My Legs Are Swollen. Do I Have Chronic Venous Insufficiency?

Chronic venous insufficiency is a common vein disease that can cause poor circulation and leg swelling. If you have discolored skin or painful, achy legs, you should talk to your provider — especially if symptoms interfere with daily activities.

Key Takeaways: Chronic Venous Insufficiency

• Chronic venous insufficiency, or CVI, happens when veins don’t move blood efficiently — like a slow-draining sink. It usually affects the legs.
• Many factors can contribute to CVI, including age, obesity, family history and standing on your feet for long periods.
• Leg swelling is the most common CVI symptom. But many people also experience leg pain, discomfort or staining that can eventually form skin ulcers.
• Compression socks are a standard CVI treatment, along with vein hygiene, laser therapies, ablation and sclerotherapy.

What Is Chronic Venous Insufficiency?

Chronic venous insufficiency (CVI) is an increase in pressure in your legs — specifically the blood vessels. It can happen anywhere you have a vein but is most common in the legs.

Melissa Gouger, NP, a nurse practitioner in vascular surgery at the Franciscan Physician Network Woodland Health Center, tells her patients to think of CVI like a slow-draining sink, where the veins are the sink.

“With a slow-draining sink, the sink operates, but you have some stagnant water,” she said. “Similarly, with venous insufficiency, the veins operate by sending blood back to the heart for oxygen, but it’s a little slow, and there’s some stagnant blood in the legs.”

CVI differs from other related vein diseases, including varicose veins or deep vein thrombosis, though these conditions can overlap. If CVI is a slow-draining sink, varicose veins are water coming back up from the drain. And deep vein thrombosis is water that clogs the sink altogether.

What Causes Chronic Venous Insufficiency?

Many factors can cause chronic venous insufficiency. Both the condition of a person’s blood vessels and outside influences, such as work environment or other health issues, play a role.

“People who are on their feet for long periods, standing or walking, are more susceptible to CVI because of changes in pressure and gravity,” said Gouger. “Gravity works against them, so to speak.”

Other risk factors for CVI include:

• Age. Risk increases as you get older and blood vessels change.
• Sex. CVI is more common in females than males.
• Obesity. More weight can put pressure on veins in the legs.
• Family history. If a close relative has CVI, you may be more likely to have it.

What Are The Symptoms Of Chronic Venous Insufficiency?

The most common, early symptom of CVI is leg swelling. Then, pain and discomfort. Gouger said many of her patients describe a dull ache that gets worse throughout the day. Or very achy legs when they put their feet up at the end of the day.

Another sign of CVI is hemosiderin staining, which happens when slowly draining blood leaks into tissues. You may notice a brownish color in the legs or a blueish hue (also known as varicosities). Over time, this staining can change the integrity of the skin, making it dry and even creating ulcers or wounds.

“If you have big varicosities coming through the skin, we know you have venous insufficiency,” explained Gouger. “But some people can come in with terrible pain and swelling, and you can’t see varicosities.”

Is Chronic Venous Insufficiency Dangerous? When Should I See A Doctor?

Chronic venous insufficiency isn’t just a cosmetic issue — it’s a mechanical issue. Though by itself, CVI isn’t dangerous, it can cause a lot of pain and discomfort.

It’s always a good idea to talk to your doctor about any changes in your health, including leg swelling or pain. They can help try to uncover what’s causing any symptoms. Gouger recommends thinking about how your symptoms affect your quality of life.

“When your symptoms affect your day-to-day, that’s when you should talk to your primary care provider about these changes and the next step,” she said. “Most of the time, they’re versed enough to give you treatment, such as compression, or initiate a referral to someone who specializes in vasculature.”

How Is CVI Diagnosed?

If you think you have CVI, your doctor will help confirm or rule out a diagnosis. First, they’ll ask about your medical history and perform a physical. The goal is to get an idea of your daily life and symptoms. Then, you’ll get an ultrasound for veins.

“This venous ultrasound not only checks the vessels to see if they’re open and there are no blood clots, but also looks at the reflux,” said Gouger. “Has blood been sitting there, and for how long? What’s the diameter of your blood vessels? These details can help us validate what the problem areas are, so we can see what to do about them.”

How Is Chronic Venous Insufficiency Treated?

Most treatment for CVI involves wearing compression stockings during the day. Compression is the most common and minimal treatment for CVI.

“Compression literally squeezes your legs and works with your muscles,” explained Gouger. “Both leg compression and elevation are important to help propel blood back to the heart.”

For some people, compression helps relieve CVI symptoms. Others may seek alternate therapies, such as:

• Endovenous laser therapy
• Radiofrequency ablation
• Sclerotherapy

These minimally invasive procedures happen in one day, usually in an outpatient setting. They use different techniques to collapse large or troublesome blood vessels, so they no longer fill with blood.

“We’re telling the body to stop letting fluid enter this area and, instead, stay on the main highway to get back to the heart,” said Gouger. “We can’t ablate or obliterate every vein in your leg, but some of the larger veins that are more chronically problematic, we can take care of those pathways to try to limit your discomfort. It’s more about improving patient quality of life and comfort.”

Can I Prevent Chronic Venous Insufficiency?

Gouger said that, unfortunately, you can’t always prevent CVI. And even after treatment, you’re still at risk of future venous insufficiency — it’s lifelong.

However, there are ways to practice good vein hygiene, such as:

• Balance how much you rest and exercise.
• Elevate your legs so they can recover, especially if you stand a lot.
• Wear supportive socks and footwear.
• Listen to your body and get your legs checked if they’re always swollen.

“I tell my patients to listen to their bodies because it may give us clues we don’t want to ignore,” Gouger said. “There are so many specialties and resources out there. We’re here to help.”

Request An Appointment Today

If you have swollen, achy legs or concerns about chronic venous insufficiency, talk to your primary care provider or request a vascular care appointment at Franciscan Health.