Diagnosing Chronic Venous Insufficiency

The veins throughout the body have one-way valves that help blood flow to the heart, where it’s pumped to the lungs for oxygen and then back to the rest of the body. In chronic venous insufficiency, vein walls weaken and valves are damaged, causing blood to pool in the legs. 

The condition can occur as a result of a lack of exercise or prolonged sitting or standing. Other causes include a blood clot in a deep vein of the legs, called deep vein thrombosis; or inflammation of the veins, called phlebitis. These conditions can block valves or weaken veins.

Certain risk factors increase the likelihood of developing chronic venous insufficiency. These include obesity and pregnancy, both of which can restrict blood flow in the legs.

People who have a sedentary lifestyle, smoke, and sit for prolonged periods, which can reduce blood flow in the legs, are at risk. The condition is more common in women age 50 and older. 

Symptoms of chronic venous insufficiency include swelling, aching, and cramping in one or both legs. People with this condition may have reddish or brown areas on the skin, scaly or leathery skin, and varicose veins.

Left untreated, the condition can lead to disabling pain and open sores or leg ulcers, especially around the inside of the ankles.

Diagnostic Tests 

To diagnose chronic venous insufficiency, your NYU Langone doctor asks about your health history to determine the extent of your symptoms. He or she also performs a physical exam to look for swelling, skin changes, varicose veins, or ulcers on the leg.

Your doctor may also recommend certain diagnostic imaging tests.

Duplex Ultrasound 

A duplex ultrasound combines Doppler and conventional ultrasound to produce two-dimensional, moving images of blood vessels in the legs. Your doctor may use this test to determine if the blood is flowing in the wrong direction and to look for evidence of deep vein thrombosis, a serious condition that can lead to life-threatening blood clots in the lungs.

During this test, a technician places a warm gel on the legs. Then he or she presses a handheld instrument called a transducer against the skin. It transmits sound waves, which produce images of blood vessels on a computer monitor.

This exam takes about 30 to 60 minutes. You can return to your usual activities afterward.

Magnetic Resonance Venogram

A magnetic resonance venogram is a type of MRI scan that uses radio waves to provide images of veins in the legs. It can detect blood flow and obstructions deep in the legs.

In this test, a local anesthetic is applied to the arm, and an IV is inserted into a vein. A contrast dye is injected into the IV to highlight blockages or valve problems on a computer screen. 

Magnetic resonance venogram can take 60 minutes or longer. You may return to your usual activities afterwards.

CT Venogram

A CT venogram uses a series of X-rays and computer software to detect blood flow and clots in the deep veins of the legs. A contrast dye is injected into a vein to highlight blood flow on a computer screen. 

This test can take 45 minutes or longer. 

Venogram

A venogram uses X-rays and a contrast dye to create images of leg veins. It allows your doctor to check for blood clots or pooling, which can occur when valves in the veins stop working properly. At NYU Langone, this type of venogram is performed less frequently than magnetic resonance venogram or CT venogram.

During this test, a contrast dye is injected into the IV. You may feel a warm or burning sensation as the dye flows into the vein. The dye highlights blockages or valve problems on a computer screen.

A venogram can take 60 minutes or longer. Afterward, you may resume your usual activities.

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