President Trump’s Chronic Venous Insufficiency: A Vascular Surgeon Explains

In a public memorandum dated 17 July 2025, the White House physician reported that President Donald Trump had been assessed for mild swelling in his lower legs. The statement said venous Doppler ultrasound showed chronic venous insufficiency, with no evidence of deep vein thrombosis or arterial disease.

That announcement brought a common circulation problem into the news. In my video, I explain the medical terms and what they can mean for patients. I am Dr Andrew Choong, a vascular surgeon in Singapore. The useful lesson is how leg veins work, why they sometimes struggle and how an assessment helps identify the cause of swelling.

What is chronic venous insufficiency?

Chronic venous insufficiency means the veins are not returning blood from the legs as effectively as they should. Normally, the calf muscles help push blood upwards, while valves in the veins help prevent it from flowing backwards.

When valves do not work properly, backward flow—called reflux—can allow blood to pool and raise pressure in the leg veins. Previous vein damage or obstruction may also contribute. The result can be swelling, heaviness, aching or changes in the skin.

Arteries and veins do different jobs. Arteries deliver blood to the legs; veins return it towards the heart. Venous insufficiency should therefore not be confused with a narrowing or blockage of the leg arteries.

Is chronic venous insufficiency always harmless?

It covers a range of severity. Some people have relatively mild symptoms. Others develop persistent swelling, skin irritation, pigmentation or a venous ulcer, often around the ankle.

That range is why the word “common” should not be taken to mean that every patient can ignore symptoms. The appropriate response depends on how the veins are functioning, the effect on daily life and whether skin damage is developing.

Varicose veins and venous disease are related, but visible veins do not tell the whole story. A leg can look different from another person’s leg and still require an individual assessment.

What does a venous duplex ultrasound show?

A duplex scan combines images of the veins with an assessment of blood flow. It can help identify backward flow through faulty valves and look for obstruction or clot, according to the clinical question being investigated.

In practice, the scan needs to be interpreted alongside symptoms and examination. Understanding where a problem begins helps determine whether advice, compression or a vein procedure is appropriate. Treatment should address the underlying findings, rather than rely only on what is visible at the skin’s surface.

Does leg swelling mean there is a blood clot?

No. Swelling has several possible causes, including venous insufficiency, but deep vein thrombosis is an important possibility when a leg becomes newly swollen or painful. A clinician assesses the pattern, timing and personal risk factors before choosing tests.

Blood tests such as D-dimer are not stand-alone answers for everyone. Their usefulness depends on the likelihood of a clot before testing and the rest of the assessment. A reported normal result should not be used to dismiss new symptoms in a different person.

New unexplained one-sided swelling needs prompt assessment. Sudden breathlessness, chest pain, fainting or collapse may signal a pulmonary embolism or another emergency; call 995 in Singapore for severe emergency symptoms.

How can chronic venous insufficiency be managed?

Management is tailored to the cause and severity. Movement, measures to reduce prolonged immobility, and appropriately selected compression may help some patients. Compression needs clinical consideration when there may also be arterial disease.

For suitable patients with superficial venous reflux, a procedure to treat the affected vein may be discussed. Options depend on the scan findings, symptoms and overall health. Skin changes or an ulcer also require a plan for local care and follow-up.

For a non-emergency discussion about swelling, varicose veins or venous symptoms, contact Andrew Choong Vascular Surgery. Current clinic location: Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563.