Chronic venous insufficiency: Trump’s leg swelling explained

After photographs of United States President Donald Trump showing his significantly swollen ankles and bruised hands sparked public concern, the White House has revealed that he has chronic venous insufficiency (CVI), a blood vessel disease that affects circulation.

As it happens, White House Press Secretary Karoline Leavitt unveiled the President’s diagnosis during a press conference, and his physician, Sean Barbabella, noted that Trump underwent several diagnostic tests, including blood work and an echocardiogram, in a letter from July 17.

What is chronic venous insufficiency?

In the letter shared by Leavitt, Barbabella wrote that CVI was “a benign and common condition” in older people, as well as that the tests haven’t detected any signs of systemic illness or heart failure, adding that his bruised hands were from “frequent handshaking and the use of aspirin (…) as part of a standard cardiovascular prevention regimen.”

“All results were within normal limits. (…) No signs of heart failure, renal impairment, or systemic illness were identified. (…) President Trump remains in excellent health.”

In the words of Monara Dini, a treating physician at the University of California, San Francisco Center for Limb Preservation, this is indeed a very common thing for someone of Trump’s age. It is a subset of a larger category of conditions called venous disorders that mainly affect the legs and only cause pain.

According to Johns Hopkins Medicine, it happens when weakened valves in leg veins (which normally make sure that blood flows towards the heart) allow the blood to flow backwards and pool under the force of gravity. As Dini explained, these valves tend to leak more often as people age.

Per Cleveland Clinic data the condition affects around 5% of all U.S. adults, with the risk of developing it increasing with age. The most common cause of valve damage is a blood clot, and symptoms primarily affect the legs, leading to achiness and cramps, swelling and discoloration, leathery-looking skin, and open sores called ulcers.

As Dini pointed out:

“The worst outcome of having this condition is ulcers that can develop. (…) The skin is retaining so much fluid that it can, at some point, burst and break the skin, and you develop ulcerations. It happens a lot, and that’s more devastating in the sense that it requires wound care. It can be painful and life-altering.”

Who can get CVI?

Meanwhile, CVI doesn’t just affect older individuals. It can also happen to people who are overweight or pregnant, who have had a leg injury or blood clots, or have the condition running in the family, as well as those who smoke and have insufficient exercise.

Most often, the treatment involves keeping the legs elevated, reducing weight, and increasing exercise. It may also include compression therapy, like wearing compression socks or pumps, to alleviate symptoms. In some cases, it warrants minor surgical interventions that repair or remove damaged tissue.