Chronic venous insufficiency is what happens when the valves inside the leg veins stop closing properly. Blood that should travel upward falls back down, pressure builds in the lower leg through the day, and that sustained pressure is what produces the whole picture — the aching and heaviness, the ankle swelling, the visible veins and, if it continues for years, the skin changes and ulcers around the ankle. Varicose veins are the visible part of it; they are not the whole condition.
In short: leaking valves let blood pool in the leg. The hallmark is symptoms that are worse by the end of the day and relieved by elevating the legs — the opposite pattern to arterial disease. Diagnosis is a colour Doppler scan. Compression and movement are the foundation of treatment; where a vein is clearly refluxing, it can be closed with laser, glue or foam under local anaesthesia.
What is venous insufficiency?
Leg veins work against gravity. The calf muscles act as a pump, squeezing blood upward with every step, and one-way valves stop it falling back between steps. When those valves fail, each step still pushes blood up but some of it immediately drops down again. The pressure in the lower leg, which should fall when you walk, instead stays high — a state described as ambulatory venous hypertension, and it is the single mechanism behind every symptom on this page.
Two things follow from that. First, the problem is a pressure problem, not a cosmetic one, which is why treating only the visible veins without finding the leaking valve tends to disappoint. Second, walking genuinely is treatment: the calf pump is the part of the system that still works, and using it lowers the pressure.
Symptoms, and the pattern that identifies them
What people notice first
- Heaviness and aching in the lower leg that builds through the day.
- Ankle swelling, typically worse by evening and gone by morning, often leaving a sock mark.
- Night cramps and restless, uneasy legs.
- Itching or burning along a vein, or over the inner ankle.
- Visible veins — bulging varicose veins, or fine spider veins clustering around the ankle.
The timing is the most useful clue there is. Venous symptoms are worse after standing and better with the legs raised. If pain instead comes on while walking and is relieved by standing still, that pattern points to the arteries rather than the veins — a different condition with a different urgency, covered under peripheral artery disease.
Skin changes, when it has gone on for years
Long-standing pressure alters the skin above the ankle. Brown staining appears as iron leaks from the vessels into the tissue; the skin can become dry, scaly and itchy (venous eczema); over time it may become hard and tight, gripping the ankle so the leg takes on an inverted-bottle shape (lipodermatosclerosis); and small white scarred patches can form (atrophie blanche). These are not cosmetic details — they mark a leg that is close to ulcerating, and they are the point at which assessment should not be postponed further.
How severity is graded
Clinicians describe venous disease with the CEAP classification. The part you will see quoted is the clinical grade, C0 to C6, and it is worth knowing because it explains why two people with "varicose veins" can be given quite different advice.
| Grade | What is present | What it usually means for treatment |
|---|---|---|
| C0 | No visible or palpable vein disease, symptoms may be present | Assessment to confirm where symptoms come from |
| C1 | Spider and reticular veins | Largely cosmetic; reflux still checked before treating |
| C2 | Varicose veins | Treatment considered where symptoms or reflux are present |
| C3 | Swelling (oedema) without skin changes | Compression plus treatment of the refluxing vein |
| C4 | Skin changes: pigmentation, eczema, lipodermatosclerosis | Active treatment advised to prevent progression |
| C5 | Healed venous ulcer | Treatment to prevent recurrence; compression long term |
| C6 | Open venous ulcer | Compression plus early treatment of the underlying reflux |
Causes and risk factors
- Family history — the strongest single factor; valve and vein wall structure is inherited.
- Age — vein walls and valves lose elasticity over time.
- Pregnancy — blood volume rises, hormones relax the vein wall and the uterus presses on the pelvic veins.
- Prolonged standing or sitting — occupations that keep the calf pump idle for hours.
- Excess weight — sustained extra load on the venous system.
- Previous deep vein thrombosis — a clot can damage valves permanently, producing post-thrombotic syndrome, which is venous insufficiency with a known cause.
- Leg injury or surgery affecting the deep veins.
Venous or arterial? The distinction that changes everything
| Venous insufficiency | Arterial disease | |
|---|---|---|
| When the pain comes | After standing, worse through the day | On walking, after a predictable distance |
| What relieves it | Elevating the legs, compression | Standing still, letting the leg hang down |
| Swelling | Common, worse by evening | Unusual |
| Skin | Brown staining, eczema, hardening above the ankle | Pale, cool, shiny, hair loss |
| Where ulcers form | Inner ankle, shallow, moist | Toes, heel, pressure points; deep and painful |
| Pulses in the foot | Normally present | Weak or absent |
Two other causes of a swollen leg are worth separating from venous disease. Swelling that includes the toes and does not settle overnight points towards lymphedema, which is managed quite differently. A leg that becomes swollen, painful and warm over hours or days may be a deep vein thrombosis and needs same-day assessment rather than compression.
If you are not yet sure which of these fits, the leg swelling triage guide starts from the two questions that separate them: one leg or both, and how quickly it came on.
To see how your own symptoms line up against this pattern, the varicose vein self-assessment works through them one by one.
Diagnosis
The examination is done standing, because veins empty when you lie down. The key test is a colour Doppler ultrasound: it shows which veins are leaking, how long the backward flow lasts, where the faulty valve sits and whether the deep veins are open and healthy. That last point matters — the plan is different if the deep system is damaged from an old clot.
