# Chronic VENOUS INSUFFICIENCY

Varicose veins and deep vein thrombosis may contribute to venous congestion resulting in chronic venous insufficiency

## Chronic Venous Insufficiency

Chronic venous insufficiency (CVI), also called chronic venous disease, develops when the leg veins struggle to push blood back up to the heart.
Normally, one-way valves keep blood in your leg veins flowing upward, helped by your calf muscles (the "calf pump"). If the valves weaken, or a vein becomes blocked, blood pools in the lower leg and the pressure builds up. Standing or sitting for long periods, a family history, pregnancy and being overweight all make this more likely.

### Symptoms

CVI can make your ankles swell and your calves feel tight, and your legs may feel heavy, tired, restless or achy – often worse after standing. It frequently goes together with varicose veins. Over time the raised pressure can cause skin changes and, in more advanced cases, sores (ulcers). The swelling can also draw in lymph fluid, which adds to it.

### Causes

CVI is caused by long-standing high pressure in the leg veins, usually from weakened valves. It can also follow a deep vein thrombosis (DVT) – a clot in a deep vein – or phlebitis (an inflamed, clotted surface vein). A DVT causes sudden leg swelling and needs urgent attention, because a clot can break off and travel to the lungs (a pulmonary embolism).
Your risk is higher with a family history, being overweight, pregnancy, too little exercise, smoking, long periods of standing or sitting, and age over 50.

### Tests

I ask about your health and symptoms and examine your legs and veins. To confirm the diagnosis, I may order a duplex ultrasound – a painless scan that shows how blood is flowing through your leg veins and how well the valves are working.

## Treatment Options

### Conservative

Most people with CVI can be managed effectively without surgery. The mainstay is compression, with a few simple lifestyle steps:
Compression stockings – elastic stockings that gently squeeze the leg and stop blood flowing backward. Worn daily, they ease swelling and aching and help prevent ulcers from coming back. For most people this is a lifelong, everyday habit – put them on first thing in the morning.
Raise your legs when resting.
Walk and exercise to work your calf pump, and avoid standing still for long (flex your calves if you must stand).
Keep to a healthy weight and stop smoking.

### Endovenous

Stenting
A small number of patients may get short-term benefit from opening a blocked vein (venoplasty, sometimes with a stent), but the problem very often comes back. We prefer the least invasive option, which is
NO INTERVENTION
THIS PRACTICE DOES NOT OFFER ENDOVENOUS PROCEDURES FOR CHRONIC VENOUS INSUFFICIENCY

### Surgery

Bypass surgery
A small number of patients may get short-term benefit from a vein bypass, but again the problem very often returns. We prefer the least invasive option, which is
NO INTERVENTION
THIS PRACTICE DOES NOT OFFER SURGERY FOR CHRONIC VENOUS INSUFFICIENCY

Reference
European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg, 2022.

## THIS PRACTICE DOES NOT OFFER ANY OPEN OR ENDOVENOUS PROCEDURES FOR VARICOSE VEINS OR CHRONIC VENOUS INSUFFICIENCY

More Videos on Chronic Venous Insufficiency

## Our Services:

### Conservative
Management

The majority of patients with chronic venous insufficiency can be treated effectively with the following:
Elevation of limbs at rest
Weight control
Exercise: walking, cycling, swimming
Smoking cessation
Compression bandages
Compression hosiery

### Wound
Care

The majority of patients who receive wound care at our practice, actually received compression bandages for uncontrolled oedema to prevent ulcers. This is offered as a free service to existing patients. Prevention is better than cure.
We offer the whole range of conservative wound care modalities as well as advanced wound care modalities including surgical debridement, negative pressure wound therapy and / or hyperbaric oxygen therapy for complex wounds related to venous insufficiency.

## Services not offered at our practice:

### Endovenous
Procedures

Catheter directed thrombolysis is only offered as an emergency procedure in selected cases for acute deep vein thrombosis.
We prefer the least invasive intervention, which is
NO INTERVENTION

### Venous
Procedures

Open venous surgical procedures attempt to bypass obstructed veins or to remove diseased veins. We prefer the least invasive intervention, which is
NO INTERVENTION

## THIS PRACTICE DOES NOT OFFER ANY OPEN OR ENDOVENOUS PROCEDURES FOR VARICOSE VEINS OR CHRONIC VENOUS INSUFFICIENCY.
We manage complex wounds and offer conservative therapy for CVI.

If you have any problems with any of these conditions, please contact your General Practitioner, or your Vascular Surgeon. If you live in Pretoria and have not seen a Vascular Surgeon before, you are more than welcome to contact my rooms for a formal consultation.

Contact us

## Gregory Weir Vascular Surgery

The purpose of this web site is to offer Dr Weir’s patients and their families access to information regarding vascular disease in general as well as specific information on certain disease processes. The information on this site does not necessarily apply to all patients with the same diagnosis. If you are not a patient of Dr Weir, please do not regard the information on this website as a substitute for a thorough assessment by a qualified Vascular Surgeon. If in doubt, consult your doctor.
If you are experiencing a medical emergency, phone us. If you are not able to get through or if we are not available, please visit your nearest casualty department.

## Consultation Rooms

Vascular & Hyperbaric Unit, Life Eugene Marais Hospital, Pretoria

Medically reviewed by Dr Gregory Weir, vascular surgeon. Last updated June 2026.