If your legs feel heavy at the end of the day, your ankles swell, or you notice skin changes around your lower legs, you might be experiencing signs of chronic venous insufficiency (CVI). CVI is a progressive vein disease, meaning it tends to worsen over time without care, but the good news is it’s very treatable. With the right care plan, patients typically enjoy meaningful, lasting relief.
At Refine Vein Center in Franklin, TN, our team, led by board-certified vein specialist Dr. Reynolds, diagnoses and treats venous disease with modern, minimally invasive care designed around your life. Below, we’ll explain what chronic venous insufficiency is in plain language, what symptoms to watch for, and exactly how we treat it here in our clinic.
What Is Chronic Venous Insufficiency?
Your leg veins have one-way valves that help blood travel back to your heart against gravity. When those valves weaken or are damaged, blood can pool in the lower legs, raising pressure in the veins. Over time, that pressure leads to symptoms like swelling, skin discoloration, aching, and, in advanced cases, venous ulcers. That ongoing, valve-related problem is what clinicians call chronic venous insufficiency.
CVI is common, especially as we age, and it often develops after years of untreated venous reflux (backward flow) in surface veins that later affects the health of surrounding skin and tissues. It’s not the same as a blood clot, but a previous deep vein thrombosis (DVT) can damage valves and set the stage for CVI.
Causes and Risk Factors for Chronic Venous Insufficiencies
Two factors typically drive venous insufficiency:
- Primary Valve Weakness – inherited or age-related changes that make valves less competent over time.
- Secondary Damage – prior DVT, trauma, or other conditions that injure valves and disrupt normal flow.
Risk increases with age, family history, pregnancy, obesity, and jobs that require long periods of either sitting or standing. Hormonal changes and smoking history also play a role. Recent patient-education resources from leading organizations highlight the same pattern: the longer reflux is present, the more likely the symptoms progress.
Chronic Venous Insufficiency Symptoms: What CVI Looks and Feels Like
CVI symptoms usually start subtly and build over time. Common signs include:
- Leg Swelling (Edema) – often worse in the evening or after long periods of sitting or standing.
- Heaviness, Aching, or Throbbing – sometimes with nighttime cramps or restless legs.
- Skin Changes – around the ankle or lower calf, including itching, redness, darkening (hyperpigmentation), thickening, or rash.
- Bulging Varicose Veins – or clusters of spider veins.
- Poorly Healing Wounds or Venous Ulcers – near the ankle in advanced stages.
Clinical resources echo the same story: as pressure builds, tiny capillaries can burst, the skin can become inflamed and discolored, and ulcers may form if reflux isn’t addressed. That progression is the “chronic” part of CVI, as well as the reason early detection is crucial.
How Is CVI Diagnosed at Refine Vein Center?
Your first visit focuses on a careful history, exam, and an ultrasound to see how blood flows in both the superficial and deep veins. Our registered vascular ultrasound technologist performs this painless, non-invasive test in-office. Ultrasound lets Dr. Reynolds confirm whether valves are leaking (reflux), where it’s happening, and how severe it is. We use all this information to craft your personalized care plan.
We emphasize ultrasound because venous disease is frequently invisible at the surface. Many people have normal-looking legs but significant reflux on imaging, and addressing the true source vein is what prevents recurrence and progression.
Treatment for Chronic Venous Insufficiency: A Patient-First Approach
CVI treatment starts with conservative measures, then by treating the underlying reflux with targeted, minimally invasive procedures when appropriate. Our goal is simple: lower venous pressure and restore healthy flow so your symptoms resolve and your legs look and feel better.
Step 1: Conservative Measures
Most insurers ask patients to try 6–12 weeks of conservative management before covering procedure treatments. This phase is also clinically useful because many people feel better with simple, consistent changes:
- Medical-grade compression stockings
- Leg elevation
- Regular walking and calf-muscle activation
Compression also supports healing after procedures, improving results and comfort.
Step 2: Definitive, Minimally Invasive Treatments
When ultrasound confirms reflux that’s driving your symptoms, we discuss one or more office-based procedures. These are performed under local anesthesia, typically take about 15 minutes, and require little to no downtime for recovery.
Thermal Ablation
There are two FDA-approved methods that use heat inside the problem vein to seal it from the inside, rerouting blood to healthier veins:
- Endovenous Laser Ablation (EVLA) – a tiny laser fiber delivers energy to close the vein.
- Radiofrequency Ablation (RFA) – a slim catheter delivers radiofrequency energy to achieve the same outcome.
Both options have high success rates (>95%), and most patients are back to routine activity quickly.
Varithena® (Polidocanol Injectable Foam)
For certain vein patterns, especially tortuous segments, we may use Varithena, an ultrasound-guided foam sclerosant that chemically closes the target vein. Some patients need just one session, though larger vein volumes may require multiple.
Ultrasound-Guided Sclerotherapy
Also known as endovenous chemical ablation, this technique uses a liquid or foam sclerosant to close refluxing veins under ultrasound guidance. It’s especially valuable for tributaries and veins not ideal for thermal ablation.
What Recovery from CVI Treatment Looks Like
Because our treatments are minimally invasive and guided by ultrasound, recovery is straightforward for most patients:
- You’ll walk immediately after the procedure and resume light activity the same day.
- Compression stockings are worn for a short period to support healing.
- Bruising or tightness along the treated vein can occur, but walking and anti-inflammatories usually help.
- We schedule a follow-up appointment to confirm the vein has closed and to plan any additional sessions if needed.
Our procedures are designed to minimize downtime while providing durable symptom relief.
Will Insurance Cover CVI Treatment?
For medically necessary venous disease, many insurance plans provide coverage, especially after the slate of conservative care approaches. Cosmetic-only concerns (like isolated spider veins) are handled differently. We’ll review your benefits and help you navigate each step.
Take the Next Step
If you’re noticing swelling, heaviness, or skin changes, don’t wait. An ultrasound-based evaluation can quickly determine whether venous reflux is the culprit, and in most cases we can treat it without surgery or significant downtime.
We’re here to help you transform your vein health and improve your life with advanced, compassionate care.
Call us at (615) 716-VEIN to book your appointment today, or request your consultation online.
