What Is Venous Insufficiency, and How Do You Treat It?

Medically Reviewed By John A. Moawad, MD, FACS
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Venous insufficiency is when vein damage stops veins from moving blood back to the heart. Valves in veins usually prevent blood from flowing backward. With venous insufficiency, the valves function improperly, causing increased pressure, blood pooling, and more. Venous insufficiency is a common condition that typically occurs in the lower extremities of the body, for example, the legs. It can become chronic, with some clinicians referring to the condition as “chronic venous insufficiency.”

There are several risk factors for venous insufficiency, including prolonged periods of sitting or standing, a history of a blood clot, and experiencing overweight. Treatment depends on the severity of the condition and can include exercise, compression wraps, and surgical procedures.

This article will explain venous insufficiency, including the symptoms, causes, and risk factors. It also discusses preventing, treating, and caring for venous insufficiency. 

What is venous insufficiency?

Unseen woman's legs leaning against balcony from floor
Ivan Andrianov/Stocksy United

The cardiovascular system forms a closed loop of blood vessels leading to and from your heart. Blood vessels are the channels through which blood travels around the body to tissues, and include veins, arteries, and capillaries.

Your heart is the center of the cardiovascular system, which works as a large pump, continuously moving blood around your body. 

Your arteries carry freshly oxygenated blood away from your heart. As the blood moves away, the diameters of the arteries get smaller until the blood moves into the tiny capillaries, delivering oxygen. After this exchange, the deoxygenated blood travels back to your heart through your veins. 

Arteries and veins are slightly different. Arterial walls are smooth, allowing fast blood flow. However, after the blood slows down in the capillaries, it does not have much pressure behind it and moves against gravity.

Because of the above, venous walls have valves that prevent blood from flowing backward and accumulating or pooling in the lower tissues of the body.

With venous insufficiency, damaged valves allow the blood to flow backward, in the wrong direction around the body. 

An illustration comparing the structure of healthy valves in the veins with damaged valves in the veins.
Illustration by Jason Hoffman

Arterial vs. venous insufficiency

Arterial insufficiency and venous insufficiency sound familiar and may be confused.

Arterial insufficiency is when blood flow becomes more difficult or blocked in the arteries because of fatty deposits inside the arteries.

Venous insufficiency is when the blood flows improperly in the veins because of damage to the valves inside the veins, allowing for backward flow and pooling of the blood. 

Both conditions, however, result in decreased oxygen and nutrients reaching the skin and other tissues of the extremities, sometimes leading to the development of ulcers

Symptoms and stages

Early symptoms of venous insufficiency include:

  • persistent swelling or swelling that occurs at night
  • skin indenting when pressed, called pitting swelling
  • pains or cramping
  • muscle fatigue
  • restless leg syndrome
  • sensation of heaviness in the legs, and prickling, aching, or throbbing
  • itchy skin
  • symptoms that appear to improve with rest and leg elevation, and that do not relate to exercise

Contact your doctor promptly for any symptoms of swelling, discomfort, or fatigue in the legs.

Additional symptoms at a more advanced stage of venous insufficiency include:

  • varicose veins
  • persistent swelling
  • skin hyperpigmentation and thinning
  • dilated venous capillaries
  • eczema
  • venous and skin ulcers
  • lipodermatosclerosis, which can include:
    • skin hardening on the lower legs
    • fibrosis of the skin
    • erythema, a type of rash

Learn more about different types of ulcers here.

Chronic venous insufficiency stages

There are several stages in the way that chronic venous insufficiency can progress and present symptoms.

These stages include:

  • Stage 0: There are no apparent clinical signs or symptoms of the condition.
  • Stage 1: There may be reticular or spider veins.
  • Stage 2: Varicose veins are present.
  • Stage 3: Swelling is present.
  • Stage 4: Pigmentation and/or eczema occurs. Alternatively, lipodermatosclerosis or atrophie blanche, a type of scarring, may occur.
  • Stage 5: Ulcers that were present now heal.
  • Stage 6: Active ulcers are present.

Without treatment, the condition tends to be progressive, meaning that it worsens over time.

Pictures

Below are some examples of how symptoms of venous insufficiency can appear.

An image of spider veins on the legs.

Spider veins can occur due to venous insufficiency.

Warot Pengpean/Shutterstock

An image of edema in the calves.

Edema of the calves and hyperpigmentation can result from venous insufficiency.

Blueee77/Shutterstock

Swelling,Of,Ankles,And,Feet,Test,By,Pushing,Finger,On

An edema pits when applying pressure, leaving an indentation.

Toa55/Shuttertsock

venous-ulcers-chronic-venous-insufficiency-body4.jpg

Venous ulcers can occur due to chronic venous insufficiency.

Casa nayafana/Shutterstock

Causes of venous insufficiency

The weakening of the vein walls and damage to the valves can cause venous insufficiency. This results in the blood flowing backward, stretching the veins and filling them with blood.

This can occur for one of two reasons.

Primary chronic venous insufficiency refers to when the condition is present due to structural differences in the vascular system that may be present from birth. It may also occur as a result of changes to the biochemistry of the vein walls.

