Chronic venous insufficiency

Chronic venous insufficiency (CVI) occurs due to inadequate functioning of venous wall and/or valves in lower limb veins resulting in excessive pooling of blood.

The condition results from venous hypertension which in turn is usually caused by reflux in the superficial venous compartment. Less common causes include:

  • deep venous compression
  • post-thrombotic stenosis or occlusion
  • deep venous reflux
  • venous hypertension caused by vascular malformations, arteriovenous fistulae, and neuromuscular disorders (rare)
Plain radiograph

Findings are non-specific but most commonly are seen in the leg 5,6:

Ultrasound
Venous Doppler ultrasound

Considered the primary imaging modality of choice. Typically the great saphenous vein and the short saphenous vein and their primary tributaries are assessed. 

The presence of reflux is determined by the direction of flow because any significant flow toward the feet is suggestive of reflux. The duration of reflux is known as the "reflux time" (replacing the commonly used "valve closure time").

  • a reflux time of > 0.5 (or 1.0 according to some publications) second has been used to suggest the diagnosis the presence of reflux, although a more refined definition with a variable “cutoff” based on location has been suggested
  • the longer the duration of reflux or the greater the reflux time implies more severe disease

Venous duplex imaging may provide information about local valve function to construct an anatomic map of disease in terms of the systems and levels of involvement. 

The presence and location of perforators are also documented. The patient should be able to stand for this procedure.

Share article

Article information

rID: 49487
System: Vascular
Tag: cases
Synonyms or Alternate Spellings:
  • Insufficient veins
  • Chronic venous disease
  • Chronic venous disease (CVD)
  • Chronic venous insufficiency (CVI)
  • Chronic venous incompetency

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Case 1
    Drag here to reorder.
  • Drag
    Case 2: periosteal reaction from CVI
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.