Chronic Venous Insufficiency vs Varicose Veins: What’s the Difference?

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Rahul Sood

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Vascular diseases refer to conditions that affect your artery or your vein – basically, any blood vessel underneath your skin. These conditions can vary in severity and cause, from simple spider veins on your superficial veins to deep vein thrombosis. There are even some vascular diseases that can be mistaken for one another, like chronic venous insufficiency (CVI) and varicose veins. 

What’s the difference between chronic venous insufficiency and varicose veins? A good way to think about this is that varicose veins can be a symptom of CVI, but not all CVI cases exhibit varicose veins. Because of their similar effects on blood flow and how they show their symptoms on the skin, it’s easy to think that these conditions are the same – but doing this may put the patient at risk when it comes to their treatments.

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How are Varicose Veins Related to Chronic Venous Insufficiency?

Before we understand how these two conditions are related, it’s important to define each of these conditions:

  • Chronic venous insufficiency refers to when the valves in your veins stop working properly, which causes blood to pool inside of your veins. Also known as venous reflux, this condition may sometimes require surgery to treat.
  • Varicose veins also occur because your vein valves stop functioning properly, but this is usually limited to the superficial veins found near the surface of your skin. It’s usually associated with CVI, but it doesn’t always happen at the same time.

Both varicose veins and CVI happen because something’s gone wrong with your vein, preventing it from shuttling blood back to your heart. Normally, this is made possible by the muscles around your venous system, which help control the vein valves to prevent any pooling of blood in your system.

However, when something goes wrong with this process, blood doesn’t return as efficiently to your heart, causing it to pool in your veins and give you the symptoms of either condition. They’re most prominent in areas like the legs since the veins down there have to work against gravity as well to pump blood efficiently.

Varicose veins can occur as a result of having CVI since both are vein disorders that affect the veins underneath the skin. The most significant difference between the two is how deep the blood pooling is – varicose veins usually occur in superficial veins while CVI can go beneath the deep vein system.

Why Is It Important to Know the Difference?

The most significant reason why it’s important to know the difference between varicose veins and CVI is because their treatments can drastically differ. Most cases of varicose veins can be attributed to the body’s natural processes slowing down over time – for many people, varicose veins are a cosmetic issue that doesn’t always require medical attention.

However, chronic venous insufficiency can quickly develop into complications if left untreated – and varicose veins are only one of the possible complications that you can experience with CVI. There are also some cases where the condition is often indicative of a more serious underlying problem, which needs immediate medical treatment to prevent any long-term complications.

What are Varicose Veins?

Varicose veins are any veins that enlarge or twist because of damage to the vein wall, abnormalities in blood pressure or blood flow, or other injuries that can affect your circulatory system. They’re most visible in the leg veins and around the ankles and feet since the blood in the legs struggle against gravity when pumping blood back to the heart.


Symptoms of varicose veins can differ depending on the patient, though there are some common signs that you can watch out for:

  • Strange sensations in the legs, like pain or tingling
  • Skin discoloration, especially around the calves and below
  • Sores on the legs that take a long time to heal
  • Mild to severe skin swelling that doesn’t go away with rest
  • Visible veins on the surface of the skin, typically blue or purple in color

A proper diagnosis of varicose veins is usually done by a doctor or dermatologist, first by checking the patient’s medical history and family history. Other diagnostic procedures like a duplex ultrasound can also be used for a more accurate diagnosis.


Because there are a lot of things that can affect the normal function of your veins, it can be difficult to come up with a comprehensive list of all the possible causes of varicose veins. These are the most common causes reported by patients:

  • Obesity: the additional body weight can drastically affect the smooth flow of your circulatory system, making blood pooling more likely
  • Lifestyle: people who don’t exercise or move around a lot can also disrupt their blood flow since their body is always in a resting state
  • Pregnancy: pregnancy puts plenty of strain on the body, adding extra weight and other disruptions which can affect normal blood flow
  • Hormonal changes: hormones can also play a key role in how effective your circulatory system works, with any imbalances affecting blood clotting
  • Leg injury: some trauma to the leg and the nearby areas can twist or block veins, causing blood to pool behind the valves until your injury is treated

For some patients, it can actually be chronic venous insufficiency that can cause varicose veins, as disruptions in your normal blood flow can make blood pooling more likely. While this doesn’t happen all the time, there have been enough links between varicose veins and CVI that it’s counted as a possible risk.


For many patients, getting treatment for varicose veins isn’t necessary as it’s just a cosmetic issue. Conversely, some patients may seek treatment for this specific reason. Treatments for varicose veins are usually only necessary if the veins get too swollen to the point that they’re causing pain, or if your healthcare provider wants to avoid putting you at risk for any complications from your condition.

