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Home Conditions Chronic venous insufficiency

Chronic venous insufficiencyWhen the valves stop holding.

The veins in your legs carry blood upward against gravity. When their valves fail, blood falls back and pressure builds, and that pressure is what causes the damage.

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The pattern

Symptoms and risk factors

What people notice, and what makes it more likely.

Symptoms

  • Aching or throbbing
  • Heaviness
  • Swelling in the ankle or lower leg
  • Night cramps
  • Itching
  • Skin discolouration near the ankle
  • A sore that is slow to heal

Risk factors

  • Family history
  • Pregnancy and hormonal changes
  • Weight gain
  • Prolonged standing or sitting
  • Previous deep vein thrombosis
  • Age

The mechanism

How your vein valves work

Getting blood down to your feet is the easy part. Returning it to your heart means moving it upward, against gravity, and your legs have two things that do that job.

The first is the calf muscle pump. Every time you take a step, your calf muscles contract and squeeze the deep veins in your lower leg, pushing blood upward. When the muscles relax, the veins refill, ready for the next contraction.

The second is a series of one-way valves inside the veins. They open to let blood through on its way up and close to stop it falling back down.

In chronic venous insufficiency those valves leak, or the vein is obstructed. Blood flows backward, which is called reflux, and pools in the lower leg. Pressure builds in the veins, and that pressure is what produces swelling, aching, heaviness, skin changes and, eventually, ulceration.

A healthy vein valve compared with a failing one On the left, a healthy valve closes fully so blood moves upward only. On the right, a failing valve leaves a gap, so blood falls back down the leg and pools below. Healthy valve Failing valve
A healthy valve closes fully, so blood only moves upward. A failing valve leaves a gap: blood falls back down the leg and pools, and the pressure that creates is what causes the damage.

CEAP C0 to C6

The stages of venous disease

Venous disease is classified in stages. Knowing roughly where you sit explains why the advice you get differs from someone else's.

  1. C0

    No visible signs

    Nothing to see or feel, but symptoms such as aching or heaviness can still be present.

  2. C1

    Spider or reticular veins

    The fine red, blue or purple vessels, and the slightly larger blue-green ones beneath the skin.

  3. C2

    Varicose veins

    Larger veins you can see and feel, raised and twisted.

  4. C3

    Swelling

    Oedema: the ankle or lower leg swells, often worse by evening.

  5. C4

    Skin changes

    The skin around the ankle discolours, hardens, or becomes dry, itchy and inflamed.

  6. C5

    Healed ulcer

    A venous leg ulcer that has healed, with the underlying problem still present.

  7. C6

    Active ulcer

    An open venous leg ulcer. These are painful and can be very difficult to heal, especially if neglected.

[CLIENT TO CONFIRM: Dr Davidson to approve these plain-English CEAP descriptions before they stand as clinic guidance]

Which stage are you?

Most people can place themselves roughly on this scale, and most are " surprised how early the treatable stages start. The scan is what turns a guess into an answer, and you get it read back to you the same visit.

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Worth an appointment

When to see someone

Any one of these is reason enough to have your legs looked at.

  • Your legs swell, ache or feel heavy most days.
  • The skin near your ankle has changed colour or texture.
  • You have had a venous ulcer before, healed or not.
  • You have had a deep vein thrombosis.
  • Compression helps but you have never been assessed.

What an assessment involves

A painless scan maps the veins in your legs, your vascular surgeon reads it with you in the same visit, and you leave with a plan. Plenty of people leave with nothing that needs treating.

About the ultrasound assessment

What can be done

Treatment options

Which one applies to you depends on the scan, not on how your legs look.

A laser closes a diseased vein from the inside, through a single entry point, under local anesthetic, in about one to two hours.

Graduated compression is strongest at the ankle and decreases up the leg, supporting the calf muscle pump and helping blood return toward the heart.

A liquid agent is injected into the vein through a fine needle, making it shrink and disappear over the weeks that follow.

All vein treatments

Prevention and self-care

Looking after your legs

None of this replaces an assessment, and all of it helps.

Keep moving

Walking activates the calf muscle pump, which is what helps push blood back up out of your legs. A manageable walk you repeat beats an ambitious one you do once.

Interrupt long sitting or standing

The pump is idle when you are still. Break up a long stretch at a desk or on your feet rather than waiting for the end of the day.

Elevate when you rest

Giving your legs a lift helps ease symptoms at the end of the day.

Wear compression if it is recommended

Graduated compression supports the pump from the outside. It is measured and fitted in clinic: see compression and bracing for the fitting detail, or compression therapy for how it works.

Look after your skin

Moisturise dry skin and report new changes rather than watching them.

The vein clinic difference

One visit. Not two years.

Vein patients used to wait more than two years and make several trips before seeing a specialist. Integrating ultrasound testing with the surgeon consultation turned that into a single appointment.

  1. Step 1

    Ultrasound

    A certified ultrasonographer maps your veins and circulation prior to your consultation.

  2. Step 2

    Surgeon consult

    Your vascular surgeon reviews the results with you and explains what they mean.

  3. Step 3

    Your plan

    Treatment, compression therapy or prevention advice, based on your results.

In more depth

Further reading

Written by the team who treat it.

Chronic venous insufficiency, answered

Questions

The questions patients ask us most often.

Is chronic venous insufficiency the same as varicose veins?

Varicose veins are one visible sign of it. You can have the disease without obvious varicose veins, and you can have symptoms with legs that look unremarkable.

Can it be cured?

Usually not. Treatment significantly alleviates symptoms, slows the disease process and improves appearance, and reduces the risk of ulcers. It remains a chronic condition, which is why keeping your leg veins in mind lifelong matters.

How is it diagnosed?

With a history, a physical examination focused mostly on the cardiovascular system, and specialized ultrasound imaging done in a standing position to see whether particular veins are refluxing. The great and small saphenous veins are commonly the ones affected.

Why is the ultrasound done standing up?

Because reflux is a gravity problem. Standing is the position in which a failing valve shows itself.

Does compression treat the cause?

No. Compression supports the leg from the outside and can reduce symptoms and swelling, but it does not repair damaged valves or remove varicose veins.

Will I end up with an ulcer?

Most people will not. The risk rises with untreated disease over time, which is the argument for assessment rather than waiting. Treatment reduces the risk of ulcers and of recurrence.

What are the CEAP stages?

CEAP is the standard way venous disease is classified, from C0 with no visible signs through to C6, an active ulcer. The stages on this page describe what each one looks like.

Can it come back after treatment?

The treated veins stay closed, but venous disease is chronic and new veins can become involved. Follow-up and ongoing compression where it is recommended both matter.

Find out where you stand.

One visit: a scan, a vascular surgeon who reads it with you, and a plan you understand.

Call 902-678-2121 Book a consultation

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