Chronic Venous Insufficiency

Chronic venous insufficiency (CVI) is a disease that occurs when superficial or deep veins or not working properly. Patients with CVI often have painful or swollen legs and may develop darkened skin, sores (ulcer) and varicose veins. CVI affects women more than men and is increasingly common over age 50.

When you stand or sit, the blood in your legs has to flow against the pull of gravity to return to your heart. One-way valves in your veins keep blood flowing in the right direction. When your leg muscles relax, the valves inside your veins close. This prevents blood from flowing back down the legs. The entire process of sending blood back to the heart from the veins is referred to as the venous pump.

When you walk and your leg muscles contract, the venous pump works well. But when you sit or stand, especially for an extended period, the blood in your leg veins can pool, increasing venous blood pressure. Deep veins (which lie in groups of muscles) and perforating veins (which connect superficial, or visible, veins to the deep veins) are usually able to withstand short periods of increased pressure. Sitting or standing for long periods of time, however, can cause the vein walls to stretch. Over time, this can cause a weakening in the walls of the veins and damage the vein valves, resulting in CVI.

Patients can also develop CVI as a complication of a deep venous thrombosis (DVT). Following an episode of DVT, up to 20% of patients can have permanent damage to the valves inside their veins. 

Causes and Symptoms

CVI can occur without a clear cause or as a result of a blood clot in the deep veins of the legs, a disease known as deep vein thrombosis (DVT).

CVI may also be associated with varicose veins, which are swollen or bulging veins that can be seen through the skin.

Risk factors include:

  • Family history of CVI
  • Varicose veins or family history of varicose veins
  • Deep vein thrombosis (DVT)
  • Obesity
  • Pregnancy
  • Sedentary lifestyle
  • Smoking
  • Extended periods of standing or sitting

Symptoms of CVI include:

  • Swollen ankles, tight feeling in the calves, cramping at night
  • Legs feel uncomfortable, painful, heavy, tired, achy or restless
  • Pain while walking or shortly after stopping
  • Ulcers on the lower part of the leg
  • Itching and throbbing


To diagnose CVI, your doctor may order the following tests in addition to doing a physical examination of your legs:

  • Vascular or Duplex ultrasound, which is a type of ultrasound that evaluates blood circulation in your legs.
  • Magnetic resonance venography (MRV), which produces three-dimensional images of the vascular system in your legs using contrast dye and magnets.

Treatment Options

Venous Ablation: Venous ablation is a minimally invasive treatment option to treat patients suffering from varicose veins or chronic venous insufficiency. We offer a variety of procedures including laser, radiofrequency (RFA, VNUS procedure), chemical injections (VenaSeal, Varithena) and pharmacomechanical ablation (ClariVein). 

Open Phlebectomy: An outpatient procedure where small incisions are made to remove varicose veins.

Powered (TRIVEX) Phlebectomy: An outpatient surgery where only a few small incisions are made to remove extensive networks of large varicose veins. 

Perforator Treatment: An outpatient surgery to treat incompetent perforator veins through laser ablation, chemical injection or open ligation. 

Sclerotherapy: An office based procedure (Northville Health Center, Brighton Center for Specialty Care, East Ann Arbor Medical Procedures Unit) where a chemical is used to treate spider, reticular or varicose veins. 

Chronic Venous Insufficiency Treatment at the University of Michigan

The Venous Health Program at the University of Michigan Frankel Cardiovascular Center is an all-inclusive resource for the treatment of venous disease. This program brings together established and experienced vascular surgeons, vascular medicine specialists, interventional radiologists and nurse practitioners to provide seamless multidisciplinary care.

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