CVI & DVT DEMYSTIFIED: YOUR ULTIMATE GUIDE TO CHRONIC VENOUS INSUFFICIENCY AND DEEP VEIN THROMBOSIS IN 2025

Did you know that up to 40% of adults may develop chronic venous insufficiency (CVI) during their lifetime, and deep vein thrombosis (DVT) affects approximately 1 in 1,000 people annually?

These two vascular conditions, though often misunderstood, can silently progress into serious health threats if left unaddressed. In this blog, we’ll demystify CVI and DVT;

• What they are?
• How are they linked?
• Why early detection is crucial?
• You’ll learn to recognize symptoms, causes, diagnostic methods, and treatment options.
• We’ll also cover prevention strategies, answer frequently asked questions, and help you take proactive steps toward healthier veins and better circulation.

Whether you’re managing a diagnosis or simply curious about your vascular health, this blog delivers everything you need in one accessible, expert-driven resource.

What Is Chronic Venous Insufficiency (CVI)?

Chronic Venous Insufficiency (CVI) is a progressive vascular condition that occurs when the veins in your legs fail to effectively return blood to the heart. This happens due to weakened or damaged vein valves, which allow blood to flow backward (venous reflux) and pool in the lower limbs, leading to swelling, discomfort, and visible skin changes over time.

Unlike temporary venous issues caused by standing or inactivity, CVI is a chronic worsening that gradually worsens if not managed promptly.

CEAP Classification of CVI (C0–C6)

To assess the severity of CVI, clinicians use the CEAP system, which classifies the disease into seven stages based on clinical symptoms:

What does an active venous ulcer look like?

Feature	Description
Shape	Irregular, often crater-like
Edge	Sloping toward the ulcer bed
Base	Red, with slough or granulation tissue
Surrounding skin	Edematous, discolored, hardened, or shiny
Pain & discharge	Present and may indicate infection

This grading helps guide diagnosis, treatment decisions, and long-term management strategies.

Key Risk Factors for Developing CVI

Understanding what puts you at risk is critical for early intervention. The most common risk factors include:

• Age: Risk increases after 50, especially in women.
• Obesity: Excess weight puts pressure on veins, impairing circulation.
• Pregnancy: Hormonal and circulatory changes during pregnancy can affect valve strength.
• Sedentary Lifestyle: Prolonged sitting or standing can hinder venous return.
• Smoking: Damages blood vessels, increases clot risk, and weakens valves.
• Genetics: A family history of varicose veins or venous disease raises your likelihood.
• History of DVT: A previous deep vein thrombosis can damage valves permanently, setting the stage for CVI.

Together, these factors contribute to chronic venous dysfunction, especially if multiple risks are present. Early lifestyle modifications and screenings can make a significant difference in delaying or minimizing progression.

What Causes Deep Vein Thrombosis (DVT)?

Deep vein thrombosis occurs when a blood clot (thrombus) forms in a deep vein, usually in the legs. The root causes of DVT are best explained by Virchow’s Triad—a foundational concept in vascular medicine:

Virchow’s Triad: The Three Primary Triggers of DVT

1. Venous Stasis (Slow or Reduced Blood Flow):
   • Common in individuals who are:
     • Bedridden or immobile (post-surgery, long flights).
     • Sedentary for extended periods (desk jobs, road trips).
     • Paralyzed or suffer from heart failure.
2. Endothelial Injury (Vessel Wall Damage):
   • When the inner lining of a vein is damaged, it can trigger clot formation.
   • Causes include:
     • Trauma or surgery involving the legs or pelvis.
     • Inflammatory diseases like vasculitis.
     • Insertion of IV catheters or central lines.
3. Hypercoagulability (Increased Clotting Tendency):
   • A state where blood is more prone to clotting than usual.
   • Can be inherited (Factor V Leiden, Protein C/S deficiency) or acquired due to:
     • Cancer.
     • Hormone therapy or oral contraceptives.
     • Pregnancy or postpartum state.
     • Dehydration.
     • Autoimmune conditions (e.g., antiphospholipid syndrome).

Symptoms of DVT:

Leg pain, swelling, warmth, redness, though some cases are asymptomatic.

Complications of DVT:

If left untreated, DVT can result in life-threatening or chronic complications, including:

Pulmonary Embolism (PE):

• When a part of the clot breaks off and travels to the lungs, blocking a pulmonary artery.
• Symptoms: Sudden shortness of breath, chest pain, rapid heart rate, coughing up blood.
• PE can be fatal within hours if not promptly treated. It’s the most feared complication of DVT.

