Diagnosis and Treatment of Chronic Venous Insufficiency

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Rahul Sood

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Chronic venous insufficiency is one of the most widespread venous diseases. In the United States, the Society for Vascular Surgery estimates that up to 40% of people suffer from this condition. If left untreated, damaged or dysfunctional leg veins can worsen over time, resulting in several complications. 

So how can chronic venous insufficiency be diagnosed and treated? The diagnosis of venous disorders can be accomplished through a physical examination or non-invasive or invasive tests. Following a diagnosis, treatment options such as conservative therapy, interventional management, and surgical management may be offered, depending on the patient’s or healthcare provider’s preferences.

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Chronic Venous Insufficiency: How Is It Diagnosed?

One-way valves in the veins enable blood to circulate to the heart, where it’s transported to the lungs for oxygen before returning to the rest of the body. Vein walls deteriorate and valves are weakened in chronic venous insufficiency, prompting blood to pool in the legs.

When the valves inside the veins are compromised, blood leaks backwards, resulting in chronic venous insufficiency. Blood pressure in the veins remains high for extended periods of time when veins and valves are impaired to the point where blood flow up to the heart is difficult.

Chronic venous insufficiency is most often caused by the clotting of blood in the deep veins in the legs, a condition known as deep vein thrombosis. This disease can also be caused by pelvic tumors and vascular abnormalities, and it can also happen for no apparent reason. Patients must be able to recognize the signs and symptoms in order to appropriately manage their disease.

Signs and Symptoms of Chronic Venous Insufficiency

As venous disorders progress, the severity of venous disease and the complications of treatment worsen. If you have any of the signs of chronic venous insufficiency, you should consult your doctor immediately. Waiting will not make the condition go away, and the sooner it’s detected and treated, the greater your chances of avoiding serious complications. The following are some clinical symptoms presented by chronic venous insufficiency:

  • Swelling of the lower legs and ankles, particularly after prolonged standing
  • Legs that hurt or are weary
  • Varicose veins or spider veins
  • Legs with a leathery appearance
  • Legs or feet with flaking or itchy skin
  • Venous pressure
  • Venous stasis ulcers

Inflammation, aching, and tightness in one or both legs are signs of chronic venous insufficiency. If left untreated, the illness can cause severe discomfort, open sores, atrophie blanche, and chronic leg ulcers, particularly on the inside of the ankles.

Diagnosis and Tests of Chronic Venous Insufficiency

A comprehensive history and physical examination, including the patient’s primary medical history, current symptoms, and risk factors, are used to diagnose chronic venous insufficiency. Comprehensive history-taking and physical examination, as well as non-invasive and invasive testing measures, may be used to make an accurate diagnosis of this venous disease.

1) History Taking and Physical Examination

It’s crucial to acquire the medical history of the patient to determine any potential risk factors associated with chronic venous insufficiency. Obesity and pregnancy, for example, can both significantly decrease blood flow in the legs. Sedentary people, smokers, and people who sit for extended periods of time, all of which can restrict blood flow in the legs, are also at risk. Women above the age of 50 are more likely to develop venous disorders.

Medical professionals may also question your family history because certain venous diseases are genetic. Another possibility is a blood clot in a deep vein of the legs, which is called deep vein thrombosis; or inflamed veins, which are called superficial thrombophlebitis. These disorders can cause veins to deteriorate or obstruct valves.

Conducting a physical exam, on the other hand, is necessary to seek for signs and clinical symptoms that can help confirm a chronic venous insufficiency diagnosis. This requires looking at the patient in an upright position to see how distended the veins are. The skin is evaluated for telangiectasia, reticular veins, or varicose veins, which are evident, dilated superficial venous abnormalities.

The standard tourniquet test, which is used in physical examinations, can be used to distinguish the clinical presentation of deep and superficial venous reflux. Rapid dilation of the varicose veins indicates deep venous reflux, while dilation lasting more than 20 seconds suggests superficial venous reflux.

A classification method, entitled CEAP Classification and Venous Clinical Severity Score, may be utilized to further examine venous insufficiency and the associated valvular reflux after obtaining a history and performing a physical examination.