  • Sclerotherapy: a chemical is injected into your swollen vein which causes it to thicken and scar until it closes. Any blood is redirected to functioning veins, and the treated vein gets absorbed as scar tissue.
  • Radiofrequency ablation: by inserting a catheter in the vein and using radiofrequency energy, any affected vein immediately collapses under the intense heat and is sealed shut. Used on larger veins.
  • Vein stripping and ligation: an incision is made to tie and seal the damaged vein at one end, with another incision made at the bottom to pull out the vein in one go. Patients may need a week or two to recover.
  • Lifestyle changes: being more physically active, stopping smoking, and elevating the legs can sometimes be enough to prevent the symptoms of varicose veins from getting worse.
  • Compression stockings: for mild cases or cases in the middle of treatment, compression stockings can be used to help improve the circulation around the legs. They can also help with recovery from treatment.

Aside from surgical options, most treatments for varicose veins have relatively quick downtimes and don’t require much aftercare. However, you should consult your doctor for further details on how to best take care of yourself after your treatment.

What is Chronic Venous Insufficiency?

Old woman suffering with leg pain due to vein problems

CVI is a general term used when the valves in your veins run into problems delivering blood back to your heart. When your valves have been damaged for a long time and blood keeps pooling in your veins, the increased blood pressure causes a chronic condition where your veins no longer function properly. This condition is most prevalent in the legs, though it can occur almost anywhere in the body.


CVI can have drastically different symptoms depending on the vein affected, but there are some common signs that patients should watch out for:

  • A sudden outbreak of varicose veins on the legs and feet
  • Persistent pain, aching, or numbness in the legs
  • Skin discoloration or uneven skin texture on the legs
  • Moderate or severe leg swelling that gets worse after standing up
  • Venous stasis ulcers, or sores that don’t heal easily

A doctor can use a physical exam and cross-check your medical/family history to see if you’re at risk or have developed CVI. Alternatively, ultrasounds can also be used to get an image of your veins to look for any irregularities.


Anything that can affect the proper flow of blood in your body can cause chronic venous insufficiency, but there are some conditions and factors that can put you more at risk. In many cases, getting injured can often put you on the path to developing CVI – though the most common cause by far is long-term conditions.

  • Obesity: excess body weight makes blood circulation far more difficult, as the muscles that can help with the normal function of your valves need to contend with your additional fat
  • High blood pressure: localized excess pressure caused by sitting or standing for a long time can disrupt the natural flow of your blood and make it more difficult for veins to function properly
  • Pregnancy: the added weight and strain on your body during pregnancy can disrupt your circulatory system, putting additional load on your veins and twisting/blocking them
  • Lack of exercise: sedentary lifestyles can cause excess blood pooling in the legs since the area doesn’t move or isn’t elevated with normal movements
  • Deep vein thrombosis: a blood clot that occurs in the deeper leg veins can cause blockages in your veins, which limit the function of your vein valves and make it more difficult to pump blood back to the heart

Additionally, family history also plays a role in how likely you are to get this condition – if you have any family member with CVI, you’re far more likely to develop it compared to other patients. Age can also play a role, as your body’s normal functions begin to slow down as you get older.


Treatments for CVI often require more medical intervention compared to other vascular diseases, especially if the condition has progressed for a while. The earlier CVI is detected, the less strain the patient has to go through with their treatment options – though this may not always be the case.

  • Endovenous thermal ablation: by using lasers or heat energy, the affected vein is closed and blocked off to prevent any more blood from flowing through it. Extremely effective for mild to moderate cases.
  • Sclerotherapy: chemical injections close the vein entirely, with the vein being absorbed by the body over time. Usually used as a cosmetic option, but can also work for superficial veins closer to the skin surface.
  • Vein bypass: for severe cases where other options haven’t worked, a healthy vein is transplanted from somewhere else in the body to provide another channel for blood to flow through.
  • Vein stripping: the damaged vein is removed in its entirety and the area is tied and sealed off so blood can no longer flow through it. While it’s considered surgical treatment, patients usually recover within 2 weeks.
  • Microincision/ambulatory phlebectomy: precise incisions are made at each end of the damaged vein, and a phlebectomy hook is used to remove the entire vein from the body.

These treatments often require more extensive downtime, especially if the affected vein is located deep under the surface of the skin.

Get Expert Vein Treatments for Varicose Veins and Other Vascular Diseases at Vein Center Doctor

While it’s easy to confuse chronic venous insufficiency and varicose veins (and in many ways, they do share a lot of similarities as problems with your blood flow showing up on your skin), learning the difference is key for effective treatments. While venous reflux is far from a fatal disease, it does require careful treatment to manage correctly.

As specialists in vascular and venous diseases, Vein Center Doctor has helped thousands of patients with vein treatment. We implement non-invasive yet effective solutions, with long-term results so you can improve your quality of life. From spider veins to varicose veins, we have the solutions you need, right now.

Reach out to us today and call 1-862-227-1054.

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Rahul Sood


About Rahul Sood

Dr. Rahul Sood is a triple board-certified physician who specializes in cosmetic vein treatment, namely spider veins and varicose veins, as well as any accompanying issues related to venous insufficiency such as leg pain. He has carried out over 10,000 leg procedures during 10-plus year career and is highly regarded throughout Westchester County and New Jersey.

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