Chronic Venous Insufficiency (CVI)

Many people with varicose veins are told, “If your veins don’t bother you, you don’t need to do anything about them.” Similarly, people who have a blood clot in their legs are given a good amount of information about their blood thinning medication but are seldom warned about the effect their blood clot can have on the circulation in their leg. Because of this poor advice, these people never see a vein specialist and are shocked when they start to develop other problems in their legs, such as:

• Swelling in the feet, ankles, and legs

• A brownish discoloration of the skin near the ankles

• Thickening of the skin at the ankles

• Open sores on the inside or outside of the lower leg or ankle

Why do these things happen?

When vein disorders develop, it’s frequently because the one-way valves in the veins have stopped working. In our deeper veins, valves are often damaged if a person has a blood clot, and in our more superficial veins it happens when inflammation in our body causes the vein wall to weaken and stretch out. As more blood flows downward, the pressure in the veins increases. As the pressure increases, it puts more stress on the tiny veins at the skin surface and these begin to stretch, causing clusters of spider veins to become visible along the inside or outside of the ankle. This high pressure, along with the weakness in the vein wall, causes fluid to seep out of the veins, resulting in swelling in the feet, ankles, and legs.

What causes the skin discoloration?

• In addition to fluid, red blood cells begin to move outside the vein. The iron that was inside the red blood cells gets picked up by our skin, turning it a brown color. Initially, this might appear as small brown spots along the inside or outside of our ankles. But as the years go by, the entire ankle area can become brown. This brown discoloration is known as hyperpigmentation.

• If there is inflammation in the area, the color may appear more red than brown, and this condition is called dermatitis.

• As the entire lower leg becomes discolored, the skin may become thickened and feel hard or leathery, a condition known as lipodermatosclerosis.

All of these changes in the appearance of the lower leg and ankle point to the same problem—the pressure in the veins has become dangerously high and this pressure is affecting the health of the skin in this area. If the underlying vein issue isn’t corrected, the skin can break down and an open sore can appear, even without any trauma. This open sore is called venous ulceration. When a person has any of these complications of their varicose veins or prior blood clot, they are said to have chronic venous insufficiency (CVI).

How do you determine if you have chronic venous insufficiency?

If you have had a blood clot (deep vein thrombosis or DVT) in your leg, or if you have varicose veins or any symptoms such as swelling, aching, heaviness, cramping, or pain, you should see a phlebologist (a vein specialist.) A phlebologist will perform an ultrasound exam, which is quick and painless. It will clearly show whether you have veins that are allowing blood to move in the wrong (downward) direction, and how severe your situation is.