A scan also answers the question that decides everything else: is the reflux in the superficial veins, which can be closed safely, or in the deep veins, which generally cannot? Treatment is planned from the map, not from the appearance of the leg. Where risk factors exist without symptoms, a vascular check-up is the structured way to look.
Treatment: what comes first
Measures that work regardless of grade
- Graduated compression stockings — the backbone of management at every stage, provided the arterial circulation has been checked.
- Walking daily — the calf pump is the treatment you administer yourself.
- Elevation — legs above hip level for periods during the day, and the foot of the bed slightly raised where swelling is marked.
- Ankle exercises at a desk or on a long journey, where walking is not possible.
- Weight management and skin care — moisturising dry skin above the ankle prevents the cracks that ulcers start from.
Closing the refluxing vein
Where the scan shows a superficial vein leaking and symptoms persist, the vein is closed. The modern options all work through a needle puncture under local anaesthesia: endovenous laser, radiofrequency, adhesive closure and foam sclerotherapy. The methods are compared side by side in non-surgical varicose vein treatment. Open surgery is reserved for anatomy a catheter cannot negotiate.
Venous ulcers
Around four in five leg ulcers are venous in origin. They sit characteristically above the inner ankle, are shallow with an irregular edge, and sit in skin that already shows staining or hardening. They are slow to heal and they recur, and both of those facts have the same explanation: the pressure that caused them is still there.
Treatment therefore has two halves that must run together. Compression — properly applied, after the arterial circulation has been confirmed — is what heals the wound. Treating the underlying reflux is what stops it coming back, and current practice favours doing that early rather than waiting for the ulcer to close first. Wound care, skin protection and infection control support both.
Get urgent medical help if a varicose vein bleeds: lie down, raise the leg above heart level and press firmly on the point with a clean pad — bleeding from a surface varicosity stops with elevation and pressure, and standing up makes it worse. Also seek prompt care for a leg that becomes suddenly swollen, painful and warm, which may be a deep vein clot; for an ulcer with spreading redness, increasing pain or fever, which suggests infection; and for any ulcer that is not improving over weeks of proper treatment.
Living with it
Closing a faulty vein removes that vein from the problem, but it does not remove the tendency that produced it. New veins can develop over the years, which is why compression, walking and weight control continue to matter afterwards, and why a review scan is useful if symptoms return. Treated early, venous insufficiency is a condition managed comfortably for decades; left until the skin has changed, it becomes considerably harder to reverse.
In Istanbul
Prof. Dr. Yusuf Kalko evaluates venous insufficiency with colour Doppler at his clinic in Istanbul (Beylikdüzü) and plans the most suitable, minimally invasive treatment. Contact us for an appointment. International patients are welcome.
Related Pages
Why Choose Turkey (Istanbul) for Your Treatment?
- Over 30 years of experience in cardiovascular and vascular surgery.
- Advanced minimally invasive and hybrid techniques.
- English- and Arabic-speaking support for international and Gulf patients.
- Easy access to Istanbul from the Gulf, Europe and beyond.
- Pre-travel remote assessment, then treatment and appointment planning.
How to Start from Abroad (Remote Consultation)
You can send your medical reports and scan images via WhatsApp for an initial assessment before traveling. We then plan your treatment and appointment in Istanbul, Turkey, and support international patients at every step.
📋 This page is part of our Vascular Diseases guide. See the overview for other vascular conditions, symptoms and treatments in Turkey (Istanbul).
Where the refluxing trunk needs closing, one option avoids heat entirely: VenaSeal glue treatment.
Frequently Asked Questions
Is venous insufficiency the same as varicose veins?
No. Varicose veins are one visible sign of it. Venous insufficiency is the underlying failure of the valves, and it can cause aching, swelling and skin changes in legs with no prominent varicose veins at all — and some varicose veins occur without significant reflux.
How do I know whether my leg pain is venous or arterial?
The timing separates them. Venous pain builds through the day after standing and eases when you raise the legs. Arterial pain comes on while walking, after a fairly predictable distance, and settles when you stand still. A Doppler scan and a check of the foot pulses confirms which it is, and the answer changes the treatment completely.
Do I have to wear compression stockings forever?
Not necessarily, but they remain the foundation of management, especially where there has been swelling, skin change or an ulcer. After a refluxing vein is treated many people need them less. The arterial circulation is always checked first, because compression is not safe for every leg.
Is treatment painful?
The closed treatments are carried out under local anaesthesia, and most people describe pressure rather than pain, with some aching and bruising along the vein for a few days afterwards. You walk immediately and go home the same day.
Will the veins come back after treatment?
The treated vein rarely reopens, but new varicose veins can appear over the years because the underlying tendency remains. Untreated tributaries are the most common cause of early recurrence, which is why follow-up scanning is worthwhile.
Do venous ulcers heal?
Most do, with correct compression and treatment of the underlying reflux — but they take weeks to months, and they recur if the pressure problem is left untreated. Treating the refluxing vein is what changes the long-term outlook rather than wound dressings alone.
Can venous insufficiency be prevented?
The inherited tendency cannot be changed, but the load on the veins can: regular walking, avoiding long motionless periods standing or sitting, keeping weight in a healthy range, elevating the legs at the end of the day, and using compression if your work keeps you upright.
Do you treat international patients?
Yes. International and Gulf patients are seen in Istanbul with English- and Arabic-speaking support, and an initial remote assessment can be made from your reports and scan images before you travel.