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Venous insufficiency
Other Resources UpToDate PubMed

Venous insufficiency

Contributors: Shanna Yang, Ryan Hoefen MD, PhD, Abhijeet Waghray MD
Other Resources UpToDate PubMed


Venous insufficiency is characterized by poor function of the venous valves, resulting in an inability of blood to move at an adequate rate toward the heart. Other contributing factors include vessel wall inflammation, venous hypertension, and dysfunctional muscle (notably calf) or vascular pump mechanisms. Dysregulation of transforming growth factor beta 1 (TGF-ß1) expression, which can cause a shift in hemodynamic forces, wall inflammation, and extracellular matrix degradation / deposition, is thought to play a role in the development of venous insufficiency.

Veins of the lower extremities are most often affected. Superficial venous valve incompetence may be due to pre-existing weakness in the vessel wall or valve leaflets or from injury, superficial phlebitis, or venous distension from hormones or hypertension. Deep venous valve dysfunction is generally due to damage from previous deep vein thrombosis.

Common early findings in the legs include pain, pruritus, tingling, nocturnal cramping, and a sensation of "heavy legs." Symptoms are alleviated when legs are elevated. Later stage findings include leg edema, skin changes, and ulceration.

Venous insufficiency is quite common, although the exact prevalence ranges from less than 1%-40% in females and less than 1%-17% in males. Risk factors include older age, familial history, tall height, pregnancy, obesity, immobility, and sedentary lifestyle.


I87.2 – Venous insufficiency (chronic) (peripheral)

20696009 – Peripheral venous insufficiency

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Differential Diagnosis & Pitfalls

  • Deep vein thrombosis
  • Cellulitis / Erysipelas
  • Congestive heart failure
  • Nephrotic syndrome
  • Liver disease
  • Endocrine disorders
  • Adverse effect of medications including calcium channel blockers, NSAIDs, and oral hypoglycemic agents
  • Lymphedema extends into the foot, compared with venous insufficiency which typically spares the foot.
  • Lipedema

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Last Reviewed:05/06/2019
Last Updated:05/07/2019
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Venous insufficiency
A medical illustration showing key findings of Venous insufficiency : Leg pain, Lower extremity edema, Telangiectasia, Leg cramp, Pruritus
Clinical image of Venous insufficiency - imageId=887587. Click to open in gallery.
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