Chronic venous insufficiency

Last revised by Dr Henry Knipe on 07 May 2022

Chronic venous insufficiency occurs due to inadequate functioning of venous walls and/or valves in the lower limbs resulting in excessive pooling of blood.

Symptoms of chronic venous insufficiency include heaviness, tension, swelling feeling, aching, itching and/or cramps 7.

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)

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

Considered the primary imaging modality of choice. Typically the great saphenous vein and the small 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"):

  • reflux time of >0.5 seconds for superficial veins and 1.0 second for deep veins has been used to diganose the presence of reflux 8, although a more refined definition with a variable “cutoff” based on location has been suggested ref
  • 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.

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Cases and figures

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  • Case 1: with soft tissue calcifications
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  • Case 2: with periosteal reaction
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  • Case 3
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  • Case 4: on MRI
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