Chronic venous insufficiency or CVI is a medical condition where the veins cannot pump enough blood back to the heart. The commonest cause of CVI is superficial venous reflux which is a treatable condition.As functional venous valves are required to provide for efficient blood return from the lower extremities, this condition typically affects the legs. If the impaired vein function causes significant symptoms, such as edema and ulceration, it is referred to as chronic venous disease. It is important to realise that CVI includes varicose veins and superficial venous reflux ("hidden varicose veins")  which can now be treated by local anaesthetic endovenous surgery.
It used to be thought that women were more affected than men, although research has now shown that men and women are affected equally.
The condition has been known since ancient times and Hippocrates used bandaging to treat it. However nowadays, most patients with CVI can be cured with treatments to the superficial venous system or stenting the deep system. It is sometimes described as chronic peripheral venous insufficiency but it should not be confused with Post-thrombotic syndrome in which the deep veins have been damaged by previous deep vein thrombosis.
Contact dermatitis. Patients with venous insufficiency have a disrupted epidermal barrier, making them more susceptible than the general population to contact sensitization and subsequent dermatitis.
Atrophie blanche. This is an end point of a variety of conditions, appears as atrophic plaques of ivory white skin with telangiectasias.
May-Thurner syndrome. This is a rare condition in which blood clots occur in the iliofemoral vein due to compression of the blood vessels in the leg. The specific problem is compression of the left common iliac vein by the overlying right common iliac artery.
An alternative explanation has shown Chronic venous insufficiency as the result of venous valves incompetence instead and/or obstacles to the flow (see)
Surgical treatment of CVI attempts a cure by physically changing the veins with incompetent valves. Surgical treatments include:
Linton procedures (an older treatment)
Ligation. Tying off a vein to prevent blood flow
Subfascial endoscopic perforator surgery. Tying off the vein with an endoscope.
Valve repair (experimental)
Valve transposition (experimental)
Treatment of CVI in the leg involves managing the symptoms (and preventing the symptoms getting worse) instead of effecting a cure. It is sometimes called conservative treatment. Conservative treatments include:
Frequent periods of rest elevating the legs above the heart level
Tilting the bed so that the feet are above the heart. This may be achieved by using a 20 cm (7-inch) bed wedge or sleeping in a 6 degree Trendelenburg position. Obese or pregnant patients might be advised by their physicians to forgo the tilted bed.