Chronic Venous Insufficiency (CVI)

Tired legs. Swollen ankles. That heavy, aching feeling that gets worse as the day goes on. These symptoms are easy to dismiss as signs of aging, a demanding job, or simply being on your feet too much. But for millions of Americans, they are the unmistakable signs of a medical condition called chronic venous insufficiency, and they are not something you should have to just live with.

Chronic venous insufficiency, or CVI, is a common but frequently overlooked condition that affects the veins in the legs. It is progressive, meaning it worsens over time without treatment. And importantly, it is very treatable when caught and addressed early.

The good news: effective care is available — explore chronic venous insufficiency treatment to see how our specialists can help.

At Miller Vein, our board-certified specialists provide expert, compassionate CVI care at clinics throughout Michigan. If your legs have been telling you something is not right, it may be time to listen.

For a closer look at this topic, our article on common CVI symptoms and what to do about them is a helpful read.

What Causes CVI?

CVI develops when the valves inside the leg veins are weakened or damaged. Several factors can cause or contribute to this process, including:

Depending on your evaluation, options like radiofrequency ablation may also play a role in your care plan.

Genetics

Family history is one of the strongest predictors of CVI. If a parent or sibling has had varicose veins or venous disease, your risk is meaningfully elevated. The structural integrity of the vein walls and valves is largely inherited, which is why CVI and its related conditions often appear across multiple generations.

Age

The veins and their valves naturally lose elasticity and strength over time. The cumulative wear of years of gravity, physical activity, and hormonal changes makes CVI progressively more common with age, particularly from the 40s onward.

Sex and Hormonal Factors

CVI is more prevalent in women than in men. Hormones, particularly estrogen and progesterone, can relax vein walls and impair valve function. Pregnancy, menopause, hormonal contraceptives, and hormone replacement therapy are all associated with increased risk.

Pregnancy

During pregnancy, blood volume increases substantially to support the developing baby. This added volume, combined with the pressure the growing uterus places on the pelvic veins, significantly increases venous pressure in the legs. Each pregnancy can cause or worsen CVI, and many women notice symptoms appearing or intensifying with subsequent pregnancies.

Prolonged Standing or Sitting

Occupations or lifestyle habits that involve long periods of standing or sitting without movement put sustained pressure on the leg veins and reduce the effectiveness of the calf muscle pump. People who spend the majority of their workday on their feet, such as nurses, teachers, and retail workers, are at particularly elevated risk, as are those in sedentary desk jobs.

Prior Deep Vein Thrombosis

A history of deep vein thrombosis (DVT) significantly increases the risk of CVI. After a DVT, the clot can damage the vein valves as it resolves, leaving them unable to function properly. The resulting valve failure leads to reflux and, over time, the development of CVI and its associated symptoms, a complication known as post-thrombotic syndrome.

Symptoms of Chronic Venous Insufficiency

CVI produces a range of symptoms that vary in severity from person to person. One of the reasons the condition is so often missed or dismissed is that many of its symptoms seem nonspecific and are easy to attribute to other causes. Understanding what to watch for is the first step toward getting the right diagnosis.

• Venous Leg Ulcers
• Aching and Pain
• Heaviness and Fatigue
• Swelling and Edema
• Throbbing
• Itching and Burning
• Leg Cramping
• Restless Legs
• Skin Changes: brownish or reddish staining around the ankles and lower legs, skin thickening or hardening (lipodermatosclerosis), and eczema-like rashes known as venous dermatitis
• Venous Leg Ulcers

Patient Stories to
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— Theresa H.

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— Vicky M.

You Can Have CVI Without Varicose Veins

One of the most important and most commonly misunderstood facts about CVI is that you do not need to have visible varicose veins to have it. Many people assume that vein disease only exists when there are visible, bulging veins on the surface of the legs. This is not true.

CVI can be present and symptomatic in people with no visible varicose veins at all. The underlying valve failure and venous reflux may be occurring in deeper vessels that are not visible on the surface. Symptoms like aching, heaviness, swelling, and restless legs can all reflect CVI even in the absence of any visible vein abnormalities.

This is why a duplex ultrasound, rather than a visual examination alone, is the essential diagnostic tool for CVI. The ultrasound images the deep venous anatomy, reveals reflux that cannot be seen from the outside, and provides the information needed to properly diagnose and plan treatment for the condition.

