What Is Chronic Venous Insufficiency? A Doctor's Explanation

Understanding Chronic Venous Insufficiency

On July 17, the White House shared that President Donald Trump was diagnosed with chronic venous insufficiency (CVI) after noticing swelling in his legs. At 79 years old, he underwent an ultrasound of his legs and was found to have no complications such as deep vein thrombosis. An echocardiogram also confirmed that his heart structure and function were normal.

Experts were consulted to explain what CVI is, its symptoms, causes, and treatment options.

What Is Chronic Venous Insufficiency?

Chronic venous insufficiency affects more than 25 million adults in the United States. It is a common condition seen by Dr. Ali Azizzadeh, a professor and director of vascular surgery at Cedars-Sinai Medical Center and associate director of the Smidt Heart Institute.

CVI occurs when the valves in the leg veins do not function correctly, leading to blood pooling and increased pressure on the veins. This condition typically affects both legs but can occur in just one.

According to Azizzadeh, veins are responsible for returning blood from the body back to the heart. When someone has CVI, the veins do not work properly, causing blood to pool in the legs instead of flowing upward toward the heart. This often results in visible swelling in the ankles and feet.

Causes of Chronic Venous Insufficiency

There are several risk factors associated with CVI. The condition is most common in middle-aged or older individuals because veins naturally weaken over time. Women are at a higher risk compared to men, with a ratio of about 2 to 1. This is partly due to pregnancy and the effects of hormones like estrogen and progesterone on the valves.

Other risk factors include a family history of CVI, being overweight or obese, and a history of blood clots in the legs. Prolonged standing can also contribute to the condition. Dr. John Higgins, a professor of cardiology at UTHealth Houston, explains that standing increases pressure on the veins compared to sitting or lying down. While Trump is not a patient of Higgins, it is noted that he is someone who spends a lot of time on his feet.

Symptoms and Complications

Most people with CVI experience mild symptoms, according to Dr. Sean Lyden, department chair of vascular surgery at Cleveland Clinic. He describes it as a “nuisance” for many, with leg swelling being the primary issue. Swelling tends to worsen throughout the day, making the legs feel heavy and uncomfortable. By bedtime, some individuals may notice “big sock lines” where socks press into the skin, a common occurrence among older adults.

In addition to swelling, some people experience discoloration in their feet and ankles. If left untreated for many years—often 10 to 15 years—the condition can lead to hardening and thickening of the skin, which can cut off blood supply and result in venous ulcers.

Despite these potential complications, most people are able to manage CVI effectively, and it does not impact life expectancy. Azizzadeh notes that CVI is not dangerous but can cause discomfort due to swelling and pain. He adds that the condition does not affect Trump’s prognosis in terms of life expectancy.

Treatment Options

The most common treatment for CVI is wearing medical-grade compression socks, typically 20-30 mmHg. These socks help push blood back toward the heart. Lyden explains that they should be worn in the morning and kept on all day. Most patients need to wear them indefinitely, though some may find them uncomfortable during hot weather.

Elevating the legs above the heart during the day can also provide relief. This can be done by lying down and resting the legs on pillows or other objects. Simple exercises, such as pumping the calf muscles, can also help. For those who are overweight, losing weight may improve symptoms.

In more severe cases, minimally invasive procedures like venous ablation may be considered. This procedure closes the affected veins, preventing blood from flowing in the wrong direction. Azizzadeh describes it as a straightforward and successful operation.

However, most people with CVI do not require surgical intervention. Higgins emphasizes that the condition is very manageable with conservative treatments. With proper care, most individuals will do just fine.