the lower leg. This skin is fragile and heals poorly, so even a small bump or scratch there can turn into a sore.
Venous Ulcers
Shallow open sores usually form near the inner ankle. They can weep, ache and take weeks or months to heal, and they can come back. Ulcers are the most advanced sign of vein disease and need prompt care.
These changes are signs of more advanced disease. Treating the leaking veins, along with compression and wound care, helps ulcers heal and lowers the chance they return. If you notice any of these skin changes, book a vein evaluation.
Varicose Vein Myths, Answered
Vein specialists use a standard scale to describe how far vein disease has progressed, from no visible signs to open sores. In plain terms:
Stage 1:
Spider veins or small surface veins appear, usually with few or no symptoms.
Stage 2:
For many people, varicose veins cause real symptoms such as pain, swelling and skin changes. That’s why treatment is often covered by insurance when it’s medically necessary.
Stage 3:
Swelling builds in the ankles or lower legs, usually worse by the end of the day.
Stage 4
Skin changes appear, such as darkening, eczema or thick, hardened skin near the ankles.
Stage 5
A venous ulcer has healed, but the skin stays fragile and the sore can come back.
Stage 6:
An open venous ulcer forms, usually near the inner ankle, and needs prompt care.
What is Venous Insufficiency and what causes it?
Leg pain can come from your veins or your arteries, and the two need different care. Veins carry blood back up to the heart, while arteries carry blood down to the legs. A problem with either can cause aching, cramping or swelling, so knowing which one is behind your symptoms is the first step toward the right treatment.
Venous insufficiency
Is a problem with blood getting back to the heart. Legs feel heavy and swollen. Symptoms get worse after standing and better when you raise your legs, and sores tend to form near the ankle.
Arterial insufficiency
(peripheral artery disease) is a problem with blood getting down to the legs. It often causes cramping pain in the calves while walking that eases with rest. Other signs are cool or pale feet, weak foot pulses and sores on the toes.
Some people have both. That matters because strong compression can be unsafe when arterial flow is poor, so your provider checks both before recommending treatment.
How CVI Is Diagnosed
Your visit starts with questions about your symptoms, past blood clots, pregnancies and family history, followed by an exam of your legs while you stand.
The main test is a venous duplex ultrasound. It’s painless and shows which valves are leaking, how much blood flows backward and whether there’s an old or new clot. Your provider may also check the pulses in your feet or order an arterial test. Together, these results map exactly where treatment is needed.
Choosing the Right Compression Stockings
The right pair of compression stockings makes a real difference for CVI. Graduated compression gently squeezes your legs, tightest at the ankle, to help push blood back toward the heart and ease swelling and heaviness. Getting the pressure level, fit and style right is what makes them comfortable enough to wear every day.
Pressure level: Stockings are rated in mmHg. Lighter levels (15–20 mmHg) are sold over the counter. Many people with CVI are prescribed 20–30 mmHg, and more advanced disease may need a higher level.
Fit: Your ankle and calf are measured, usually in the morning before swelling builds. A poor fit can roll, pinch or simply not help.
Style: Knee-high stockings work for most people. Thigh-high or pantyhose styles may be advised in some cases.
Safety: Check with your provider before starting firm compression if you have poor circulation in your arteries, diabetes with numb feet, or skin breakdown.
Compression eases symptoms while you wear it, but it doesn’t repair valves.
Can CVI Be Cured? How Treatment Works
Damaged vein valves don’t heal on their own. The goal of treatment is to take the faulty veins out of circulation and control symptoms. Care usually follows three steps.
STEP 1: COMPRESSION AND DAILY HABITS
Care usually starts with medical-grade compression stockings, raising your legs and walking every day. These steps ease swelling and heaviness and support healthy blood flow. Many insurance plans also require a trial of compression before they’ll approve vein procedures.
STEP 2: CLOSING THE FAULTY VEINS
When ultrasound shows reflux, minimally invasive treatments close the leaking veins so blood reroutes through healthy ones. Options include radiofrequency ablation, laser ablation, VenaSeal®, ClariVein®, sclerotherapy and ambulatory phlebectomy. Most are done in the office in about an hour.
STEP 3: ONGOING CARE
Follow-up visits check that treated veins have closed and your legs are healing well. If you have skin changes or ulcers, compression and wound care continue. New problem veins can be treated if they appear later, so regular checkups help keep CVI under control.
Exercises and Habits That Help
These simple habits support your veins and can ease swelling, heaviness and aching alongside treatment. They work best when you make them part of your daily routine.
Habits can ease symptoms, but they can’t repair damaged valves. Supplements such as horse chestnut seed extract may help some people, but always ask your provider first.
Do you…
- Walk most days, and do calf raises or ankle pumps to power the calf muscle pump.
- Raise your legs above heart level for 15 to 30 minutes a few times a day.
- Break up long periods of sitting or standing.
- Keep a healthy weight to lower pressure in the leg veins.
- Moisturize dry, itchy skin around the ankles and protect it from cuts.
Frequently Asked Questions
Chronic venous insufficiency (CVI) is a condition in which the valves in your leg veins don’t close properly, so blood flows backward and pools in the lower legs. The added pressure can cause swelling, heaviness and varicose veins. Over time, it can also cause skin changes and sores.
Early signs include legs that feel heavy or tired by evening, ankle swelling that improves overnight, aching after standing, night cramps, itching, and new spider or varicose veins. Symptoms often ease when you raise your legs.
Damaged vein valves don’t repair themselves, so CVI can’t be reversed in the usual sense. Closing the faulty veins can greatly reduce symptoms and slow the disease, and new problem veins can be treated if they appear later.
There’s no single best treatment. Compression stockings are usually the first step. When ultrasound shows reflux, minimally invasive options such as radiofrequency ablation, laser ablation, VenaSeal® or sclerotherapy close the faulty veins. The right choice depends on which veins are affected.
CVI isn’t usually life-threatening, but it tends to progress without treatment. Ongoing pressure can lead to skin damage, infections and venous ulcers that are slow to heal. Early treatment can help prevent these complications.
Vein specialists, vascular surgeons and interventional radiologists all treat CVI. At MVM Health, our vein specialists diagnose it with ultrasound and offer minimally invasive treatment at clinics in Pennsylvania, New Jersey, Ohio and Arizona.
CVI doesn’t cause heart failure, but both conditions can cause leg swelling, so your provider checks for each. A past blood clot can lead to CVI, and people with varicose veins can develop small surface clots. Sudden swelling with pain in one leg needs same-day care.
Many people with CVI use 20–30 mmHg medical-grade stockings. Milder symptoms may need less, and advanced disease may need more. The right level and size should come from your provider after measuring your legs and checking your arteries.
Venous insufficiency is a problem with blood returning to the heart. It causes swelling and heaviness that ease when you raise your legs. Arterial insufficiency (peripheral artery disease) is reduced blood flow to the legs. It causes cramping pain when walking that eases with rest, and cool, pale feet.
Some supplements, such as horse chestnut seed extract, may ease symptoms for some people in the short term. They don’t fix leaking valves, and some interact with medicines, so talk to your provider before starting any supplement.
Yes. Walking, calf raises and ankle pumps strengthen the calf muscles that push blood upward, which can ease swelling and heaviness. Exercise supports treatment but can’t repair damaged valves on its own.
Many people with CVI describe tired, heavy legs, especially by evening. Body-wide fatigue, weight gain or shortness of breath usually point to another cause, so have your doctor check them.
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