Chronic Venous Insufficiency (CVI)

CVI occurs when leg veins can't efficiently return blood to the heart, causing blood to pool in the lower legs. Symptoms typically worsen throughout the day (especially with prolonged standing/sitting) and improve with leg elevation — a key feature that helps distinguish it from PAD.

Early/Common Symptoms

• Leg swelling (edema) — especially around the ankles, typically worse by evening and improves overnight or with elevation

• Aching, heaviness, or fatigue in the legs — often described as "tired legs"

• Leg pain or cramping, sometimes worse after standing for long periods

• Itching in the lower leg or ankle area

• Throbbing or tingling sensations

• Restless legs, particularly at night

Visible Changes

• Varicose veins — enlarged, twisted, bulging veins visible under the skin

• Spider veins (telangiectasias) — smaller, thread-like visible veins

• Skin discoloration — reddish-brown or dark staining, particularly around the ankles (from blood breakdown products depositing in tissue over time — called hemosiderin staining)

• Skin changes/texture — dry, thickened, or hardened skin (a condition called lipodermatosclerosis in advanced cases)

• Shiny or leathery-looking skin

Advanced/Severe Symptoms

• Venous stasis ulcers — open sores, typically around the inner ankle (medial malleolus); these are:Usually shallow with irregular borders
  Often surrounded by discolored, hardened skin
  Slow to heal and prone to recurrence

• Weeping or oozing from swollen skin (venous eczema/stasis dermatitis)

• Cellulitis (skin infection) — can occur if skin breaks down or ulcers become infected

• Atrophie blanche — smooth, ivory-white scarred patches, sometimes surrounded by dilated small blood vessels