The natural history of untreated venous insufficiency is the development of vein related complications such as progressive edema and swelling in the affected extremity, leading to insidious onset of skin changes, including thickening of the skin and eventual discoloration from the deposit of red blood cells in the skin. Most of the severe skin changes seen in patients with venous insufficiency are reversible, and once the underlying superficial leaky veins have been treated the skin often returns to a more normal color and texture. Over time, after successful endovenous treatment of severe superficial venous insufficiency, the risks of bleeding and ulceration are also lowered significantly. In summary, most severe appearing skin changes seen in patients with chronic venous insufficiency are secondary to superficial venous dysfunction and once the underlying problems have been treated (with endovenous closure) the skin changes can be halted at the least and reversed in many patients.