Chronic venous insufficiency

Last reviewed: 2 Sep 2023
Last updated: 22 Jun 2023



History and exam

Key diagnostic factors

  • corona phlebectatica (malleolar flare or ankle flare)
  • ankle swelling
  • hyperpigmentation (brawny edema)
  • lipodermatosclerosis
  • atrophie blanche
  • leg ulcers
More key diagnostic factors

Other diagnostic factors

  • leg fatigue, aching, and/or discomfort
  • heavy legs
  • leg cramps
  • telangiectasias
  • reticular veins
  • dilated tortuous veins
  • dry and scaly skin
  • skin burning and itching
  • unilateral leg swelling
Other diagnostic factors

Risk factors

  • increasing age
  • family history
  • smoking
  • deep vein thrombosis
  • orthostatic occupation
  • female sex
  • obesity (waist circumference)
  • ligamentous laxity
More risk factors

Diagnostic investigations

1st investigations to order

  • duplex ultrasound
More 1st investigations to order

Investigations to consider

  • ascending phlebography
  • CT venography
  • magnetic resonance venography
  • CT abdomen and pelvis
  • abdomen and pelvis ultrasound
  • intravascular ultrasound
  • air plethysmography
More investigations to consider

Treatment algorithm


all symptomatic patients



Joseph L. Mills Sr, MD

Professor and Chief

Division of Vascular Surgery and Endovascular Therapy

Michael E. DeBakey Department of Surgery

Baylor College of Medicine




JLM declares that he has no competing interests.

David G. Armstrong, DPM, MD, PhD

Professor of Surgery

Director of Southwestern Academic Limb Salvage Alliance (SALSA)

Keck School of Medicine of University of Southern California (USC)

Los Angeles



DGA declares that his work is partially supported by grants from the National Institutes of Health and the National Institute of Diabetes and Digestive and Kidney Diseases.

Peer reviewers

Anahita Dua, MD, MS, MBA, FACS

Assistant Professor of Surgery

Massachusetts General Hospital/Harvard Medical School




AD declares that she has no competing interests.

Paul Tisi, MBBS, MS, FRCSEd

Medical Director/Consultant Vascular Surgeon

Bedford Hospital




PT declares that he has no competing interests.

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