Trump has ‘chronic venous insufficiency’. Is it dangerous? Can it be treated?

US President Donald Trump has been diagnosed with “chronic venous insufficiency” after experiencing some mild swelling in his lower legs.

According to a letter the White House published from the president’s doctor, the condition is common and not harmful, and the 79-year-old “remains in excellent health”.

But what is chronic venous insufficiency? What causes it, and can it lead to other health problems? Let’s take a look.

A disease of the veins

Veins are the blood vessels that carry de-oxygenated blood from all parts of the body to the heart.

Chronic venous insufficiency is a disease of the veins and mostly affects the legs.

When someone has this condition, it becomes more difficult for the blood to flow back to the heart. In other words, blood pools in the legs, rather than travelling up easily through the legs, pelvis and abdomen to the heart.

Blood pooling in the legs creates increased pressure in the veins in the legs and feet. This can cause swelling (called oedema), skin discolouration, varicose veins, and even skin ulcers (the skin stretches because of the increased pressure and becomes weak and can tear).

What causes chronic venous insufficiency?

There are several potential causes of chronic venous insufficiency, including damaged valves inside the veins in the legs.

When we’re standing, blood has to flow back to the heart from the legs against gravity. Veins have valves inside them which ensure this one-way flow and stop blood from running back the wrong way.

When valves in the veins – either the deeper veins or those closer to the skin’s surface – are damaged, this allows blood to flow backwards and pool in the legs.

Damage to the inside lining of the vein wall can also cause chronic venous insufficiency. When the lining is damaged, it becomes less smooth and blood cells can stick to the wall and build up. This can block the inside of the vein and impede the return of blood to the heart. Smoking is a major cause of this, though it also happens naturally with age.

Physical compression of a vein in the pelvis from the outside can also be a factor. Pregnancy, obesity or a tumour can push on a pelvic vein from the outside. This makes it harder for blood to flow through that vein, which causes back up of blood in the veins of the leg.

Deep vein thrombosis (DVT) also increases the risk of chronic venous insufficiency. This is where blood clots form in the deep veins, most commonly in the legs. It can block blood flow or damage the vein wall, and increase blood pooling further down the leg.

In a study I did with colleagues looking at people with chronic venous insufficiency, about 10% had a previous deep vein thrombosis. However, Trump’s doctor said there was no evidence of deep vein thrombosis in his case.

Who gets it?

The data on how many people get chronic venous insufficiency vary, but it is relatively common. In the United States, an estimated 10% to 35% of adults have the condition.

A number of factors increase a person’s likelihood of developing chronic venous insufficiency. Smoking and having previously had a deep vein thrombosis are strongly linked to this condition. Other risk factors include older age, pregnancy, obesity, and prolonged periods of standing still.

Is it dangerous?

On its own, chronic venous insufficiency is not life-threatening, but it is a progressive condition. It increases the risk of other conditions which can be more serious.

Interestingly, while deep vein thrombosis increases the risk of chronic venous insufficiency, people with chronic venous insufficiency also have a higher risk of deep vein thrombosis. This is because pooled blood doesn’t move as much, so it can start to form a clot.

Deep vein thrombosis then increases the risk of pulmonary embolism, blood clots in the lungs, which are life threatening.

In the legs, the most serious consequence of chronic venous insufficiency is developing a venous ulcer. Venous ulcers can be painful, are prone to infection (such as cellulitis), and have a high rate of recurring.

Research has shown 4% of adults aged 65 and older in the US develop venous ulcers as a result of chronic venous insufficiency.

Can it be treated?

Whether and how chronic venous insufficiency can be treated depends somewhat on the cause.

Initial conservative treatment usually involves elevating the legs and wearing compression stockings. Elevating the legs higher than the body means gravity will help blood flow back to the heart. Compression stockings help to push blood from the leg veins towards the heart.

Exercise such as walking also helps because when the muscles in the legs contract, this moves more blood from the legs back to the heart. Exercise and diet changes may also be recommended to address any weight-related issues.

In more progressive or severe cases, surgery may be needed to fix the inside of the veins, remove any underlying deep vein thrombosis, or insert a stent in the case of a vein compression.

Overall, Trump has been diagnosed with a common condition for someone of his age, and his doctors have ruled out severe underlying disease. But this is a reminder of the importance of healthy veins and of the risk factors for venous disease.