2) Diagnostic Tests

A vein specialist will inquire about your medical history in order to determine the severity of your symptoms and diagnose chronic venous insufficiency. They will also conduct a physical examination to check for swelling, skin abnormalities, varicose veins, and chronic leg ulcers. Additionally, your physician may recommend diagnostic imaging tests to assist in further evaluating your condition.

Duplex Ultrasound

A duplex ultrasound integrates Doppler and traditional ultrasound to create two-dimensional, moving images of the blood arteries in the legs. This test may be used by your doctor to see if blood is flowing in the opposite direction and to examine for indications of deep vein thrombosis, a serious venous disease that can result in life-threatening blood clots in the lungs.

The application of a warm gel to the legs is done by a healthcare provider during this procedure. The transducer is held against the skin by the technician. It sends out sound waves that appear on a computer monitor as images of blood vessels. This exam lasts between 30 to 60 minutes. After this diagnostic procedure, you can resume your regular activities.

Magnetic Resonance Venography (MRV)

A magnetic resonance venogram is a variation of MRI scan that utilizes radio waves to produce images of the veins in the legs. It has the ability to detect blood flow and blockages in the legs. An IV is put into a vein after a local anesthetic has been administered to the arm. Injections of contrast dye are performed through an IV line to investigate any obstructions or valve problems on a computer screen. 

CT Venogram

A CT venogram detects blood flow and blockages in the deep veins of the legs using a sequence of X-rays and computer software. Blood flow is highlighted on a computer screen by injecting a contrast dye into a vein. This examination could take up to 45 minutes.


A venogram creates images of leg veins using X-rays and a contrast dye. It enables your doctor to examine for blood clots or pooling, which can develop when vein valves malfunction. A contrast dye is put into the IV during this procedure. As the dye travels into the vein, you may experience a warm or burning feeling. On a computer screen, the dye reveals obstructions or valve abnormalities.

Vein Center Doctor: Chronic Venous Insufficiency Management and Treatment

In recent years, superficial venous reflux has been treated primarily in the outpatient clinic with minimally invasive procedures such as ablation or closure of dysfunctional veins. Blood flow is shifted into the deep veins, which decreases blood pressure and pooling within the superficial veins. Minimally invasive and conservative measures usually take 1 to 2 hours. These treatments carry a low risk of bruising, scarring, and bleeding since they use a small incision.

1) Compression Therapy

Compression therapy is the gold standard for chronic venous insufficiency, with the intended function of compressing the leg and reducing fluid buildup caused by venous hypertension and varicose veins. Pain, edema, skin pigmentation, and venous function are all improved in compliant patients. It’s also been proven to be an effective venous ulcer treatment method because it can assist in the healing of ulcers and preventing venous ulcer recurrence.

Compression stockings are available in a wide range of compression levels, ranging from 8 to 10 mm Hg to 40 to 50 mm Hg. Your doctor can advise you on the best compression suited for your condition. Any stockings with a compression of more than 20 mm Hg will require a prescription. Poorly fitting elastic stockings might aggravate your disease by restricting blood flow in the region where they have bunched up.

2) Sclerotherapy

Sclerotherapy is a treatment in which a unique type of medicine is injected into a vein, inducing an inflammatory response within the vein, causing it to close. The chemical creates scarring in the veins, preventing them from carrying blood. Other veins then return the blood to the heart. 

Sclerosing agents like a hypertonic sodium chloride solution, detergents, and sodium iodide are used in this interventional treatment. It’s used to treat a wide range of medical conditions, including bleeding varicosities, dilated veins, and minor cavernous hemangiomas, and also as an adjunctive therapy to surgery. Sclerotherapy is a viable option for older multimorbid patients or those who refuse surgical or endovenous procedures.

3) Radiofrequency Vein Ablation

Vein Center Doctor offers the most cutting-edge procedures for venous diseases, including minimally invasive procedures like radiofrequency vein ablation. This technique of thermal ablation destroys the inner lining of the vein using heat energy transmitted by radiofrequency catheters with a heating element at their tip. 

