Chronic Venous Insufficiency (CVI) is the general term that is used to refer to the presence of inadequately functioning veins in the lower extremities. Normal functioning veins transport oxygen-depleted blood back to the heart and lungs for re-oxygenation, along with other functions. When veins are not able to transport blood they are considered non-functional.

How does Chronic Venous Insufficiency present?
There are different manifestations of CVI and varying degrees of severity.

At one end of the spectrum, CVI may present simply as a cosmetic concern without any symptoms or adverse effect on the tissues that the veins are supporting. This is often observed as dilated veins under the skin, such as Spider Veins or Varicose Veins.

At the other end of the CVI spectrum, malfunctioning veins can be associated with symptoms and may adversely affect the structure and function of tissue that the veins are supporting. Symptoms that may be associated with CVI include pain and cramping often in the presence of swelling of the leg, foot and ankle. With more severe involvement, there may be changes in the texture and color of the skin, which can turn into in leg ulcers.

How is Chronic Venous Insufficiency diagnosed?
The first step in diagnosis is the observation of atypical appearing veins, (alteration in skin color or texture, pain, cramping or swelling). A history of thrombophlebitis or injury to the legs may also provide a clue as to the presence of CVI. The presence of CVI may be confirmed with Ultrasound.

How is Chronic Venous Insufficiency treated?
Treatment will depend upon the specific veins that are found to be insufficient or non-functioning. For visible Spider Veins or Varicose Veins, Sclerotherapy is usually the treatment of choice for their removal. When the Saphenous Veins are discovered to be insufficient to a significant extent, Endovenous Ablation is the preferred method for their removal. Endovenous Ablation is a safer, less invasive alternative to a procedure that is known as Vein Stripping & Ligation, which is now rarely performed.

“You cannot go wrong with this dermatologist. Dr. Green and his staff are the very best! They go out of their way to assure patient satisfaction. I have used many services in the Bethesda location, and have always been more than satisfied. I highly recommend Dr. Green.” 

Susan E.

Dr. David Green, M.D.

Dr. David Green is a Board certified Dermatologist in Bethesda, Maryland. Dr. Green specializes in Dermatology, Dermatologic Cosmetic and Laser Surgery and the treatment of Varicose Veins and vascular disorders.

He is Certified by the American Board of Dermatology, is a Fellow of the American Academy of Dermatology, and a Member of the American Society for Dermatologic Surgery, and the American College of Phlebology. He treats patients from Maryland, Washington DC, Virginia and throughout the Mid Atlantic region.


Dr. David Green proudly offers services in his Bethesda, Maryland office.

4800 Montgomery Ln.,
Suite LL50
Bethesda, MD 20814
Phone: 301.907.7250


10.32.09: Delegation and Assignment of Performance of Cosmetic Medical Procedures and Use of Cosmetic Medical Devices. This is a Maryland safety regulation that governs who can legally perform medical cosmetic procedures.  Dr. Green administers all injectable treatments (including Botox™, Juvederm™, Voluma™, Kyblella™, and other fillers & Sclerotherapy) and laser treatments.