Venous disease
Chronic Venous Insufficiency & Leg Ulcers
Years of failing leg vein valves — swelling, skin darkening, itching, then ankle ulcers. Progressive, and treatable when addressed early in Singapore.
Last reviewed 30 Jun 2026
Reviewed by Dr Tay Jia Sheng · Vascular, Endovascular & General Surgeon
What is chronic venous insufficiency?
Chronic venous insufficiency (CVI) — one of the conditions I assess and treat in Singapore — is most often the long-term consequence of leaking vein valves — the same disease process as varicose veins, further along the road. It can also follow a deep vein thrombosis (the post-thrombotic syndrome) or obstruction of the deep veins. Either way, blood pools in the lower legs under pressure, and over years that pressure damages the skin and tissues around the ankle.
How it progresses
CVI tends to advance through recognisable stages:
- Aching, heaviness and ankle swelling that builds during the day
- Skin changes — darkening (a rusty-brown discolouration), dryness, itching and eczema around the lower calf and ankle
- Lipodermatosclerosis — the skin and fat harden and the lower leg tightens like an inverted champagne bottle
- Venous ulcers — shallow, weeping, often painful wounds near the ankle that heal slowly or not at all
A venous ulcer is not a skin problem with a skin solution; it is a pressure problem. Dressings alone treat the surface while the cause persists.
How I assess it
Duplex ultrasound at the consultation maps exactly which veins are refluxing — superficial, deep or perforator veins — and whether an old deep vein thrombosis is contributing. I read the scan myself, and the treatment plan follows the map.
Treatment options
- Compression therapy — the foundation for symptom control and ulcer healing
- Endovenous ablation or medical adhesive closure of refluxing superficial veins — closing the leak reduces the pressure that prevents healing and cuts the risk of ulcer recurrence
- Foam sclerotherapy for tributaries and perforators
- Wound care for active ulcers, in parallel with treating the underlying veins
When to see a doctor promptly
Skin darkening or itching around the ankle, one leg swelling more than the other, or any wound near the ankle that has not begun healing within two weeks deserves early vascular assessment — ulcers prevented are far easier than ulcers healed.
Frequently asked questions
- How is chronic venous insufficiency different from varicose veins?
- It is most often the same disease further along the road: leaking vein valves let blood pool in the lower leg under pressure, and over years that pressure damages the skin and tissues around the ankle. Varicose veins are one visible sign of the leak; swelling, skin darkening, hardening and ulcers are what long-standing pressure does.
- What are the early signs I should watch for?
- Aching and heaviness with ankle swelling that builds through the day, then skin changes around the lower calf and ankle — a rusty-brown discolouration, dryness, itching or eczema. These signal pressure that can progress towards an ulcer, and they are the stage at which treatment does the most good.
- Why won't my leg ulcer heal with dressings?
- Because a venous ulcer is a pressure problem, not a skin problem. Dressings treat the surface while the cause — refluxing veins — persists. Healing usually needs compression together with treatment of the underlying leak, with wound care running alongside rather than instead.
- What does treatment involve?
- Compression therapy is the foundation for symptom control and ulcer healing. Where duplex ultrasound shows refluxing superficial veins, closing them — by endovenous ablation or medical adhesive closure — reduces the pressure that prevents healing and lowers the chance of the ulcer returning. Foam sclerotherapy addresses tributaries and perforators.
- Can CVI be caused by an old blood clot?
- Yes. Chronic venous insufficiency can follow a deep vein thrombosis — the post-thrombotic syndrome — or obstruction of the deep veins. The duplex scan at consultation maps whether superficial, deep or perforator veins are refluxing and whether an old DVT is contributing, and the plan follows that map.