There is a range of symptoms that includes the following [6]:

• Dull aches, heaviness and cramping in the legs
• Itching and tingling in the legs
• Pain that worsens when standing
• Swelling in the legs
• Redness of legs and ankles
• Changes in skin colour, especially at the ankles
• Superficial varicose veins
• Lipodermatosclerosis (when skin hardens and thickens on the legs and ankles)
• Ulcers on the legs and ankles
• Wounds on the legs or ankles that are slow to heal
• Cellulitis

• Leg Edema

  Chronic Venous insufficiency can cause varicose veins, leg edema, leg pain, chronic skin changes, and non-healing ulcers. These problems may make it difficult to sit or stand for extended periods. Schedule an Appointment [gasurgery.com]

  Leg edema tends to be unilateral or asymmetric; bilateral symmetric edema is more likely to result from a systemic disorder (eg, heart failure, hypoalbuminemia) or certain drugs (eg, calcium channel blockers). [msdmanuals.com]

  Elastic bandages are used initially until edema and ulcers resolve and leg size stabilizes; commercial compression stockings are then used. [merckmanuals.com]

  One leg may be more affected than the other (asymmetrical edema). [medicinenet.com]

• Congestive Heart Failure

  heart failure distinguishing factor other symptoms of heart failure, including dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea Pressure ulcers distinguishing factor typically on pressure points and associated with failure to reposition [step2.medbullets.com]

  When left untreated, CVI can cause problems similar to Congestive Heart Failure or Chronic Obstructive Pulmonary Disease, both of which are serious complications and pose significant threat to the patient’s health. [skinandvein.com]

  Risk Factors Diabetes mellitus Congestive heart failure Peripheral vascular disease Deep vein thrombosis Pregnancy Obesity Complications One of the most typical complications associated with venous insufficiency ulcers is infection of the affected tissue [woundsource.com]

  Analysis of the fluid can help differentiate ascites that is caused by cirrhosis from other causes of ascites, such as cancer, tuberculosis, congestive heart failure, and nephrosis. [medicinenet.com]

  For obese patients or those with a great deal of edema, intermittent pneumatic compression pumps may be used, although the pumps should not be used in patients with uncompensated congestive heart failure. [lymphedemapeople.com]

• Nausea

  The most common side effects are itching, nausea, heartburn, headache, and dizziness. Most studies show no difference when compared to placebo. [lymphedemapeople.com]

• Heart Failure

  failure distinguishing factor other symptoms of heart failure, including dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea Pressure ulcers distinguishing factor typically on pressure points and associated with failure to reposition frequently [step2.medbullets.com]

  In people with heart failure due to weak heart muscle (cardiomyopathy), both the right and left ventricles of the heart are usually affected. [medicinenet.com]

  When left untreated, CVI can cause problems similar to Congestive Heart Failure or Chronic Obstructive Pulmonary Disease, both of which are serious complications and pose significant threat to the patient’s health. [skinandvein.com]

  The volume of this overnight rostral fluid shift is strongly correlated with the degree of overnight increase in neck circumference and the number of apneas and hypopneas per hour of sleep in patients with heart failure or hypertension who are otherwise [medicalnewstoday.com]

• Vascular Disease

  However, it’s not simply the cosmetic effects that should be of concern to those with Chronic Venous Insufficiency as these can lead to an even more serious vascular disease if it goes untreated by a vascular surgeon. [skinandvein.com]

  CONCLUSION: Athletes, e.g., runners with complaints in the leg should be investigated for musculoskeletal defect but also for vascular disease,e.g., small saphenous vein insufficiency. [ncbi.nlm.nih.gov]

  To put this in perspective, venous vascular disease is 5 times as prevalent as peripheral arterial disease and 2.5 times as prevalent as coronary artery disease. [vasculardiseasemanagement.com]

• Vein Disorder

  Vein disorders are hereditary. Inherited factors related to blood clots or clotting disorders are also important, as you could also have inherited the same clotting disorder. [phlebology.org]

