Chronic Venous Insufficiency vs Varicose Veins: Connection, Symptoms & Risks

Varicose veins are a common, often visible cosmetic symptom of the more serious condition called chronic venous insufficiency (CVI). CVI occurs when the leg veins can no longer effectively return blood to the heart. CVI occurs when vein valves fail, allowing blood to pool and create high pressure, which stretches veins into visible varicose veins. Over time, this sustained pressure can lead to symptoms like swelling, skin changes, and ulcers, making varicose veins a potential sign of a more severe underlying venous problem. 

What is Chronic Venous Insufficiency (CVI)?

Chronic Venous Insufficiency (CVI) occurs when the leg veins, especially the valves, become weak or damaged, causing blood to collect rather than flow properly back to the heart. This can lead to symptoms like leg swelling, aching, varicose veins, and skin discolouration. If left untreated, CVI can progress to more severe problems such as painful, non-healing skin ulcers.

CVI is very common and usually affects people over age 50. As you get older, the risk is higher. If CVI is left untreated, the pressure in your leg veins can become so high that the tiny blood vessels (capillaries) may burst. When this occurs, the skin in that area may turn reddish-brown and can easily break open with even a slight bump or scratch. This can cause tissue inflammation in that area as well as tissue damage. It can also cause venous stasis ulcers (open sores on your skin’s surface). These venous stasis ulcers heal slowly and can easily become infected. The infection can extend into the nearby tissues. This condition is called cellulitis, and it can be dangerous if not treated promptly.

CVI causes symptoms like achy or tired legs. You may feel a burning, tingling or “pins and needles” sensation in your legs. There may be cramping in your legs at night. Your skin can be discoloured and look reddish-brown. You may experience edema (swelling) in your lower legs and ankles, particularly after standing for a while or toward the end of the day. Your skin may be flaking, itching or leathery-looking on your legs or feet. There can be a full or heavy feeling in your legs. Some people may have ulcers (open sores), usually near the ankles. If they are very painful, they may be infected. 

Severe swelling in your lower leg can lead to the formation of scar tissue, which traps fluid within the tissues. As a result, your calf may feel enlarged and firm to the touch, and your skin becomes more prone to persistent ulcers.

Varicose Veins

Varicose veins are the visible symptoms of the underlying venous insufficiency disease. It is not a disease but a manifestation of a problem. Varicose veins are veins beneath the skin that appear twisted and enlarged. These vessels have become dilated, elongated and deformed due to the high pressure to which they are constantly exposed.

Many people believe that varicose veins are an aesthetic concern. However, it is tangible evidence that the valves in your vascular system can no longer function properly and that the blood is escaping backwards (reflux). Varicose veins cause increased pain in the legs, a feeling of heaviness and fullness, itching and cramps at night.

The Connection Between Chronic Venous Insufficiency and Varicose Veins

Both varicose veins and chronic venous insufficiency are types of primary venous disease. This occurs as a result of structural weakening of the vein wall. The exact nature and cause are not completely understood. It is important to understand how the lower limbs function. The lower limb venous system overcomes gravity to return blood to the heart. Did you know that the calf muscles pump, and the venous valve system accomplishes this task? The superficial veins function as the principal collection system, dilating to accommodate large volumes of blood from tissue and skin before draining to the deep system for return to the heart.

It is important to understand that the fundamental issue in both varicose veins and CVI is venous hypertension (high blood pressure) within the leg veins. In the legs, veins rely on one-way valves to ensure blood flows upward toward the heart. When these valves become weak or leaky (valve reflux), they can’t prevent blood from flowing backwards or pooling. This backward flow of blood causes it to collect in the veins. Prolonged high pressure and blood accumulation gradually stretch the veins, making them appear as varicose veins. Varicose veins are a manifestation of the underlying problem, but chronic venous insufficiency describes the overall failure of the venous system to function properly, leading to more advanced symptoms and tissue damage. 

Summary

Varicose veins are a symptom that can appear as the chronic venous system struggles to function. Chronic venous insufficiency describes the more severe, underlying problem where veins are unable to do their job effectively, leading to symptoms that go beyond just visible, enlarged veins and can include skin and tissue changes. It is important to consult a medical professional to decide on the course of treatment for either condition.

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