Secondary chronic venous insufficiency occurs as a result of another condition called deep vein thrombosis. This is when blood clots form within a vein. As a result, the vein may experience an inflammatory response, which can damage the vein walls.

Risk factors

Some risk factors may increase your chance of experiencing venous insufficiency.

Venous insufficiency tends to be more common in females and people who experience:

  • higher levels of the hormone progesterone
  • older adulthood
  • genetic factors or a family history of the condition
  • obesity
  • taller height
  • pregnancy
  • lifestyle factors, such as:
    • smoking
    • having a sedentary lifestyle
    • sitting or standing for long periods of time
  • serious injuries or certain conditions, such as:
    • deep vein thrombosis in the legs
    • May-Thurner syndrome
    • leg and venous injuries

Prevention

Not all cases of venous insufficiency are preventable.

However, there are some things you can do to reduce the impact of certain risk factors.

Prevention methods may include:

  • maintaining a moderate weight
  • getting regular exercise
  • managing your blood pressure
  • avoiding sitting or standing for long periods without moving around
  • discussing compression stockings with a healthcare professional if you have to be sedentary for long periods
  • caring for any underlying leg or venous conditions and following your treatment plan as prescribed

Learn more about deep vein thrombosis and its treatment here.

Treatment

The goal of treatment is to reduce discomfort and address symptoms. It also aims to reduce the risk of experiencing complications.  

The exact course of treatment your doctor recommends will depend on the severity or stage of venous insufficiency.

Initial treatment begins with elevating the legs throughout the day and learning exercises to strengthen the calf muscles. It can also focus on weight management and compression therapy, which uses stocking or wraps to improve blood flow and care for ulcers. 

Depending on which vein the condition affects, there are several surgical options, such as:

  • Sclerotherapy: Clinicians will use saline water, foam, or a chemical solution and inject it into the affected vein to harden it. Afterward, the body no longer uses that vein, so others grow around to bypass it. 
  • Endovenous thermal ablation: This is a type of laser therapy that aims to close the vein to stop blood from flowing through it.
  • Radiofrequency ablation (RFA): RFA is similar to endovenous thermal ablation, but it involves radiofrequency energy rather than a laser to treat the vein. Both methods are minimally invasive treatment techniques.
  • Phlebectomy: This is the removal of the damaged vein through small surgical incisions a doctor makes near the vein.
  • Saphenous ligation: In this procedure, a clinician ties off the affected vein and removes it, allowing other veins to support the blood flow.

Venous insufficiency can sometimes reoccur after surgery, and all surgeries carry the risk additional of complications.

To improve effectiveness, clinicians can combine surgical options with compression therapy.

At-home management tips

If you currently have venous insufficiency, the following steps may help you to slow the progression of the condition or manage your symptoms:

  • Maintain a moderate weight.
  • Wear compression stockings or wraps to help blood flow, with the guidance of your doctor. They can recommend how to use compression products.
  • Eat a balanced diet, and do not exceed daily recommendations for salt or sodium intake.
  • Get regular exercise throughout the week.
  • Avoid sitting or standing in one place or position for long periods. Take regular breaks to move around.
  • Elevate your legs periodically throughout the day.
  • Avoid wearing tight clothing or high heels.
  • Monitor your blood pressure regularly with a doctor to keep it in a stable range.
  • Check your skin daily for symptoms of ulcers.
  • Moisturize the skin daily.

Complications and outlook

Without treatment, venous insufficiency can often lead to disability and can progressively worsen. In such cases, people may require long-term clinical treatment over several years.

Sometimes, people can experience complications even with treatment.

Possible complications can include:

  • ulcers, which may be painful and difficult to treat
  • acute and chronic pain
  • discoloration
  • secondary blood conditions, such as:
  • surgical complications, such as infection, tissue damage, and scarring
  • death due to complications

FAQs

Below are some answers to frequently asked questions about venous insufficiency.

Can you reverse venous insufficiency?

Venous insufficiency is a chronic condition that has no cure yet, although effective treatment and management may help stop the condition from progressing or developing complications.

Some surgical treatments can even remove an affected vein. However, in some cases, venous insufficiency can reoccur after surgery.

What is the most serious complication of venous insufficiency?

Without treatment, venous insufficiency can cause further complications such as hemorrhage or bleeding and pulmonary embolism, among others.

In some cases, these complications can be life threatening.

Additionally, chronic venous insufficiency can cause long-term pain and disability, which may affect quality of life.

Summary

Venous insufficiency refers to veins in your legs experiencing damage, which prevents them from returning blood to the heart. Typically, as blood flows through your veins, valves open and close to keep blood flow in the correct direction. However, sometimes these valves experience damage.

This can happen due to other venous or blood conditions, genetic differences, and lifestyle factors. When damage occurs, the blood begins to pool in the legs, leading to swelling and skin changes.

Treatment options include compression stockings or wraps, maintaining a moderate weight and blood pressure, and getting regular exercise. If the condition becomes more advanced, surgical procedures may also be suitable. 

Contact your doctor for any initial symptoms of swelling or discomfort in the legs.

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Medical Reviewer: John A. Moawad, MD, FACS
Last Review Date: 2022 Jul 28
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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