What is Chronic Venous Insufficiency (CVI)?

CVI is short for Chronic Venous Insufficiency. This is a condition where the one-way valves in the deep veins of the legs begin to fail, resulting in the deep veins getting engorged with blood. This builds up higher pressure in these deep veins, which spills over into superficial veins of the legs. When the superficial veins get engorged with blood, this spills over into surface veins that also become engorged. These surface veins are visible through the skin, and usually prompt the patient to visit a doctor. Other patients aren’t bothered by the appearance of veins, but come to the doctor because of aching, heaviness, pain, restless legs, cramps, and swelling of the legs.

Appearance of CVI

CVI presents as darkening of the skin, leg swelling, ulcers on the legs from pooling venous blood, bulging varicose veins. Varicose veins are an advanced stage of a CVI. 15% of all adults suffer from CVI, and the worse cases have large ropy bulging varicose veins. But not all people with CVI have varicose veins. Symptoms of CVI include aching, heaviness, tiredness, weakness of the legs, swelling of the legs, leg cramps, and restless legs.

Not all Veins are Varicose Veins

Varicose veins are the large ropy bulging veins in the legs – they may be painful. Almost always, those with the large bulging varicose veins have CVI.

Reticular veins are the medium sized veins below the skin that appear green. Reticular veins may be a sign of CVI and warrants further evaluation with ultrasound.

Spider veins are the tiny hair-sized red colored surface veins. Spider veins are considered cosmetic and treatment of spider veins is not paid by insurance.

Ultrasound Exam: Searching for Venous Reflux

If a patient has any of these symptoms listed above, they will be scheduled for an ultrasound exam of the legs. This ultrasound exam is usually covered by insurance, provided that it is medically necessary. By documenting your symptoms, we prove that the ultrasound is medically necessary. The ultrasound is painless, and takes about 45 minutes. We are looking for a condition called venous reflux. In venous reflux, the flow of blood in a superficial vein reverses. We search in three veins in each leg – the common femoral vein, the great saphenous vein, and the small saphenous vein in each leg. If we identify this backwards flow of blood in any of these veins, then we have proven that the patient has venous reflux.

Conservative Therapy

Before an insurance company will cover the cost of treatment of CVI, they require that the patient has tried and failed “conservative therapy”. Conservative therapy consists of three items: compression hoses, exercise (such as walking) and elevating your legs. Some insurance place a minimum time requirement for attempting conservative therapy – usually 90 days. Other insurances do not have a minimum time that you need to try conservative therapy.

Photographs of Your Legs

Some insurance companies require photos of the lower extremities, so we take photos of each potential patient’s legs, and keep them on file, in case they request photos. We take great care to protect your privacy, and do not share these images with anyone other than your insurance company or another individual involved with your care. We comply fully with HIPAA.

What Makes You Eligible for Treatment of CVI?

There are several requirements that must be met for your insurance to cover your treatment.

Presence of venous reflux

Presence of symptoms of CVI

Failure of conservative therapy for CVI

Most insurance plans cover the treatment of Chronic Venous Insufficiency, when we show the presence of venous reflux, and document that the patient is suffering from symptoms of CVI, despite attempting conservative therapy, as per their requirements.

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