Chronic Venous Insufficiency: Symptoms, Causes, and Treatment in New York

Chronic venous insufficiency (CVI) is one of the most common yet underdiagnosed vascular conditions in the United States, affecting an estimated 40 percent of Americans at some point in their lives. Despite its prevalence, many people endure symptoms for years — or even decades — before receiving a proper diagnosis.

At its core, CVI is a problem of circulation. Healthy leg veins contain one-way valves that push blood upward against gravity, back toward the heart. When those valves weaken or become damaged, blood pools in the lower legs instead of moving forward. This pooling creates chronically elevated pressure inside the veins — a state known as venous hypertension — which drives the full spectrum of CVI symptoms.

As board-certified phlebologists who have specialized exclusively in vein disease for over 55 years combined, Dr. Martin Schulman and Dr. Lee G. Schulman see CVI at every stage of progression. The encouraging news: caught early, CVI is highly manageable. Even in more advanced presentations, today's minimally invasive procedures deliver lasting relief with same-day recovery.

The symptoms of chronic venous insufficiency exist on a spectrum. Early-stage CVI may present as little more than tired, heavy legs at the end of the day. As the condition progresses, symptoms become more pronounced and can significantly impact quality of life.

Common symptoms include:

CVI develops when the one-way valves inside the leg veins become incompetent — meaning they no longer close properly and allow blood to flow backward (a process called reflux). Several factors increase the risk of this occurring:

It is worth noting that CVI and varicose veins are closely related but not identical. Many people with CVI have visible varicose veins, but CVI can also be present without obvious surface changes — detectable only through duplex ultrasound imaging.

Accurate diagnosis of CVI begins with a thorough clinical evaluation. At Schulman Vein Center, our physicians start by reviewing your medical history, occupational habits, symptoms, and any prior vein treatments or clot history.

The cornerstone diagnostic tool is duplex ultrasound — a non-invasive imaging technique that maps the venous anatomy of your legs and identifies exactly where reflux is occurring. This study is performed in-office, requires no preparation, and typically takes 30–45 minutes.

Duplex ultrasound allows us to:

This imaging-guided approach is why a specialist evaluation at Schulman Vein Center yields far more actionable information than a general practitioner visit. Treatment decisions rooted in objective ultrasound findings lead to better, more durable outcomes.

The goal of CVI treatment is to eliminate reflux in the affected veins, restore healthy circulation, and prevent disease progression. At Schulman Vein Center, we offer the full spectrum of FDA-approved, minimally invasive treatments — each selected based on your specific anatomy and disease pattern.

Patients often ask whether varicose veins and CVI are the same condition. The short answer: varicose veins are frequently a symptom of CVI, but the two are distinct diagnoses.

CVI refers to the underlying functional impairment — the failure of venous valves to maintain proper one-way flow. Varicose veins are the visible manifestation that often results from that impairment. However, CVI can exist without prominent surface veins (particularly in deeper venous segments), and varicose veins can appear in patients whose valve function remains largely intact.

This distinction matters clinically. Treating visible varicose veins without addressing underlying reflux is a common reason treatments fail or symptoms recur. At Schulman Vein Center, duplex ultrasound mapping ensures we treat the root cause — not just the surface presentation.

Many patients wait too long to seek care — either because they assume leg symptoms are a normal part of aging or because they believe visible veins are purely a cosmetic issue. Both assumptions can delay treatment and allow CVI to advance to more serious stages.

Seek a specialist evaluation if you experience:

At Schulman Vein Center, we offer a complimentary vein screening at all three of our locations — Manhattan, Manhasset, and Commack — so there is no barrier to getting an expert opinion. Our board-certified physicians can typically provide an initial assessment and ultrasound interpretation within a single visit.

While minimally invasive procedures address the structural cause of CVI, lifestyle modifications play an important complementary role — particularly in slowing progression and managing symptoms between treatments.

Chronic venous insufficiency is a progressive condition — early intervention consistently leads to better outcomes than delayed treatment. Whether your symptoms are mild or you have been managing CVI for years, a specialist evaluation at Schulman Vein Center will give you a clear picture of your venous health and a precise, personalized treatment plan.

Dr. Martin Schulman and Dr. Lee G. Schulman have spent decades dedicated exclusively to vein disease. With more than 200 five-star Google reviews and locations across the New York metro area — Manhattan, Manhasset, and Commack — Schulman Vein Center is one of the most trusted names in vein care in the region.

We invite you to schedule a complimentary Free Vein Screening at any of our three locations. Our specialists will review your symptoms, perform a physical examination, and determine whether duplex ultrasound is appropriate — all at no cost and no obligation. Relief from heavy, swollen, aching legs may be closer than you think.