What Is Venous Insufficiency and What Causes It?

minimally invasive treatment

Venous insufficiency is more common than you may think — more than 25 million Americans experience some type of vein-related health problem. Despite how widespread this is, many people are unaware of the true causes of venous insufficiency or the current treatments available. 

What is venous insufficiency and what causes it? Rather than relying on random web searches, out-of-date resources, or word of mouth, it’s best to go straight to a medical professional to get the facts on a particular medical condition. 

What is Venous Insufficiency?

Venous insufficiency is a condition that occurs when the walls and/or the valves in a person’s leg veins are not working properly, creating a situation in which it is difficult for the blood to return from the legs to the heart. When this is a long-term rather than temporary problem, it is called chronic venous insufficiency, or CVI. As a result, CVI causes blood to “pool” or collect in these compromised veins; this pooling is also called stasis.

Vein valves are busy circulating blood through your body, and the ones in your legs are working overtime. The circulatory system transports blood to and from the heart. Arteries carry oxygenated blood to all the body’s organs and limbs, and veins return the blood to the heart. In the process of going back to the heart, the blood must flow upward through the veins in the legs. 

To enable this, muscles in the calves and feet contract with each step a person takes, squeezing the veins and helping to push the blood upward. And so that the blood continues its upward journey, and not go back down, the veins contain one-way valves. 

These valves carry the extra task of pushing blood against the weight of gravity. Similar to how taking on too much pressure can wear us down physically, vein valves can become weakened or damaged over time. Blood can then pool in the leg, causing swelling, pain, or the formation of a varicose vein.

What Causes Venous Insufficiency?

Chronic venous insufficiency occurs when one-way valves in the legs (and sometimes elsewhere) become damaged and allow the blood to flow backward. CVI can occur because of deep vein thrombosis (DVT), a disease in which a blood clot forms in the deep veins of the legs. CVI also can be caused by vascular defects and pelvic tumors. Sometimes the origins of a patient’s CVI remains unknown.

There are a lot of factors that can increase your risk of developing some sort of vein problem. This includes:

  • Family history. Genetics can play a huge role in whether or not you’ll develop vein problems at some point in your life.
  • Leg damage. Trauma to your leg can increase your risk of vein problems, whether it’s through an old injury, surgery, or a previous blood clot.
  • Stationary lifestyle. Sitting or standing for hours at a time can be bad for your circulation and your veins. This is most commonly associated with professions that require employees to either sit or stand all day, such as in office or retail work.
  • Pregnancy. The hormonal changes and extra pressure on your legs can damage your veins, and the effects can be worse with each subsequent pregnancy. Although symptoms tend to subside after delivery, varicose veins are apt to return postpartum. Read more about venous insufficiency and pregnancy.

What Are the Symptoms of Venous Insufficiency?

Poor vein health is commonly associated with visible veins, but you can certainly have vein problems without any visible symptoms. Other signs can include:

  • Swollen legs or ankles. As blood pools in the lower leg, the vein swells. This can create associated swelling in the leg or ankle.
  • Itchy, painful, or restless legs. Unhealthy veins can be painful. If your legs are hurting even without putting excess pressure on them, your veins may be at fault.
  • Brownish skin. Sometimes venous insufficiency can appear similar to a skin condition. Skin around the ankles especially can appear discolored.
  • Varicose veins. The symptom most commonly associated with venous insufficiency, varicose veins are dark, bulging, and very visible under the skin.
  • Leg ulcers. Venous insufficiency lowers your veins’ healing abilities. This increases your risk of developing an ulcer after experiencing any trauma to the leg.

Is Venous Insufficiency A Serious Condition?

Yes! Chronic venous insufficiency is a serious medical condition. Although there are most definitely aesthetic reasons to treat CVI, it is not a cosmetic problem only. Furthermore, as the disease progresses, it becomes more serious and the treatments become more involved. It’s extremely important to see a vein specialist at the onset of symptoms – CVI won’t simply go away if you ignore it. The sooner it is diagnosed and treated, the better a patient’s odds of avoiding the most serious complications.

When CVI is left untreated, the pressure and swelling in the leg builds up until the capillary blood vessels burst. When this occurs, the skin in the area of the burst capillaries turns a reddish-brown and becomes easily broken when it comes into contact with other objects. Ultimately, this sometimes leads to open skin sores (venous stasis ulcers). These ulcers are at risk for infection and can take a long time to heal. What’s worse, the resultant infection can spread, a condition known as cellulitis.

Who Is Most at Risk For Developing CVI?

