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.

Aortic Dissection Awareness Day: Recognising a Vascular Emergency

Aortic dissection is a medical emergency in which blood enters a tear in the inner lining of the aorta and separates layers of its wall. Because the aorta supplies blood to the whole body, the consequences can develop quickly and involve more than the chest.

In this Aortic Dissection Awareness Day talk, published on 19 September 2024, I explain why recognising the possibility matters. I am Dr Andrew Choong, a vascular surgeon in Singapore. My message is to think about the aorta when symptoms and circumstances suggest a serious aortic problem, so that appropriate assessment is not delayed.

What happens during an aortic dissection?

The aorta is the main artery leaving the heart. It travels through the chest and abdomen, with branches supplying the brain, arms, abdominal organs and legs. Its wall is made of layers.

When blood tracks between those layers, it can disrupt blood flow to important branches. A dissection can also be associated with rupture or other life-threatening complications. The location and extent determine which organs are at risk and what treatment is needed.

A dissection is different from an aneurysm. An aneurysm is an abnormal enlargement of an artery; dissection refers to separation within the wall. Both fall within aortic disease, but they are not interchangeable terms.

Which symptoms should raise concern?

Sudden, severe chest or back pain is an important warning pattern, especially when the pain is at its worst from the beginning. Some people describe tearing pain, but that description is not essential. Abdominal pain or other symptoms may occur.

Depending on the branches involved, there may also be fainting, stroke-like symptoms, severe breathlessness or a painful, cold or weak limb. In the talk, I describe aortic dissection as a condition that can mimic other emergencies.

If sudden severe symptoms occur, call 995 in Singapore for emergency assessment. Do not wait for a clinic appointment or try to decide from an online checklist whether the pain is definitely a dissection. Other causes of sudden severe pain may also require urgent care.

How do doctors diagnose aortic dissection?

The emergency team considers the symptoms, examination and medical history, including known aortic disease or relevant inherited conditions. High blood pressure is an important risk factor, although its presence alone does not diagnose a dissection.

CT angiography is commonly used when acute aortic disease is suspected because it can show the aorta and its branches quickly and in detail. In particular circumstances, other imaging such as transoesophageal echocardiography or MRI may be appropriate.

The “think aorta” message is a prompt for timely clinical judgement and suitable imaging. It does not mean that every episode of back pain needs a CT scan. The choice of test depends on the level of concern and the patient’s condition.

How is an aortic dissection treated?

Treatment depends on which part of the aorta is involved and whether complications are present. A dissection involving the ascending aorta, called type A, generally requires urgent surgical assessment and repair.

A type B dissection does not involve the ascending aorta. If it is uncomplicated, treatment often begins with careful medical management, including control of blood pressure and heart rate, followed by surveillance. Complications such as threatened organ blood flow or rupture may require intervention.

For selected patients, an endovascular stent graft can be placed through the blood vessels to cover the entry tear and redirect blood flow. Other situations require open surgery. The safest approach is determined by the anatomy, urgency and specialist assessment.

Separate guides explain TEVAR for selected type B dissection and open, hybrid and endovascular aortic arch repair.

Why is follow-up important after treatment?

Recovery from the immediate event is one stage of care. The remaining aorta may still require imaging, blood-pressure management and specialist review. Follow-up helps the team identify changes and plan further treatment when necessary.

For non-emergency questions about known aortic disease or follow-up, you can explore my aortic awareness information and contact Andrew Choong Vascular Surgery. A family history of aortic disease may also warrant a discussion about appropriate assessment.

Current clinic location: Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Acute warning symptoms belong in an emergency service, where assessment and treatment can begin immediately.