Chronic venous insufficiency (CVI): How to keep your veins healthy and detect symptoms early
- Norman Reffke
- Jul 31
- 3 min read
Do you often have heavy legs in the evenings – as if someone had poured lead into them? You may be ignoring the swelling in your ankles, but it could be a sign of a widespread, silent disease: chronic venous insufficiency. In this article, you'll learn how to recognize the early signs, what exactly is happening in your veins – and what you can do about it.
Table of contents
What is chronic venous insufficiency?
How does CVI develop?
Typical symptoms of CVI
The three stages of CVI
Diagnosis by the phlebologist
Treatment options
Nutrition & supplements for vein health
Coaching integration in everyday life
7 warning signs you should take seriously
Conclusion
Sources
What is chronic venous insufficiency?
Chronic venous insufficiency (CVI) is a disease of the leg veins. It occurs when blood is no longer efficiently transported back to the heart, but instead accumulates in the veins. Often, the cause is defective venous valves, which act like check valves to direct blood upwards. If these valves are damaged, the blood flows backward – sometimes with dramatic consequences.
How does CVI develop?
The most common causes are:
Weakness of the venous valves : They lose their backflow barrier
Lack of exercise : Without a muscle pump, there is no pressure to return the blood
Long periods of standing or sitting : particularly critical in everyday working life
Obesity : Increases pressure on the venous system
Hormonal factors : e.g. pregnancy or hormonal contraceptives
Genetic predisposition : Often familial
Typical symptoms of CVI
Feeling of heaviness and tension in the legs (especially in the evening)
Swelling of the ankles
Visible varicose veins or spider veins
Skin discoloration (brownish-reddish)
Itching, eczema on the lower legs
In severe cases: "open leg" (ulcus cruris)
The three stages of CVI
Stage I: Reversible swelling and tension after exercise
Stage II: Persistent edema, skin discoloration, and eczema
Stage III: Hardened skin, open ulcers, severely reduced quality of life
Diagnosis by the phlebologist
A specialized phlebologist typically uses duplex sonography , a combination of imaging and Doppler ultrasound. Other procedures include:
Light reflection rheography (LRR)
Photoplethysmography (PPG)
D-dimer test for suspected thrombosis
Treatment options
Conservative measures
Compression therapy: Medical stockings, tailored to stage
Movement: Activation of the calf muscle pump (e.g. foot rocking)
Positioning: Elevate legs to relieve pressure
Skin care: Moisturizing creams for itching and eczema
Drug treatment
Vein-tonizing phytotherapeutics : e.g. horse chestnut, red vine leaves, flavonoids
Anticoagulants : If there is a risk of thrombosis
Surgical & interventional procedures
Sclerotherapy : obliteration of small veins with injection
Stripping : Surgical removal of defective veins
Endovenous laser or radiowave therapy
Nutrition & supplements for vein health
A vein-friendly diet should include:
Vitamin C & OPC (e.g. from grape seeds) : Support collagen formation and vascular stability
Zinc & Copper : Important for connective tissue and repair processes
Omega-3 fatty acids : have an inflammation-modulating effect
Bioflavonoids (e.g. from citrus fruits) : Promote microcirculation
Recommended intake (guidelines):
OPC : 100–200 mg/day
Vitamin C : 500–1,000 mg/day
Omega-3 : 1–2 g EPA/DHA daily
🛈 Please note: These recommendations are based on literature and do not replace individual advice.
Coaching integration in everyday life
Vein strengthening measures are firmly integrated into VMC coaching:
Daily micro-movements (foot tapping, tiptoe standing)
Vein exercises in the morning
OPC + vitamin C treatment in the reset phase
Cold-warm alternating showers for toning
Blackroll training for calf relaxation
These elements are automatically adjusted in the daily schedule when CVI risks are detected.
7 warning signs you should take seriously
Evening swelling of the ankles
Feeling of tension in the lower legs after sitting
Visible spider veins or varicose veins
Discolored skin around the ankles
Itching or redness on the legs
Nighttime calf cramps
Feeling of cold or heat in the legs without any external cause
Conclusion: It is never too early to protect your veins
CVI is a gradual disease—but also one you can actively influence. Exercise, a targeted diet, and a careful eye on your legs make all the difference. If you're already feeling the first signs, now's the right time to take action.
Tip: If you are also interested in topics such as varicose veins, phlebitis or thrombosis, read on in our article “What your legs tell you about your health”.
Sources
Rabe E. et al. (2020). Guidelines for the diagnosis and treatment of CVI . Phlebology. https://www.phlebologie.de
Nicolaides AN (2018). Investigation of chronic venous disease . Int Angiol. https://pubmed.ncbi.nlm.nih.gov/29786045
EFSA Journal (2019). Scientific Opinion on the substantiation of health claims related to grape seed extract and protection of blood vessels . https://efsa.europa.eu
Mayo Clinic (2023). Chronic venous insufficiency . https://www.mayoclinic.org
Cochrane Library (2021). Compression therapy for venous leg ulcers . https://www.cochranelibrary.com