  If you can’t get the relief you need by using home treatments for venous reflux, it may be time to go to a vein clinic. Vascular surgeons are experts at helping patients with vein disorders, and Tampa Bay treatment can be effective. [premierheartandveincare.com]

  In fact, more people lose work time from vein disorders than from artery disease. By the age of 50, nearly 40% of women and 20% of men have significant leg vein problems. Spider veins occur much more frequently in women. [vascularcures.org]

• Dermatitis

  2016 2017 2018 2019 Non-Billable/Non-Specific Code Type 2 Excludes contact dermatitis ( L23 - L25 ) dry skin dermatitis ( L85.3 ) small plaque parapsoriasis ( L41.3 ) stasis dermatitis ( I87.2 ) Dermatitis (eczematous) L30.9 ICD-10-CM Diagnosis Code [icd10data.com]

  Prognosis likely to recur even after treatment Presentation Symptoms lower leg swelling with pain or ache restlessness feeling of heaviness itch burning or tingling nocturnal leg cramping lower leg symptoms relieved by elevation Physical exam stasis dermatitis [step2.medbullets.com]

  We describe 2 unusual clinical presentations of KS in the setting of chronic venous insufficiency with clinical and histologic features consistent with stasis dermatitis but positive HHV-8 immunostaining. [ncbi.nlm.nih.gov]

  [6] also known as varicose eczema Contact dermatitis. [6] Patients with venous insufficiency have a disrupted epidermal barrier, making them more susceptible than the general population to contact sensitization and subsequent dermatitis. [en.wikipedia.org]

• Eczema

  Topical treatments are aimed at treating the skin effects of stasis dermatitis, which may manifest as varicose eczema. [pulsetoday.co.uk]

  RESULTS: The healing of ulcers and resolution of venous eczema in 6 months were considered the primary end-point. Healing of ulcers was found in 45/55 (82%) cases in group 1 and in 31/35 (88%) cases in group 2. [ncbi.nlm.nih.gov]

• Hyperpigmentation

  On physical exam, her bilateral lower legs are edematous with brown hyperpigmentation around the ankles. There are no ulcers. She is scheduled for a duplex ultrasound. [step2.medbullets.com]

  Chronic venous insufficiency (CVI) is the most advanced form of chronic venous disease (CVD), and is often associated with skin changes such as hyperpigmentation, eczema, lipodermatosclerosis and venous skin ulceration that cause discomfort, pain, sleep [ncbi.nlm.nih.gov]

  Varicose veins Leg ulcers Itching (pruritis) Hyperpigmentation (dark discoloration of the skin) Swelling of the legs and ankles Skin abnormalities including eczema, thickening, increased risk of infection, and inflammation. [columbiasurgery.org]

  Signs also include edema, venous eczema, hyperpigmentation of skin of the ankle, atrophie blanche, and lipodermatosclerosis. In the lower extremity, there are three main venous system including superficial, deep, and perforating veins. [link.springer.com]

  Venous stasis dermatitis consists of reddish brown hyperpigmentation, induration, venous ectasia, lipodermatosclerosis (fibrosing subcutaneous panniculitis), and venous stasis ulcers. [msdmanuals.com]

• Pruritus

  Pruritus may accompany skin changes. [msdmanuals.com]

  Signs and symptoms [ edit ] Chronic venous insufficiency Signs and symptoms of CVI in the leg include the following: Varicose veins Itching ( pruritus ) Hyperpigmentation Phlebetic lymphedema [5] Chronic swelling of the legs and ankles Venous ulceration [en.wikipedia.org]

  Those signs and symptoms include: Itching or pruritus. Varicose veins. Phlebitic lymphedema. Persistent swelling of ankles and legs is a symptom of chronic venous insufficiency. Ulceration of the veins. Pain while you stand. Leg cramps. Weak legs. [epainassist.com]

  Her previous treatments consisted of a number of different medications that she had tried for her “neuropathy” as well as numerous unspecified medications for her dermatologic complaints of pruritus including a fair share of steroid-based creams. [vasculardiseasemanagement.com]

