Chronic Venous Insufficiency: Symptoms, Causes & Treatment

Chronic venous insufficiency is a condition in which the valves in the veins of the legs do not function properly, making it difficult for blood to return from the lower limbs to the heart. This leads to symptoms such as leg swelling, heaviness, burning or tingling sensations, and nighttime leg cramps.

This condition is more common in women and older adults and may be caused by congenital valve defects, damage to the walls of the leg veins, or obstruction of blood flow.

Treatment for chronic venous insufficiency depends on the severity of the condition and may involve medications, compression stockings, or surgery, as prescribed by a general practitioner, vascular surgeon, or angiologist.

Common symptoms

The main symptoms of chronic venous insufficiency include:

• Swelling in the legs, feet, or ankles

• Heaviness and fatigue in the legs

• Itching, tingling, or throbbing sensations

• Increased sensitivity in the affected area

• Leg pain that worsens when standing or sitting for long periods and improves with rest and leg elevation

• Burning sensation in the legs

• Nighttime leg cramps

In addition, visible signs such as spider veins, varicose veins, swelling, and dark spots on the legs may also appear.

In more severe cases, symptoms may include bulging veins, skin atrophy or severe skin damage, and the formation of ulcers, especially on the inner part of the ankle.

Confirming a diagnosis

Diagnosis of chronic venous insufficiency is made by a vascular specialist or general practitioner based on symptoms, medical and family history, risk factors, symptom duration, and physical examination.

The doctor may also request a Doppler ultrasound, which is the main diagnostic test after a clinical evaluation. This exam helps detect valve dysfunction or chronic obstruction of the veins.

Additional tests may include venous plethysmography, which evaluates blood reflux in the veins, or an MRI to rule out conditions with similar symptoms, such as lymphedema, stasis dermatitis, or varicose veins.

If the diagnosis is still uncertain, the doctor may request a venography, a type of X-ray that allows visualization of the veins after injecting a contrast dye.

Possible causes

Chronic venous insufficiency is caused by malfunctioning valves in the veins, which are responsible for directing blood back to the heart. When these valves fail to close properly, it can lead to blood reflux and increased pressure in the legs.

Several factors can increase the risk of developing chronic venous insufficiency, including:

• Congenital valve defects or abnormalities in the vein walls

• History of deep vein thrombosis and/or thrombophlebitis

• Pregnancy

• Use of oral contraceptives

• Sedentary lifestyle, obesity, and smoking

• Prolonged standing

• Family history of chronic venous insufficiency

• Previous trauma to the affected leg

• May-Thurner syndrome, which causes non-thrombotic obstruction in the veins

In people with chronic venous insufficiency, the inability of the valves to close fully allows blood to flow backward toward the legs, increasing pressure and causing symptoms.

How treatment is done

Treatment for chronic venous insufficiency should be guided by a vascular specialist, general practitioner, or angiologist, and may include:

• Compression stockings to help reduce leg swelling and improve venous return

• Antibiotics, in cases of skin infection or ulcers

• Anticoagulants, to prevent blood clot formation

• Laser therapy, to treat varicose veins

• Sclerotherapy, for the treatment of spider veins or varicose veins

• Surgery, to remove varicose veins and prevent the disease from progressing

• Venoactive dietary supplements, such as diosmin and hesperidin, which are commonly tekn to relieve symptoms and reduce inflammation of the vein walls

Doctors may also recommend physical activity under the guidance of a fitness professional, such as walking, to improve blood circulation and support weight loss.

Can chronic venous insufficiency be cured?

Chronic venous insufficiency can be cured in some cases with appropriate medical treatment. However, outcomes depend on the underlying cause and the severity of the condition.

In situations where a full cure is not possible, symptoms can often be managed effectively to prevent complications.

Care during treatment

Some important care measures during treatment for chronic venous insufficiency include:

• Avoid standing for long periods

• Sit or lie down with legs elevated to support blood flow

• Avoid hot environments, prolonged sun exposure, hot showers, or saunas

• Stay physically active

• Avoid wearing high heels or very flat shoes

• Stop smoking or avoid tobacco use

• Reduce salt intake

• Maintain a healthy weight

These measures can help prevent or relieve symptoms and reduce the risk of worsening the condition.

Possible complications

If left untreated, chronic venous insufficiency may lead to complications such as thrombophlebitis, pulmonary embolism, chronic leg pain, or deep vein thrombosis.

Another common complication is the development of skin ulcers, particularly on the inner side of the ankle (medial malleolus).