If you are experiencing leg symptoms and have been told your legs look fine, it may be worth asking for a vein evaluation specifically.

How Is CVI Diagnosed?

Diagnosing CVI begins with a thorough clinical evaluation, including a review of your symptoms, medical history, and risk factors. But the cornerstone of diagnosis is a duplex ultrasound examination.

A duplex ultrasound is a non-invasive, painless imaging study that uses sound waves to visualize blood flow through the veins in real time. It allows our specialists to see both the structure of the venous system and the direction and pattern of blood flow within it. This makes it possible to identify venous reflux, map the affected veins, assess the severity of valve dysfunction, and detect any underlying deep vein abnormalities.

This information is not just important for confirming a diagnosis. It directly guides the treatment plan. Without a detailed ultrasound map of the venous system, it is not possible to know which veins are causing the symptoms or which intervention will most effectively address the root problem.

At Miller Vein, every CVI evaluation includes a comprehensive duplex ultrasound performed by our experienced vascular team. The results are reviewed directly with you so you understand exactly what is going on and what we recommend as next steps.

The Importance of Early Treatment

CVI does not stay stable. Without treatment, the condition tends to progress steadily, and the stakes get higher at each stage of advancement. Early-stage CVI involving aching, heaviness, and mild swelling is highly responsive to treatment and relatively straightforward to manage. Late-stage CVI involving skin breakdown, lipodermatosclerosis, and venous ulcers is far more complex, more painful, and more difficult to resolve.

This is why waiting is rarely the right strategy. Many people delay seeking care because their symptoms seem manageable, because they assume leg discomfort is just part of getting older, or because they think treatment is only necessary when varicose veins are visible. All of these assumptions can lead to a condition that could have been treated simply becoming a much larger problem.

If your legs are telling you something is wrong, whether through aching, swelling, heaviness, or skin changes, the right time to get evaluated is now.

Our CVI
Treatment Options

CVI is very treatable, and modern treatment is safe and performed entirely in an office setting with no surgical incisions and little to no downtime. The goal of treatment is to close the faulty veins, redirect blood flow through healthier vessels, and relieve the symptoms and risks associated with venous reflux.

Endovenous Thermal Ablation Sclerotherapy Microphlebectomy Compression Therapy Lymphedema Therapy

Endovenous Thermal Ablation Sclerotherapy Microphlebectomy Compression Therapy Lymphedema Therapy

Thermal ablation is the most commonly used and highly effective treatment for the underlying reflux driving CVI. A thin catheter is inserted into the affected vein under ultrasound guidance and delivers controlled heat energy, either laser or radiofrequency, that causes the vein wall to collapse and seal. The body gradually reabsorbs the closed vein over the following weeks, and blood naturally reroutes through the healthy veins surrounding it.

The procedure is performed under local anesthesia in the office, takes approximately one hour, and allows most patients to walk out and resume light activity the same day.

Laser Ablation

Sclerotherapy involves injecting a medication directly into affected veins to cause them to close and fade. It is used for smaller varicose veins and the spider veins that often accompany CVI. Ultrasound-guided sclerotherapy allows treatment of veins that are not visible on the surface but are contributing to symptoms and reflux.

Sclerotherapy

For larger surface varicose veins that are visible and symptomatic, microphlebectomy offers direct removal through tiny puncture-sized openings in the skin. No stitches are required. The procedure is performed under local anesthesia and leaves minimal scarring.

Microphlebectomy

Graduated compression stockings are an important component of CVI management, both before and after procedural treatment. They apply gentle, graduated pressure to the leg that helps counteract venous pressure, reduce swelling, and improve circulation.

Because CVI is the most common cause of secondary lymphedema, patients with significant swelling may benefit from the addition of Certified Lymphedema Therapy to their care plan. Miller Vein is the first and only vein clinic in Michigan to offer on-site Certified Lymphedema Therapy, making us uniquely positioned to address both the venous and lymphatic components of CVI-related swelling in one place.

Lymphedema Treatment

Frequently Asked Questions About Chronic Venous Insufficiency (CVI)

Board-Certified Specialists That Practice with Care

Our dedicated Team

Dr. Rana Burek, DO

Jeffrey H. Miller, MD

Jennifer Malicke, DO

Krista M. Bannon, MD

Madeline Paquette, DNP

Michael E. Lulenski, MD

Robin Doak, CLT

Steven K. Wang, MD