Chronic Venous Insufficiency

Raised venous pressure causes swelling, discomfort, pigmentation and, in advanced disease, ulcers. Treatment depends on whether the problem lies in the superficial veins, the deep veins or both.

Primary valve failure most often affects the superficial veins. Secondary disease can follow deep vein thrombosis, which damages deep venous valves or leaves chronic obstruction. Obesity, reduced mobility, pregnancy and prolonged standing raise venous pressure further and worsen symptoms. Because leg swelling has many causes, heart, kidney, lymphatic and medication-related contributors are also considered during assessment.

Early symptoms include swelling, aching, heaviness, itching, night cramps and restless sensations that typically worsen through the day and after standing. Varicose veins are common but not always present. More advanced disease can cause:

• Venous eczema and brown skin staining around the ankle
• Hardening and tightening of the lower-leg tissues
• Episodes of inflammation or cellulitis
• Recurrent venous ulcers, usually near the ankle

Duplex ultrasound is the key investigation. It identifies reflux, evidence of previous thrombosis and areas of obstruction in both superficial and deep veins, and it guides decisions about compression, superficial vein treatment and whether deeper imaging is needed.

When iliac or caval obstruction is suspected, CT venography, MR venography, conventional venography or intravascular ultrasound (IVUS) may follow. Testing is chosen stepwise so patients are not exposed to procedures that will not change management. The pattern of swelling and skin change is also evaluated, because heart, kidney, lymphatic and medication-related causes may coexist.

Compression and lifestyle measures

Properly fitted compression stockings or bandaging reduce swelling and support ulcer healing, and remain the foundation of care. Walking, calf-muscle exercises, weight management, leg elevation and regular skin moisturising all help. Compression must be used cautiously, or modified, when arterial circulation is impaired, so arterial assessment comes first when there is doubt.

Treating superficial reflux

Endovenous ablation, sclerotherapy or phlebectomy can lower venous pressure when incompetent superficial veins are a significant contributor, and can improve ulcer healing and reduce recurrence.

Treating deep venous obstruction

Selected patients with significant iliac or caval obstruction may benefit from venous angioplasty and stenting. Case selection rests on symptoms, imaging and the likelihood that the obstruction, rather than reflux or another cause, is driving the problem.

Venous ulcer care

Ulcers usually need compression, structured wound care and correction of the contributing venous disease together. Infection, arterial disease, diabetes and pressure are assessed at the same time, because any of these can stall healing.

Ongoing venous hypertension can cause recurrent cellulitis, bleeding, thrombophlebitis and ulcers that are slow to heal or that recur after healing. Intervention improves the underlying haemodynamics, but compression, skin care and periodic review often continue long term.

Report promptly any new ulcer, spreading redness, sudden increase in swelling or marked change in one leg; sudden one-sided swelling in particular needs same-day review to exclude thrombosis.

The most important practical question is whether symptoms are being driven mainly by superficial reflux, deep venous obstruction, damaged deep-vein valves or a combination of these. This distinction influences whether treatment should focus on compression, superficial vein intervention, deeper venous imaging or, in selected cases, venous stenting.

Compression is often central to management, but the strength and style should be matched to the degree of swelling, skin change, mobility and arterial circulation. Patients should understand how and when to wear it, what improvement to expect, and when discomfort, numbness or skin injury means the garment needs to be reviewed.

Treatment can improve venous pressure and support ulcer healing, but skin care, walking, calf-muscle activity and long-term follow-up often remain important. Bring any current compression garments to the consultation so their fit can be assessed. Previous ultrasound reports, details of past thrombosis and photographs of changing skin or wounds can also help clarify the pattern and progression of disease.

Yarra Vascular Surgeons treats the whole spectrum of chronic venous insufficiency, from compression and superficial vein treatment through to deep venous imaging and stenting for selected obstruction, with venous ulcer care coordinated alongside.

Persistent leg swelling, heaviness, pigmentation, eczema or venous ulceration can indicate chronic venous insufficiency. Yarra Vascular Surgeons assesses both superficial reflux and deep venous obstruction, supported by vascular ultrasound and advanced imaging where required. Treatment may include compression, endovenous therapy, wound care or venous stenting, selected according to the underlying cause rather than symptoms alone.