• Foot Ulcer

  Leg and Foot Ulcers. Cleveland Clinic. http://my.clevelandclinic.org/heart/disorders/vascular/legfootulcer.aspx. Accessed July 12, 2017. Gabriel A. Vascular Ulcers. Medscape Reference. http://emedicine.medscape.com/article/1298345-overview. [woundsource.com]

  Symptoms: Chronic foot or leg swelling in the affected limb, varicose veins, no healing leg ulcers, affected limb may experience pain pressure, itching, dull ache, or heaviness in the affected limb. [lymphedemapeople.com]

• Confusion

  Kaposi sarcoma (KS) is a vascular neoplasm associated with human herpesvirus 8 (HHV-8) infection that can be confused with the clinical and histological findings of chronic venous insufficiency. [ncbi.nlm.nih.gov]

  Importantly, to avoid confusion, the 'Long Saphenous' is now the 'Great Saphenous'. What are Varicose veins? Below is a basic outline of the anatomy and function of the veins and what constitutes venous incompetence. [ultrasoundpaedia.com]

  Mental confusion, severe headaches, weakness and lethargy, acute visual disturbances, and facial and glottic edema are clinically obvious and quite severe. [evtoday.com]

  It is sometimes called chronic peripheral venous insufficiency and should not be confused with post-thrombotic syndrome in which the deep veins have been damaged by previous deep vein thrombosis. [en.wikipedia.org]

  Sign of severe CVD, and not to be confused with healed ulcer scars. [sigvaris.com]

• Burning Sensation

  While varicose veins aren't considered a serious medical condition, they can cause discomfort: rashes, burning sensations or a feeling of heaviness in the legs. [affinityhealth.org]

  Achy, painful legs Tired, heavy, fatigued legs Swelling of ankles and legs Bulging veins (varicose veins) Itching, irritation, dryness, tingling or burning sensation of the skin Skin discoloration, redness or inflammation Ulcer or non-healing wounds on [veinatlanta.com]

  Subjective symptoms include throbbing, cramping, burning sensations, and leg fatigue. Patients can also develop chronic leg ulcers that may not heal. [medical-dictionary.thefreedictionary.com]

Clinical history and physical examination (including examination of leg veins when the patient is sitting and dangling his legs) are usually adequate to allow a tentative diagnosis.

A duplex ultrasound will allow analysis of blood flow through the veins and rule out the differential diagnoses such as a blood clot.

Mild conditions are best handled with self-care steps. These include, but are not limited to the following [7]:

• Regular exercise
• Compression stockings to decrease swelling
• Reduction of weight
• Refraining from sitting or standing for long periods
• Frequent periods of rest with legs raised above the heart (this may include tilting the patient’s bed)
• Manual compression by lymphatic massage therapy
• Prompt attention to sores and wounds

Severe conditions may require more intensive treatments including:

• Sclerotherapy: Saline or a chemical solution is injected into the damaged vein which causes it to harden and then disappear [8].
• Venous ablation: Heat closes off and destroys the damaged vein and it disappears with time.
• Microphlebectomy: The damaged vein is removed through small incisions made in the skin near the vessel.
• Venous bypass: Blood flow is diverted around the damaged vein using a synthetic tube or a healthy blood vessel taken from elsewhere in the body to make the by-pass or detour.
• Angioplasty and stenting: A small medical balloon is used to widen the blocked vein in angioplasty when the inflated balloon inside the damaged vessel improves blood flow. The vessel is prevented from collapsing again by inserting a tiny metal mesh tube (stent) inside the vein [9].
• Endovenous laser ablation: This may be indicated for early signs of venous insufficiency such as tired or heavy legs with pain, persistent skin sores due to poor blood flow or lipodermatosclerosis.

Although chronic venous insufficiency tends to deteriorate over time, it can be successfully managed from the early stages with self-help steps such as adequate exercise, weight control and the use of pressure stockings [5].

The most common cause of venous insufficiency is superficial venous reflux and varicose veins. It is commonly found in aging patients who spend most of their day inactive [2].