Pregnant women are at particular risk of developing CVI, but anyone can develop CVI. Young and old, athletes and non-athletes. Sometimes people think men are at a lower risk for developing CVI, but, in fact, they are at a greater risk for delaying treatment because one of the primary symptoms, varicose veins, often goes ignored because of the proverbial, “out of sight, out of mind.”

Also, there is a genetic predisposition that may be present, but that is just one of many contributing factors. Again, the bottom line is that anyone displaying symptoms should schedule a consultation with a vein specialist right away.

How is Venous Insufficiency Diagnosed?

The only way to correct chronic venous insufficiency is by obtaining treatment by a medical professional who is skilled in vascular issues. At Central Florida Vein & Vascular Center, we employ a venous reflux test to diagnose patients. The venous reflux test is a completely noninvasive examination that we use to test valve function in the leg veins. 

This diagnostic vascular ultrasound procedure typically is ordered for patients who report symptoms or signs that may be caused by venous disease. The test is performed on an outpatient basis, and usually takes no more than an hour to perform – oftentimes less. Because we use the venous reflux test for the sole purpose of making a diagnosis, it is covered by most insurance companies.

What to Expect During a Diagnostic Exam

When you drop by to see a specialist, like the knowledgeable ones at the Central Florida Vein & Vascular Center, they’ll first assess your vein health with a diagnostic exam, using a tool like an ultrasound to get a better look at your veins. 

This is a critical step, as you can’t see the full picture of your vein health with just your eyes. Afterward, the specialist will create a treatment plan for your vein health, taking into consideration how serious your symptoms are, your medical history, age, and overall health.

How is Venous Insufficiency Treated?

Chronic venous insufficiency can be treated with a number of advanced minimally-invasive and non-invasive procedures. Treatment options include endovenous laser treatment (EVLT) and ultrasound guided foam sclerotherapy (UGS), which is a needle-based technology. No matter which treatment is best for you, you’ll find that the recovery time is typically extremely short and the success rates are high.

Treatment has come a long way since the painful days of vein stripping. At Central Florida Vein & Vascular Center, we offer several treatment options for venous insufficiency. All of our procedures are minimally invasive with little downtime, so you can quickly get back on your feet and enjoy pain-free legs. Insurance carriers will often cover the costs as well. Here are some of the procedures that may be included in a treatment plan.

Endovenous Laser Treatment

This procedure has replaced vein stripping, becoming the gold standard in eliminating troublesome veins. During endovenous laser treatment, a specialist uses an ultrasound to first locate the damaged vein. They then apply heat to the vein through a catheter, causing the vein to collapse and seal shut. What happens to the blood in the vein? It’s automatically routed to healthy veins that can handle proper circulation.


Sclerotherapy is most commonly used to minimize the appearance of spider veins, although it can also be used as a follow-up to any small, visible veins lingering after endovenous laser treatment. A specialist will use an ultrasound or veinlite to target the vein before injecting a sclerosing agent into it. This agent causes the vessels to scar and become less visible, effectively reducing their appearance.


Sometimes endovenous laser treatment or sclerotherapy isn’t enough to fully minimize the appearance of veins. Microphlebectomy can get rid of dark, bulging veins without scarring and pain. A specialist first makes small, 1-2mm micro-incisions, through which they can divide and remove the vein. The bulging vein is gone immediately post-procedure, and the only “scars” are small dots where the micro-incisions were made. These fade within a few weeks.


Did you know that a special sort of glue can help venous insufficiency? During venaseal, a specialist applies medical glue to the damaged vein through a catheter. The vein seals shut, hardens, and is then absorbed by the body. This removes the vein without any scarring or vein stripping.

Call the Vein Experts

When it comes to venous insufficiency, that resident expert is vascular doctor in Orlando, John D. Horowitz, MD, FACS. Dr. Horowitz, a highly skilled vascular surgeon, has been practicing Vascular Surgery in Orlando since 1993 and founded Central Florida Vein & Vascular Center in 2001.

One of Central Florida’s top dedicated vein care facilities, the Center provides a level of expertise in vein care not seen anywhere else in the region. What’s more, Dr. Horowitz is a pioneer in minimally-invasive vein therapy and is board certified in both general and vascular surgery. 

He has earned academic distinctions through his numerous publications and teaching faculty appointments, and he is an active member of the Southern Vascular Society, the Florida Vascular Society, and the American College of Phlebology. Here, Dr. Horowitz explains all about venous insufficiency.

If you have a question or concern that isn’t covered here, the vein specialists in Kissimmee at Central Florida Vein & Vascular Center can help. You can schedule a consultation with one of our specialists by calling 407-545-3385 or 352-658-5547. We’ll address your concerns, assess your vein health, and craft a treatment plan that will be best for you and your veins.

*Reviewed by John D. Horowitz, MD, FACS

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