Post-Thrombotic Syndrome (PTS):

• A long-term condition caused by residual damage to vein valves following DVT.
• Symptoms:
  • Chronic leg pain, swelling, and heaviness.
  • Skin discoloration or hardening (lipodermatosclerosis).
  • Venous ulcers in severe cases.
• Impact: Affects up to 50% of patients who’ve had DVT, especially when anticoagulation or compression was delayed.

Both complications underscore the importance of early detection, fast intervention, and long-term monitoring in DVT care.

How CVI and DVT Are Connected

Although Chronic Venous Insufficiency (CVI) and Deep Vein Thrombosis (DVT) are distinct conditions, they are often two stages of the same vascular continuum. The most common pathway linking them is through venous valve damage, a direct consequence of a DVT episode.

After a DVT, even if the clot dissolves or is treated, residual damage to the vein and its valves often remains. These damaged valves become incompetent, allowing blood to flow backward (reflux), especially when standing or sitting.

This backward flow leads to:

• Increased venous pressure (venous hypertension).
• Blood pooling in the lower limbs.
• Tissue inflammation, swelling, and chronic skin changes.

These are hallmark features of Chronic Venous Insufficiency (CVI).

Diagnosis and Testing

• CVI Diagnosis: Physical exam and duplex ultrasound to evaluate valve function and blood reflux.
• DVT Diagnosis: Using Wells score, D‑dimer test, and confirmed with compression ultrasound.

The Wells Score is based on a set of clinical criteria. Each positive finding is assigned a point value. The total score then helps classify the patient’s DVT risk level.

Wells Criteria for DVT:

Clinical Feature	Points
Active cancer (treatment ongoing or within 6 months)	+1
Paralysis, paresis, or recent immobilization of lower extremities	+1
Recently bedridden for >3 days or major surgery within 12 weeks	+1
Localized tenderness along the deep venous system	+1
Entire leg swollen	+1
Calf swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity)	+1
Pitting edema confined to the symptomatic leg	+1
Collateral superficial veins (non-varicose)	+1
Previous DVT	+1
Alternative diagnosis more likely than DVT	−2

• High Probability:≥3 points
  • DVT is likely. Proceed to duplex ultrasound directly.
• Moderate Probability:1–2 points
  • Consider D-dimer test first. If positive, follow with imaging.
• Low Probability:0 or fewer points
  • DVT is unlikely. A negative D-dimer usually rules out DVT.

Treatment Options for CVI and DVT

Conservative Treatments

• Compression Therapy: Graduated stockings 20–40 mmHg reduces swelling and support blood flow.
• Leg Elevation & Exercise: Elevating legs and calf-boosting activities like walking or ankle exercises.
• Weight Management & Lifestyle: Maintaining healthy weight, avoiding smoking, and active living.

Medical Management (DVT)

• Anticoagulation: DOACs (rivaroxaban, apixaban) or heparin/warfarin reduce clotting risk.
• Thrombolysis/IVC Filters: For large clots or high-risk patients not able to bleed.

Interventional & Surgical Options (CVI)

• Minimally Invasive Procedures: Endovenous laser ablation, radiofrequency ablation, sclerotherapy, phlebectomy.
• Surgical Repair: Vein stripping or CHIVA methods in severe cases. CHIVA stands for “Cure Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire”, which translates to “Conservative and Hemodynamic Treatment of Venous Insufficiency in an Outpatient Setting”. It is a non-ablative, vein-preserving surgical technique used to treat varicose veins and chronic venous insufficiency, with a strong focus on preserving the saphenous vein of the leg and improving venous hemodynamics rather than removing or destroying the vein.

Managing Post-Thrombotic Syndrome

• Compression & Long-Term Care: Essential for reducing pain, swelling, and ulcer risks.

 Lifestyle Changes & Long-Term Management

• Diet & Movement: Mediterranean-style anti-inflammatory diet and regular low-impact exercise.
• Smoking & Weight Control: Avoid tobacco and maintain a healthy BMI.
• Travel Tips: Regular movement, compression socks during long flights to prevent DVT.

How to Prevent CVI and DVT

• Early Risk Management: Identify risk via detailed history and imaging if necessary.
• High-Risk Screening: Compression, medication for surgery or immobility cases.
• Daily Habits: Break lengthy sitting, stay active, eat well, and wear appropriate compression when advised.

FAQs

Is CVI life-threatening?
 Generally not fatal but can lead to medical complications like ulcers—requires timely care.

Can DVT resolve on its own?
 Blood clots may shrink, but untreated DVT risks irreversible damage and pulmonary embolism, anticoagulation is standard.

What happens if I ignore CVI symptoms?
 Possible severe swelling, skin changes, infection, venous ulcers, and risk of DVT.

Conclusion

Early intervention is key: diagnosing and managing CVI and DVT promptly can prevent chronic pain and serious complications. A proactive combination of medical, lifestyle, and procedural steps ensures healthier veins and improved quality of life.