What Is Chronic Venous Insufficiency? Trump’s Diagnosis, Explained

On July 17, the White House announced that President Donald Trump was diagnosed with a condition called chronic venous insufficiency after he noticed swelling in his legs. According to Press Secretary Karoline Leavitt, Trump, who is 79, was diagnosed following an ultrasound of his legs; he does not have complications of the condition, such as deep vein thrombosis, and an echocardiogram indicated that he has normal cardiac structure and function. We asked experts what to know about the condition, including what it feels like and how it’s treated. What is chronic venous insufficiency? Chronic venous insufficiency (CVI) affects more than 25 million adults in the U.S. It’s one of the most common diagnoses that Dr. Ali Azizzadeh, professor and director of vascular surgery at Cedars-Sinai Medical Center and associate director of the Smidt Heart Institute, sees in his patients every day.  CVI occurs when the valves in the legs don’t work correctly, which causes blood to pool, putting increased pressure on the veins. It tends to affect both legs, though it can occur in just one. Read More: 7 Myths About Cardiomyopathy—Debunked “We have blood vessels that take the blood from the heart to the rest of the body—those are arteries,” Azizzadeh says. “Veins are responsible for returning the blood from the rest of the body back to the heart. When somebody has chronic venous insufficiency, that means the veins are not working properly, and because of that, the blood—instead of going up towards the heart from the legs—can pool in the leg.” That often leads to visible swelling in the ankles and feet. What causes the condition? There are a variety of risk factors for chronic venous insufficiency. The condition is most common in people who are middle-aged or older, since veins naturally weaken over time, says Dr. John Higgins, professor of cardiology at UTHealth Houston. Women are at heightened risk compared to men: “It’s about 2 to 1 for women, and the reason for that is pregnancy, as well as the effects of hormones like estrogen and progesterone on the the valves,” he says. Read More: 9 Weird Symptoms Cardiologists Say You Should Never Ignore Other risk factors include a family history of CVI, being overweight or obese, and having a history of blood clots in the legs. Standing for long periods of time can also play a role. “When you stand up, there’s more pressure on your veins than when you’re sitting or laying down,” Higgins says. As for the president—who is not a patient of Higgins—“he’s someone who’s on his feet a lot.” What kind of symptoms and complications does it cause? The majority of the time, chronic venous insufficiency is little more than a “nuisance,” according to Dr. Sean Lyden, department chair of vascular surgery at Cleveland Clinic. “For most people, it’s nothing except for some leg swelling,” he says. “As the day goes on, their leg swells more and more, so it feels tight, heavy, and bursting.” By the time patients with CVI go to bed, they might notice the “big sock lines” that indent skin where socks hit, a common thing among older adults, he adds. Some people also experience discoloration in their feet and ankles. When people have CVI for a long time—10 or 15 years—they can develop hardening and thickening in the skin, which can eventually cut off the blood supply and lead to venous ulcers, Lyden adds. Generally, however, most people are able to successfully manage the condition, and it does not affect life expectancy. “It’s a very common diagnosis, and it’s not dangerous,” says Azizzadeh. “It’s more that it bothers the patient, with regards to the swelling and the pain and the discomfort.” Azizzadeh, who does not treat Trump, adds that CVI “doesn’t impact [Trump’s] prognosis in terms of life expectancy or anything like that.” How is chronic venous insufficiency treated? The most common treatment for chronic venous insufficiency is wearing 20-30 mmHg medical-grade compression socks, which push blood back up to the heart. “You put them on in the morning and you keep them on all day,” Lyden says. “It stops the veins from dilating until they drain better.” Most people with CVI need to wear these socks forever, though Lyden acknowledges that, in the summer heat, the extra layer can be unpleasant. People often don’t put them on when they’re going outside on hot days, which causes their legs to swell up again. People with CVI also benefit from elevating their legs above their heart during the day, which can be done by lying down and resting the legs on pillows or cushions, or on top of, for example, a coffee table or desk. Simple exercises can also make a positive difference. “Pumping your calf muscles helps,” Higgins says. For those who are overweight, losing weight can improve symptoms. Read More: The 1 Heart-Health Habit You Should Start When You’re Young In advanced cases, when conservative treatment doesn’t sufficiently improve symptoms, some people undergo a minimally invasive outpatient procedure called venous ablation. “It’s a very simple operation,” Azizzadeh says. “It closes the leak,” so blood no longer flows in the wrong direction. “It’s very straightforward and successful.”  Still, for the majority of people, CVI doesn’t reach the point of requiring surgical intervention. “The bottom line is, it’s very manageable,” Higgins says. “Most people will do just fine with the conservative therapy.”