Radiofrequency vein ablation is minimally invasive and only uses local anesthesia, so it’s an outpatient surgery that enables patients to get back to their daily routine as quickly as possible. Following the radiofrequency vein ablation procedure, the site of catheter entry will be manually compressed after which compression bandages or stockings will be worn for up to 3 days to prevent side effects like bruising and tenderness.

Patients with superficial veins with diameters of less than 2 mm, a medical history of deep vein thrombosis or malignancy, or pregnant women should not have this surgery, despite the clear benefits.

4) Endovenous Laser Ablation / Endovenous Laser Therapy 

Major varicose veins that were formerly treated with stripping surgery are now treated with endovenous laser ablation. A laser fiber is inserted into the dysfunctional vein through a small incision under ultrasound monitoring. 

The vein is then numbed with local anesthesia, and the laser is turned on while the fiber is gradually extracted. Laser therapy causes a reaction in the vein wall along the treatment area, resulting in vein wall collapse and sclerosis with minimal discomfort.

The following veins have been effectively and safely ablate with endovenous laser ablation:

  • Superficial accessory saphenous vein
  • Anterior and posterior accessory great saphenous vein
  • Thigh extension of the small saphenous vein
  • Great and small saphenous veins
  • Anterior and posterior circumflex veins of the thigh

5) VenaSeal

Venous reflux disease causes backward blood flow, which the VenaSeal procedure may minimize or stop. The blood circulation will improve as a result of this innovative vein treatment, and you will experience fewer symptoms if any. 

The use of compression socks alone could benefit certain people with impaired blood circulation. Meanwhile, others will require VenaSeal treatment to seal or remove the vein. The flow of blood is enhanced by sealing the damaged vein with this procedure. Our vein specialists use VenaSeal to seal the diseased vein by injecting a little amount of medical adhesive into it. This enables the blood to automatically reroute to another vein.

Alternative Medical Management and Treatment Options for Chronic Venous Insufficiency

Lower legs shown for a person doing walking exercise on the road.

The goal of treatment is to intervene in the early stages of the venous disease to prevent wound complications and infections. Medical management and treatments are designed to decrease the blood pressure in the veins so that swelling and symptoms can be reduced and the return blood flow to the heart can be managed. Venous disorders can be treated with medication or, in more severe situations, surgery. 

Only about 10% of patients with chronic venous insufficiency need surgical intervention to treat their venous malformations. However, knowing all of the therapy options available to you is still important in order to effectively manage your venous disease.

1) Physical Activity

Chronic venous insufficiency, like any disease, is best treated in its early stages. For patients suffering venous disease, vascular medicine or vascular surgery professionals usually propose a mixture of treatments. The following are some basic treatment approaches that can aid with the improvement of symptoms manifested by venous insufficiency:

  • If you must spend long periods standing or sitting, Try flexing and extending your feet, ankles, and legs a few times every 30 minutes to avoid blood pooling in the legs, especially if you’ll be spending long periods standing or sitting.
  • Take regular pauses to sit down and elevate your feet if you have to stand for long amounts of time.
  • Exercise on a regular basis. Walking is particularly advantageous.
  • Perform leg elevation exercises while sitting or lying down, keeping them above the level of your heart.

2) Skincare

Venous ulcers are exposed sores on the skin that develop as a result of chronic venous hypertension and faulty venous valves. Venous stasis ulcers form in regions where blood gathers and pools, preventing oxygen and nutrients from reaching the tissues. The skin eventually develops noticeable venous ulceration. Venous ulcers commonly develop on the inside of the leg, directly above the ankle.

It’s essential to observe an effective skin routine to prevent venous ulcerations from getting worse. Keep your skin nourished and moisturized to prevent cracking and drying. If the skin is irritated but not ruptured or leaking fluid, your doctor may instruct you to use an anti-itch cream with hydrocortisone, an antifungal cream to treat fungal infections, or a zinc oxide lotion to protect the skin.

