A patient with chronic venous insufficiency may present with which of the following symptoms?

The presence of brown pigmentation and staining in a patient with chronic venous insufficiency is a hallmark sign of this condition. This pigmentation occurs due to the accumulation of hemosiderin, a pigment that results from the breakdown of red blood cells, in the tissues surrounding the affected veins. When venous return is impaired due to factors such as valve incompetence, it can lead to increased pressure in the veins. Eventually, this pressure causes fluid to leak from the venous system into the surrounding tissues, resulting in edema and the characteristic brown discoloration known as stasis dermatitis.

In contrast, symptoms like cool legs and feet generally indicate arterial insufficiency rather than venous issues. Gangrene and ulceration on the toes are also more commonly associated with arterial occlusion or severe ischemia, rather than the chronic venous conditions that would present with brown pigmentation and staining. Thus, the pigmentation is a direct result of the pathophysiological changes occurring in chronic venous insufficiency, making it the correct response in this scenario.