Venous Insufficiency
Chronic venous insufficiency occurs when leg vein valves fail, causing blood to pool — leading to swelling, varicose veins, and in advanced cases, venous ulcers. Treatable with compression therapy, ablation, and sclerotherapy.
Varicose and spider veins can cause discomfort and cosmetic concerns
Chronic venous insufficiency occurs when the one-way valves inside the leg veins weaken or fail, causing blood to pool rather than return efficiently to the heart. The resulting increase in venous pressure leads to progressive leg swelling, skin changes, and if untreated, venous ulceration. CVI is a common but frequently underdiagnosed cause of leg symptoms in Singapore.
Symptoms
CVI typically presents with ankle and calf swelling that worsens throughout the day, leg aching or heaviness after prolonged standing, varicose veins, and skin discolouration or thickening near the ankles. In advanced disease, venous ulcers, slow-healing wounds around the ankle, may develop and require specialist wound management. Symptoms are often mistaken for normal ageing or generalised fatigue, delaying diagnosis.
Causes & Risk Factors
CVI develops when venous valve function is chronically impaired. Risk factors include a prior history of deep vein thrombosis (DVT), prolonged standing or sitting, pregnancy, obesity, advancing age, and a family history of venous disease. Post-thrombotic syndrome, CVI arising after DVT, represents one of the more severe forms and requires early intervention to prevent ulceration.
Diagnosis
Assessment begins with a clinical examination of the legs, followed by duplex ultrasound, the gold-standard investigation for mapping venous anatomy, identifying valve reflux, and quantifying disease severity. In complex or recurrent cases, advanced cross-sectional imaging such as CT venography or MR venography may be indicated to evaluate the deep venous system.
Treatment Options
Treatment is tailored to disease severity and symptom burden. Compression therapy using medical-grade stockings remains the cornerstone of conservative management, reducing venous pressure and controlling swelling. For patients with significant venous reflux, minimally invasive ablative procedures, radiofrequency ablation or endovenous laser therapy, seal the affected vein and redirect blood through healthier vessels. Sclerotherapy treats associated varicose and reticular veins. Surgical intervention is reserved for refractory or anatomically complex disease. Venous ulcers require a dedicated wound care programme alongside venous treatment to achieve healing.
Why See a Vascular Specialist?
CVI exists on a spectrum from mild reflux to advanced ulceration and accurate staging determines treatment. A vascular medicine specialist with in-house duplex ultrasound can assess the full extent of venous disease, distinguish CVI from other causes of leg swelling such as lymphoedema or heart failure, and design a targeted treatment plan rather than a one-size-fits-all approach.
Experiencing persistent leg swelling, varicose veins, or skin changes around the ankle? Dr. Peter Chang consults at Paragon Medical Centre, Orchard Road. Book a vascular assessment today.