There are several risk factors for chronic venous insufficiency. These include [3]:

• Age
• Family history
• Deep vein thrombosis - also called post-thrombotic syndrome
• Obesity
• Pregnancy
• Prolonged sitting or standing
• Tall height
• Arterio-venous fistula
• Phlebitis
• Thrombophilias

Recent studies tend to refute the suggestion that women are more prone to develop this condition compared to men.

Leg veins have valves in them to ensure one-way flow of blood back towards the heart. However, if these valves are damaged or the venous walls are weakened, blood may pool in the veins. Chronic venous insufficiency leads to development of varicose veins (both superficial and deep) and superficial venous reflux. The lack of healthy blood flow leads to edema fluid because of the change in local blood pressure altering the dynamics of flow between vascular and tissue fluids. This poor circulation leads to both inadequate tissue perfusion and removal of wastes with subsequent reduced tissue health. Injuries heal less rapidly and infections (e.g. cellulitis) can become more serious and lead to greater spread [4].

Healthy lifestyle including adequate exercise and avoiding excessive inactivity is needed to prevent venous insufficiency. Maintaining a healthy weight is also important. Should early signs develop, it becomes important to modify behaviour patterns so that chronic problems do not develop [10].

Deep veins in the legs have valves in them to ensure a unidirectional flow of blood towards the heart. However, these valves may can become damaged in certain conditions leading to the pooling of the blood in the veins [1]. Early treatment is recommended to prevent chronic insufficiency from developing. It is also known as chronic venous stasis and chronic venous disease.

Venous insufficiency refers to problems associated with inadequate blood returning from the lower legs to the heart. It occurs when the valves in the veins can no longer ensure the one-way flow of blood back to the heart. It is commonly found in ageing patients who spend most of their day inactive. There is a range of symptoms including dull aches, heaviness and cramping in the legs along with itching and tingling. There are changes in skin color along with the development of ulcers in extreme cases. Mild cases can be treated with self-help methods such as compression stockings and lifestyle changes. Exercise and healthy weight are important but resting with the feet above the heart or massage therapy will be beneficial. More severe lesions may need surgery and a variety of techniques are available for different types of chronic venous insufficiency. Maintaining an ideal weight and performing regular exercise are very important in preventing venous insufficiency or restricting it in an early phase.

1. Coon WW, Willis PW 3rd, Keller JB. Venous thromboembolism and other venous disease in the Tecumseh community health study. Circulation. Oct 1973;48(4):839-46.
2. Chiesa R, Marone EM, Limoni C, Volonte M, Schaefer E, Petrini O. Chronic venous insufficiency in Italy: the 24-cities cohort study. Eur J Vasc Endovasc Surg. Oct 2005;30(4):422-9.
3. Tsai S, Dubovoy A, Wainess R. Severe chronic venous insufficiency: magnitude of the problem and consequences. Ann Vasc Surg. 2005;19:705-11.
4. Zaniewski M, Simka M. Biophysics of venous return from the brain from the perspective of the pathophysiology of chronic cerebrospinal venous insufficiency. Rev Recent Clin Trials. May 2012;7(2):88-92.
5. Evans GA, Evans DM, Seal RM, Craven JL. Spontaneous fatal haemorrhage caused by varicose veins.Lancet. Dec 15 1973;2(7842):1359-61
6. Bonnetblanc JM. Leg ulcerations: a clinical appraisal. Eur J Dermatol. May-Jun 2005;15(3):127-32.
7. Zhan HT, Bush RL. A review of the current management and treatment options for superficial venous insufficiency. World J Surg. Oct 2014;38(10):2580-8.
8. Tretbar LL. Treatment of small bleeding varicose veins with injection sclerotherapy. Bleeding blue blebs.Dermatol Surg. Jan 1996;22(1):78-80.
9. Raju S, Neglén P. Stents for chronic venous insufficiency: why, where, how and when--a review. J Miss State Med Assoc. Jul 2008;49(7):199-205
10. Zimmet SE. Venous leg ulcers: modern evaluation and management. Dermatol Surg. Mar 1999;25(3):236-41