by EBSCO Medical Review Board


Chronic venous insufficiency (CVI) is when the veins and valves in the legs do not work as they should. This can cause a backup of blood in the veins, especially in the legs.

Venous Insufficiency
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In some people, the cause is not known. In others, damage to the valves causes problems in the veins. Common causes of this are:

Risk Factors

This problem is more common in people who have DVT. Other things that may raise the risk are:

  • Obesity
  • Lack of physical activity
  • Family members with the same problems
  • Smoking
  • Pregnancy


Problems may be:

  • Leg swelling
  • Pain in the legs, especially after walking:
    • Aching
    • Dullness
    • Tiredness
    • Cramping
  • Red or brown darkening of the skin on the legs
  • Enlarged veins
  • Leg sores, especially around the inside of the ankles
  • Scaling skin on the legs
  • Hard, leathery skin on the legs


The doctor will ask about your symptoms and health history. A physical exam may be done. This may be enough to suspect the diagnosis.

Images of the veins may be taken. This can be done with an ultrasound. This can confirm the diagnosis.


The goal of care is to maintain blood flow and prevent it from pooling in the veins. Choices are:

  • Compression stockings to keep blood from pooling in the legs
  • Regular exercise
  • Procedures to reroute blood flow, such as:
    • Sclerotherapy
    • Ablation

People who are not helped by these methods may need surgery. The type of surgery will depend on the cause.


To lower the risk of this problem:

  • Maintain a healthy weight.
  • Exercise regularly.
  • Avoid smoking.


National Heart, Lung, and Blood Institute 

Society for Vascular Surgery 


Canadian Society for Vascular Surgery 

Health Canada 


American College of Phlebology (ACP) practice guideline on treatment of superficial venous disease of lower leg can be found at ACP 2016 Feb 3.

Chronic venous insufficiency. Society for Vascular Surgery website. Available at: Accessed November 24, 2020.

Chronic venous insufficiency and postphlebitic syndrome. Merck Manual Professional Version website. Available at: Accessed November 24, 2020.

Venous insufficiency. EBSCO DynaMed website. Available at: Updated August 18, 2016. Accessed July 11, 2018.

3/30/2015 DynaMed Systematic Literature Surveillance Dos Santos Crisóstomo RS, Costo DS, et al. Influence of manual lymphatic drainage on health-related quality of life and symptoms of chronic venous insufficiency: a randomized controlled trial. Arch Phys Med Rehabil. 2015;96(2):283-291.

Revision Information

  • Reviewer: EBSCO Medical Review Board Marcin Chwistek, MD
  • Review Date: 09/2020
  • Update Date: 04/20/2021