Updated:
by
Tricia Croake, MD
Medically reviewed by Tricia Croake, MD, on February, 13, 2026
If you have heavy, tired legs at the end of the day, swelling around your ankles, or aching that seems to come and go, you might chalk it up to aging, weight, or a long day on your feet, when in fact it is due to chronic venous insufficiency.
What if those symptoms are not aging at all, but a circulation problem hiding beneath the surface?
Vein disease is far more common than most people realize, and the numbers are far larger than most people expect. According to the National Library of Medicine (NIH), in the United States, about 25 million people have varicose veins, with 2 to 6 million experiencing advanced chronic venous insufficiency, including leg swelling and skin changes. Nearly 500,000 people develop painful venous ulcers, highlighting how widespread and serious untreated vein disease is.
To understand why chronic venous insufficiency (CVI) is so frequently overlooked, and why early vein care matters, we spoke with Dr. Tricia Croake, lead physician at Center for Vein Restoration in Pinehurst, North Carolina.
📅To schedule an appointment with Dr. Croake in Pinehurst, NC, CLICK HERE
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One of the biggest reasons vein disease is underdiagnosed is that its symptoms are often non-specific:
“People often start by seeing their primary care doctor. From there, they may be referred to a dermatologist for skin changes, a cardiologist for leg swelling, an orthopedist for leg pain, or to a wound care specialist for a sore. The symptoms get treated separately, unfortunately, often no one puts the whole picture together.” – Dr. Tricia Croake
Leg swelling may be blamed on heart issues. Skin discoloration or itching may be treated as a dermatologic condition. Aching or heaviness may be dismissed as arthritis, fatigue, or overuse.
Another common issue is the type of imaging used:
“Many patients are sent for ultrasounds to rule out a blood clot,” Dr. Croake says. “But those scans are not designed to look for chronic venous insufficiency. You need a specific venous reflux ultrasound to diagnose vein disease.”
Perhaps the biggest reason vein disease flies under the radar is that people normalize their symptoms:
“They say, ‘My legs feel heavy because I’m getting older,’ or ‘I’ve been on my feet all day,’” she says. “Others assume it runs in the family and nothing can be done. But when vein disease is treated, those symptoms often improve dramatically.” – Dr. Tricia Croake
Several groups are at higher risk, and many are often overlooked.
“Genetics plays a major role,” says Dr. Croake. “If one parent has vein disease, there is about a 50 percent chance their child will develop it. If both parents are affected, the risk increases to 90 percent.”
Other risk factors include:
“The more risk factors you have, the more important it is to pay attention to symptoms,” Dr. Croake notes.
For many patients, the turning point is a venous ultrasound.
“When patients see the ultrasound results, it’s very validating,” says Dr. Croake. “We can show them clear evidence that their veins are enlarged and refluxing. It helps them understand that their symptoms are real and that there’s a reason for them.”
That clarity often brings relief, especially for people who were told their symptoms were cosmetic or unrelated.
If you’re noticing leg swelling, skin changes, or ongoing discomfort, it’s time to get answers. Center for Vein Restoration specialists use advanced ultrasound imaging to diagnose venous insufficiency early and recommend treatment to help prevent complications.
📞 Call Center for Vein Restoration at 240-249-8250
📅 Or book online HERE
“Yes, absolutely,” says Dr. Croake
Many people believe vein disease always comes with large, bulging varicose veins. That is often not the case.
“The majority of patients I see do not have obvious bulging veins. It’s not until we do an ultrasound that we see enlarged veins and reflux, which is blood flowing in the wrong direction. This is why individuals with symptoms such as leg swelling, heaviness, aching, burning, itching, or restless legs at night should not rely on appearance alone. Vein disease can exist beneath the surface. – Dr. Tricia Croake
Vein disease tends to progress quietly over time. Progression is often silent until complications arise.
Early symptoms may worsen. Occasional swelling can become constant. Skin may change color, become darker, or discolored around the ankles and lower legs. The skin can harden, thicken, itch, burn, or become tender.
“Later on, patients can develop venous ulcers. These are open wounds that heal very slowly and can become infected. Some people even develop inflammation that looks like a skin infection, called cellulitis.” – Dr. Tricia Croake
Over time, untreated venous insufficiency can limit mobility, increase discomfort, and significantly affect quality of life. The good news is that early diagnosis can help prevent many of these complications.
After the ultrasound, patients meet with the vein specialist to review the findings and discuss next steps.
“I explain what chronic venous insufficiency is, what we’re seeing on their scan, and what treatment options make sense for them,” Dr. Croake says.
Treatment plans may include minimally invasive outpatient procedures such as radiofrequency ablation, medical sclerotherapy, or phlebectomy, depending on the type and severity of vein disease.
Patients also receive guidance on logistics.
“We make sure insurance authorization is completed before any procedure,” she explains. “If patients have financial concerns, our team helps them understand coverage and costs ahead of time. We want people to feel supported, not overwhelmed.” – Dr. Tricia Croake
In most cases, insurance covers medically necessary vein treatment, though coverage criteria can vary by plan.
One of Dr. Croake’s top priorities is education for both patients and healthcare providers.
“Arterial disease is taught extensively in medical training, and it should be,” she says. “But chronic venous insufficiency is often overlooked, even though it affects millions of people and costs the healthcare system significantly.” – Dr. Tricia Croake
Vein disease can present in many ways, from tired, heavy legs to swelling, skin changes, restless legs, or nighttime cramping. When it is included in the differential diagnosis, patients are more likely to get the right testing and care.
If leg symptoms are affecting your comfort, mobility, or peace of mind, a vein evaluation can help you understand what’s really going on.
Schedule a consultation with a vein specialist at Center for Vein Restoration today. Our team will help you gain clarity, reassurance, and a plan tailored to you.
📞 Call 240-249-8250 to speak with a Patient Services Representative or schedule your consultation online at a CVR near you today.
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