Chronic venous insufficiency

Overview

Chronic venous insufficiency (CVI) is a condition where the veins in your legs have trouble sending blood back to your heart. Blood can pool in the legs, causing swelling, pain, and skin changes.

Yes, CVI is very common, especially as people get older. It affects millions of adults worldwide.

CVI often affects people over 50, but anyone can develop it. It is more common in people who stand or sit for long hours, are overweight, pregnant, or have a family history of vein problems.

Symptoms

Common symptoms

• Swelling in the legs or ankles, especially after standing for a while.
• Aching, heaviness, or tiredness in the legs.
• Varicose veins (large, twisted veins visible under the skin).
• Itching or a feeling of restlessness in the legs.
• Skin changes, such as a brownish discoloration or dryness, often around the ankles.
• Leg ulcers (open sores) that can be slow to heal.

Symptoms in children

• CVI in children is rare. If it happens, symptoms may include visible veins, mild leg swelling, or discomfort after activity.

Symptoms in older adults

• In older adults, symptoms can be more severe. They may have major swelling, skin thickening, and a higher risk of leg ulcers.
• Leg pain and heaviness can make walking or daily tasks harder.

Causes

Main causes

• Weakened or damaged valves inside the leg veins that normally keep blood flowing upward to the heart.
• Blood clots in the deep veins of the legs (DVT) that damage the valves.
• Increased pressure in the leg veins due to factors like obesity, pregnancy, or long periods of standing.

Risk factors

• Age (being over 50)
• Family history of vein problems or varicose veins
• Pregnancy
• Being overweight or obese
• Sitting or standing for long hours without moving
• Lack of regular exercise
• Previous leg injury or surgery

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe swelling or pain in one leg, especially with redness or warmth – get emergency care.
• If you develop a leg ulcer with signs of infection (increasing pain, redness, pus, or fever) – see a doctor urgently.

Book a routine appointment if:

• If you have ongoing leg swelling, aching, or heaviness that bothers you.
• If you notice varicose veins or skin changes on your legs.
• If you have a leg ulcer that is not healing or is getting worse.

Diagnosis

Your doctor will ask about your symptoms and examine your legs. They may also use a simple ultrasound scan to check how your veins are working.

Tests that may be done

• Physical exam – looking for swelling, skin changes, and varicose veins.
• Duplex ultrasound – a painless scan that uses sound waves to see blood flow in your veins and check the valves.

What to expect at your appointment

The ultrasound is quick and painless – a gel is applied to your leg, and a small device is moved over the skin. You can go home right after. The results help your doctor decide the best care for you.

Treatment

Treatment for CVI focuses on relieving symptoms, preventing worsening, and improving vein function. Many people can manage it with self-care and medical treatments. The right approach depends on how severe your condition is.

Self-care at home

• Elevate your legs above heart level for 15–30 minutes several times a day.
• Wear graduated compression stockings (these are special tight stockings that help blood flow) – ask your doctor or pharmacist how to get the right fit.
• Stay active: walk regularly and avoid sitting or standing in one place for too long.
• Maintain a healthy weight.
• Move your ankles and legs often if you must sit for long periods.

Medical treatments

Your doctor may recommend treatments such as endovenous ablation (using heat to seal faulty veins), sclerotherapy (injecting a solution to close small veins), or laser therapy. These are done in a clinic and have a short recovery time. Compression therapy is often the first step. Never start any treatment without a doctor’s advice.

When is surgery considered?

Surgery may be considered if other treatments do not work or if you have severe symptoms. Procedures like vein stripping (removing the affected vein) are less common today but still used in some cases. Your doctor will discuss the best option for you.

Living with this condition

Living with CVI means making small changes a part of your daily routine. Wear your compression stockings as directed, elevate your legs when you can, and try to move every hour if you are sitting or standing. Check your legs regularly for skin changes or sores.

Lifestyle tips

• Take breaks: if you stand at work, sit down and elevate your legs when possible.
• If you sit a lot, get up and walk around every 30–60 minutes.
• Avoid crossing your legs while sitting.
• Wear comfortable, non-restrictive clothing.
• Keep your skin moisturized, especially around the ankles.

Diet and exercise

Eating a balanced diet low in salt can help reduce swelling. Eat plenty of fruits, vegetables, and whole grains. Regular exercise, like walking, swimming, or cycling, strengthens your calf muscles and helps push blood up your legs. Aim for at least 30 minutes of activity most days.

Mental health and emotional wellbeing

Living with a long-term condition like CVI can feel frustrating or stressful. You may feel self-conscious about your legs or anxious about ulcers. It is normal to have these feelings. Talk to your doctor or a counselor if they affect your daily life.

Prevention

You cannot always prevent CVI, especially if you have a family history. But you can lower your risk by staying active, keeping a healthy weight, avoiding long periods of standing or sitting, and wearing compression stockings if your doctor recommends them.

Screening programmes

There is no routine screening for CVI. But if you have risk factors or symptoms, your doctor can check your veins with a simple ultrasound.

Complications

If left untreated

• Leg ulcers (open sores) that can be painful and hard to heal.
• Skin changes, such as thickening, hardening, or darkening.
• Increased risk of deep vein thrombosis (DVT), a blood clot in the leg.
• Chronic pain and swelling that can limit your activities.

Long-term outlook

For most people, CVI is manageable with treatment and lifestyle changes. With proper care, symptoms can improve, and serious complications like ulcers can be prevented. Many people live active, full lives with CVI. If you have concerns, talk to your doctor about the best plan for you.

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