Venous ulcers can quickly get infected, resulting in cellulitis or gangrene and the possibility of amputation of the foot or leg if not treated. Venous ulcers and other venous disorders can also be treated with the following choice of dressings:

  • Unna Boot – Unna boots are wet gauze bandages that are wrapped around the lower leg from the venous leg ulcers to just below the knee. The gauze hardens into a comfortable leg boot. The support provided by the boot helps to enhance blood flow in the veins and assists in venous ulcer healing. If the wound does not heal after two weeks, the boot is removed and replaced.
  • Hydrocolloid Dressings – A hydrocolloid dressing is a type of bandage that has a breathable outer layer that keeps liquid, bacteria, and viruses out and an interior layer that absorbs wound drainage and promotes healing of ulcers. The dressing can also be used as a debridement treatment to extract any dead or non-viable tissue due to venous ulceration.
  • Transparent Dressings – The venous ulceration or open wound is covered with transparent plastic-like sheets. Every 5 to 7 days, the dressing is changed. To keep the dressing in place and enhance circulation in the leg and foot, a support stocking is worn over it.

3) Surgical Procedures

Chronic venous insufficiency that has not responded to conventional treatments, as well as non-healing or infected venous ulcers, may require surgery. It’s possible to use an open surgery procedure or a catheter-based interventional treatment and management. 

Surgical and endovenous procedures are used to extract or eliminate defective veins or disconnect the reflux source from the majority of the vascular system in the medical management of chronic venous diseases. Appropriate compression therapy, however, is one of the therapeutic constants when used in conjunction with surgical or endovenous procedures.

If self-care and compression stockings don’t succeed to combat the symptoms of venous insufficiency, or if varicose veins become more severe, a doctor may suggest surgical intervention or endovenous procedures, such as:

  • Ligation and Stripping – This procedure requires sealing venous malformations in the vein before it connects to a deep vein and then removing it using minor cuts. For the most part, this will be an outpatient operation. The removal of the vein will not stop blood from circulating in the leg since higher amounts of blood are managed by deep veins in the leg.
  • Microincision / Ambulatory Phlebectomy – A series of microscopic skin punctures are used to remove smaller superficial veins or varicose veins. In this outpatient procedure, only the areas of the leg that will be pricked are numbed. In most cases, scarring is mild.
  • Vein Bypass – The use of vein bypass is reserved for the most severe cases of chronic venous insufficiency in the upper thigh or pelvic veins when other treatments have failed. It involves rerouting blood around the obstructed vein that is causing vein insufficiency using a graft or a transplanted vein from another part of your body.
  • Debridement – When a venous ulcer displays indications of infection, such as fever, an extremely high white blood count, and prolonged or excessive discharge, debridement is frequently performed. Debridement is the process of extracting necrotic or dead tissue, infected tissue and bone, foreign debris, and leftover dressing material. The process stimulates the production of platelets, a component of blood, and growth factors, which both promote healing.

How Can You Prevent Chronic Venous Insufficiency?

Follow these recommendations to lower your risk of developing chronic venous insufficiency:

  • Exercise regularly and maintain a healthy diet.
  • Quit smoking.
  • Make any necessary adjustments to your workspace to relieve any venous pressure on your legs.
  • Spend as little time as possible sitting or standing.
  • Buy footwear that provides additional support.

None of these items will prevent you from developing chronic venous insufficiency. Although, these precautions lead to a healthier lifestyle with low blood pressure, which lowers your risk of developing venous insufficiency.

Vein Removal Starts With a Specialist From Vein Center Doctor

The first step in treating chronic venous insufficiency is to have a proper diagnosis. Depending on the patient and physician preferences, medical treatment of this venous disease can be conservative, interventional, or surgical.

At Vein Center Doctor, our team of medical professionals, led by Dr. Rahul Sood, delivers outstanding, patient-centered care to efficiently address vascular diseases and avoid possible issues. Let us take care of your venous reflux and other leg vein issues by contacting us at 862-227-1143 (NJ) or at 862-227-1054 (NY) today for a free consultation.

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Find exactly what you need to get rid of your vein-related problems. Dr. Sood and the rest of our team at Vein Center Doctor are ready to help: schedule your free consultation today.

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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