Vein weakness: Venous insufficiency

When the venous system weakens

Venous insufficiency

What is vein weakness?

Vein weakness (medically: venous insufficiency) describes the reduced functionality of the venous system in the legs in transporting oxygen-poor blood in a targeted manner to the heart. Vein weakness can develop into varicose vein disorder (varicosis). As the vein weakness progresses, it can lead to fluid accumulation in the tissue (venous oedema) and skin changes such as pigmentation. This is then referred to as chronic venous insufficiency (CVI)

CVI causes – how chronic venous insufficiency develops

The veins  are subject to high pressure on a day-to-day basis – especially due to a lack of movements or long periods of work-related standing or sitting. The muscle pumps are then less active and do not sufficiently support the onwards-transport of blood. The veins expand further and further, and the venous valves can no longer close due to the enlarged diameter. The result: The blood collects, and the superficial veins, which are not stabilised by muscles or bones, become dilated.

This creates spider veins and the initial twisted varicose veins. In advanced stages, the blood collected in the veins also leads to increased release of fluids into the surrounding tissue. This “water in the legs” is responsible for swollen legs and thick ankles. As soon as a fluid accumulation occurs in the tissue due to venous insufficiency (oedema) and any accompanying skin changes, doctors refer to this as chronic venous insufficiency (CVI).

Symptoms and signs of chronic venous insufficiency (CVI)

Chronic venous insufficiency (CVI) may have the following symptoms:

  • Varicose veins: Dilated veins with a diameter larger than three millimetres
  • Oedema: Swollen ankles / legs, visible and palpable collection of liquid in tissue
  • Skin changes: Brown spots on the skin (pigmentation), inflammatory changes of the skin (eczema), white atrophic scarring (Atrophie blanche), hardening of the subcutaneous tissue in the context of chronic oedema (lipodermatosclerosis)

Risk factors for developing CVI

Risk factors for venous insufficiency are, among others, age-related loss of venous function, hereditary disposition and hormonal influences that lead to a weakening of the venous wall, for example, during pregnancy. The risk factors for CVI are comparable with those of a classic varicose vein condition.

Factors that can be influenced include:

  • Primarily sitting or standing activities (for example, at work),
  • being overweight,
  • warmth (for example, saunas, hot baths, underfloor heating)
  • alcohol consumption or
  • tight clothing and high heels.

Factors that cannot be influenced include:

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  • Age-related loss of vein function
  • genetic predisposition and
  • hormonal influences that lead to a weakening of the venous wall, for example, during pregnancy.
  • A healthy lifestyle with a lot of movement and a healthy diet can also do the veins good.

    Vein weakness prevention – tips for everyday life

    You can take control of actively preventing vein insufficiency and other venous conditions yourself by minimising the influenceable risk factors that have been described. Here are some tips for your everyday life:

    • Movement: Move around as often as you can. Change your position often and frequently raise your legs: It’s better to walk and lie down than to stand and sit.
    • Sport and exercise: Plan ten minutes of vein exercises into your everyday routine.
    • Healthy diet: Eat a balanced diet.
    • Optimise your weight: Reduce any excess weight.
    • Clothing: Wear comfortable, loose clothing.
    • Shoes: Choose comfortable, flat shoes.
    • Shower: Wash your feet in cold water regularly.

    Diagnosis and treatment of chronic venous insufficiency (CVI)

    Upon signs of chronic venous insufficiency, a specialist doctor (phlebologists, angiologists, vascular surgeons, dermatologists) should examine the legs. The doctor usually starts with the so-called anamnesis: He asks the patient about his medical history, including the current symptoms and possible risk factors. He then carries out a visual examination and palpitation: Throughout the examination, he will pay particular attention to skin changes and palpates the structure of the tissue in order to detect possible hardening or swelling. Additionally, he can carry out an ultrasound examination (duplex sonography, Doppler sonography) to evaluate the venous insufficiency based on the ultrasound image. This also allows him to detect any venous inflammation and blood clot, which may have formed. 

    These examination methods are not painful and do not involve any risks!

    Treatment of CVI using medical compression stockings

    Vein weakness is not healable. Nevertheless, there are various possibilities to significantly alleviate symptoms and improve the quality of life.

    Like in all chronic venous diseases, the basic therapy of chronic venous insufficiency is compression stockings accompanied by movement. The stockings exert exterior pressure on the tissue and work against the muscles. During movement, the muscles become tense, the veins between the muscles are compressed, and the venous valves close better. As a result, the blood is pumped to the heart as intended. Symptoms such as pain, swelling and feelings of tightness are significantly improved, leading to an increased quality of life.1

    In the most severe form of CVI – a leg ulcer (Ulcus cruris venosum) – compression therapy can have another critical role: It is important for wound-healing. If the leg ulcer has healed, the subsequent wearing of medical compression stockings are recommended to prevent the development of further lower leg ulcers.1 This is referred to medically as recurrence.

    Besides the compression therapy, there are also surgical – sometimes minimally-invasive – procedures to eliminate or remove pathologically altered veins. The best known are vein stripping, sclerotherapy and laser treatment. The general rule: You decide together with your doctor what measures are necessary and advisable. You can find further therapy measures here.

    Which doctors treat venous insufficiencies?

    A vein specialist is known as a “phlebologist“hlebologist”. Phlebologists specialise in the diagnosis and treatment of vascular diseases, particularly venous diseases. They treat venous diseases, such as vein weakness and varicose veins (varicosis) in the lower extremities. Dermatologists and vascular surgeons are also specialised in venous diseases.

    What happens if the venous insufficiency is not treated?

    Venous insufficiency is the trigger for a wide range of symptoms and diseases. This can progress in the course of mis-diagnosis and treatment. The subsequent outcome can be serious. This includes the following:

    • Skin colour changes (pigmentation)
    • Eczema (inflammatory skin diseases)
    • Leg ulcer (vein-related lower leg ulcer, Ulcus cruris venosum)

    Medi compression stockings

    Thanks to their breathable, stretchy material, medical compression stockings are very comfortable for men and women to wear and are adapted to meet your individual needs as a patient. Profit from modern, technologically advanced & tried-and-tested vein therapy with state-of-the-art medical compression stockings. They look the same as classic fine stockings or knee socks for men, but have an additional vein-supporting function.

    Find out more about compression stockings by medi here.


    Rabe E et al. Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement. Phlebology 2018;33(3):163-184.

    Your doctor makes the diagnosis and decides on the therapy. If necessary, your doctor can prescribe wound therapy products. The patient is advised by trained personnel (e.g. in a medical supply store, pharmacy, wound centre). After this, the patient receives products that are customised to meet their individual needs.