Chronic Venous Insufficiency
The hidden circulation problem behind heavy, swollen, aching legs — and the condition modern vein care was built to treat.
What chronic venous insufficiency is
Your leg veins carry blood back to the heart against gravity, using one-way valves as checkpoints. In chronic venous insufficiency (CVI), those valves weaken and leak, letting blood fall backward and pool in the lower legs. The result is persistent venous pressure that the leg was never designed to carry.
CVI is the root condition. Varicose veins and many spider veins are its visible signs — but CVI can also progress quietly, with swelling and skin changes and no bulging veins at all.
Symptoms
- Legs that feel heavy, tired, or achy — worse by evening, better with elevation
- Swelling of the ankles and lower legs
- Itching, burning, or cramping in the calves; restless legs at night
- Skin darkening, dryness, or eczema-like irritation around the ankles
- In advanced stages, firm thickened skin or open sores that heal slowly
Causes and risk factors
Family history is the leading risk factor. Others include age, pregnancy, occupations with long hours of standing or sitting, excess weight, prior deep vein thrombosis, and leg injury. CVI is common — and commonly missed, because early symptoms are easy to attribute to aging, weight, or being on your feet all day.
How CVI progresses if untreated
CVI is a progressive condition. What begins as evening heaviness can advance over years to constant swelling, then to skin damage from chronic pressure — discoloration, thickening, and fragile skin around the ankle — and ultimately to venous ulcers that are painful and slow to heal. Superficial clots and bleeding from surface veins can also occur. The pattern is gradual, which is exactly why recognizing the early signs of CVI matters: earlier treatment is simpler treatment.
Simple habits help slow that progression — regular walking, elevating the legs at day’s end, and wearing compression stockings when recommended. These measures manage the pressure, but they cannot repair a valve that has already failed.
How we diagnose it
The definitive test is a duplex ultrasound — a painless scan that shows both the structure of your veins and the direction of blood flow, pinpointing which valves are leaking and how severely. At Avancé Vein Care, Dr. Tadepalli performs and interprets every duplex ultrasound himself. The scan happens at your consultation in our Sparta office, and you leave the same visit with answers.
“Chronic venous insufficiency rarely announces itself. My job is to listen carefully, look with the ultrasound, and treat the source of the problem — not just what shows on the surface.”— Dr. Satish Tadepalli, MD, MPH, DABVLM
How we treat it
Patients searching for chronic venous insufficiency treatment in NJ are often surprised by how far the field has come. Treatment no longer means hospital surgery: the diseased vein is closed from the inside in an office visit under local anesthesia, and blood reroutes through healthy veins. Walk in. Walk out.
- Radiofrequency ablation (RFA) — controlled heat seals the refluxing vein; visits typically run 45–90 minutes.
- Endovenous laser ablation (EVLA) — laser energy closes the vein with comparable results.
- VenaSeal™ — medical adhesive closure, with no tumescent anesthesia needed.
- Varithena® and ultrasound-guided foam sclerotherapy — for tortuous or residual veins a catheter cannot reach.
Closure rates for these techniques are well above 90% in published studies. When CVI is symptomatic and confirmed on ultrasound, treatment is generally covered by insurance as medically necessary — we verify coverage before treatment and handle pre-authorization, so you know what to expect before treatment.
Further reading from an independent source: Venous insufficiency — MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine. Link verified 18 August 2026.