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IMPORTANT: The overviews are provided for informational purposes only and should not be used as a substitute for talking with your doctor. Be sure to talk with your healthcare provider for a complete discussion of these conditions as well as the benefits and risks of any treatment options.

Chronic Venous Insufficiency

What is Chronic Venous Insufficiency?

Veins play a crucial role in circulating blood back to the heart, but when they don’t work properly, it can lead to problems like varicose veins and chronic venous insufficiency (CVI). CVI occurs when vein valves fail, causing blood pooling, swelling, and skin changes in the legs. Varicose veins often appear with CVI, where veins appear enlarged and twisted.

Deep vein thrombosis (DVT) is the most common cause of chronic venous insufficiency. The blood clot damages the valves and patients with a history of DVT face a higher risk of developing CVI1.

Cross section diagram comparing normal and varicose veins

Causes & Risk Factors

Icon comparing a sitting person to a standing person

Prolonged 
Standing/Sitting
Poor circulation

Icon of a family

Age & Family History
Higher risk with aging

Icon of a pregnant person

Pregnancy & Obesity
Increased venous pressure

Icon of legs with swollen veins

History of Deep Vein Thrombosis
Leads to venous damage

Signs & Symptoms

Varicose veins icon

Bulging 
Varicose Veins

Icon of a swollen leg

Leg Swelling
that worsens throughout the day, heaviness, or aching

Icon showing legs with a discolored area

Skin Discoloration (brown, red, or purple patches) & thickening

Icon of a leg with acute venous condition

Slow-Healing
Venous Ulcers

Staging

Chronic Venous Insufficiency (CVI) is often diagnosed with venous duplex ultrasound and staged using the CEAP Classification System, which standardizes assessment based on clinical severity, etiology, anatomy, and pathophysiology (CEAP).

CEAP Classification for CVI2

CEAP Category

Clinical Features

C0
C1
C2
C0

No clinical signs

C1

Telangiectasias or Reticular Veins

C2

No clinical signs

C3
C3

Edema (pitting or non-pitting)3

C4a
C4b
C4c
C4a

Pigmentation or Eczema

C4b

Lipodermatosclerosis or Atrophie Blanche

C4c

Corona Phlebectatica

C5
C6
C5

Healed Venous Ulcer

C6

Active Venous Ulcer4

Recent expert consensus indicates that CEAP C3-C6 CVI patients—characterized by edema—should be managed same as those with lymphedema. This approach acknowledges the interconnectedness of the venous and lymphatic systems, where venous hypertension can lead to lymphatic overload, resulting in combined venous-lymphatic insufficiency, often referred to as phlebolymphedema.

Solutions

In addition to lifestyle modification and compression therapy, common treatments include prescription medications like blood thinners, and procedural interventions like thrombectomy.

Dayspring is a FDA-cleared wearable compression treatment indicated for the treatment of lymphedema, phlebolymphedema, venous insufficiency, lipedema, related conditions to chronic edema and supports mobility during treatment5.

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K9

An active pipeline development program by Koya that aims to provide a minimally invasive ablation solution that is clinically effective while improving the overall patient experience and accessibility.

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References