Chronic Venous Insufficiency Explained

Dr Choong: Hi, my name's Dr Andrew and I'm a vascular surgeon based in Singapore. Earlier this year, on the 18th of July 2025, White House press secretary Karoline Leavitt announced to the world that President Donald Trump had chronic venous insufficiency. I react to the press briefing, decode the medical jargon, and give my take on the diagnosis.

Press briefing: On another note, I know that many in the media have been speculating about bruising on the president's hand and also swelling in the president's legs. So, in the effort of transparency, the president wanted me to share a note from his physician with all of you today. In recent weeks, President Trump noted mild swelling in his lower legs.

Dr Choong: There are a huge number of different causes of leg swelling, some serious, some not so serious. Let's listen and see what the White House medical unit did to investigate President Trump's lower limb swelling.

Press briefing: In keeping with routine medical care and out of an abundance of caution, this concern was thoroughly evaluated by the White House medical unit. The president underwent a comprehensive examination, including diagnostic vascular studies.

Dr Choong: Diagnostic vascular studies are normally non-invasive ultrasound scans. They serve two purposes. They look at the structure and the anatomy of the blood vessels, but they can also look at the blood flow as well.

Press briefing: Bilateral lower extremity venous Doppler ultrasounds were performed.

Dr Choong: Bilateral lower extremity venous Doppler ultrasound is a bit of a mouthful, but what it's really referring to is doing diagnostic vascular scans of both of his legs, specifically looking at the venous system, the system that returns blood to the heart from his legs. And this is an ultrasound scan which, as I said, looks at structure, looks at anatomy and looks at blood flow.

Press briefing: … and revealed chronic venous insufficiency, a benign and common condition …

Dr Choong: So this is probably the first point of contention. The diagnosis of chronic venous insufficiency has been made, and I will talk about that later. It is an incredibly common condition, but to call it benign without context probably needs a little bit more explanation, and I hope to be able to offer that to you later on in this video.

Press briefing: … particularly in individuals over the age of 70. Importantly, there was no evidence of deep vein thrombosis or arterial disease.

Dr Choong: There's a few things to unpack here. Chronic venous insufficiency is indeed more common in those over 70. But what Karoline Leavitt also said was that President Trump did not have any deep vein thrombosis or arterial disease. Starting with the last one first, the body essentially has two circulation systems. It has the arterial system and it has the venous system. The arterial system comes direct from the heart. The heart is like a big pump, pumping the blood around the body. The venous system is a slightly more passive system which relies on movement in the legs to drive the blood back towards the heart. In the legs in particular, there are also a series of one-way valves that it relies upon.

Press briefing: Laboratory testing included a complete blood count, comprehensive metabolic panel, coagulation profile, D-dimer, B-type natriuretic peptide and cardiac biomarkers. All results were within normal limits. An echocardiogram was also performed and confirmed normal cardiac structure and function. No signs of heart failure, renal impairment or systemic illness were identified.

Dr Choong: Earlier on in the video, when I spoke about potentially serious and less serious causes of leg swelling: Karoline Leavitt here is detailing what the White House medical team has done to ensure that it is not a serious cause of leg swelling. So they've excluded heart failure as a potential issue. They've excluded renal failure, or kidney failure, as a potential issue. And they've also done a generic set of blood tests to further investigate President Trump's condition. However, two blood tests that Karoline Leavitt mentioned are not generic and are worthy of discussion.

D-dimer is a protein fragment that is found in the body and increases in level as blood clots are broken down. So, interestingly, if your D-dimer is normal or zero, then it is highly unlikely that you have a significant blood clot, either a deep vein thrombosis or a pulmonary embolism, in your body. However, if it is high, it doesn't necessarily mean that you have a significant blood clot, but obviously the risk is there, and I would suggest you need other modalities to investigate your condition further. One of the analogies that may work for you is the crumbs on the floor analogy. If you do find crumbs on the floor, then it is highly possible that there might have been a cake and somebody was eating it and spilled crumbs on the floor. If, however, you find no crumbs on the floor, then the likelihood of somebody walking around eating a cake is low. Look, it's a bit tenuous, I get it. But it's probably one of the better ways that I've heard of describing the value of D-dimer in these situations.

The other blood test that Karoline Leavitt mentioned is B-type natriuretic peptide. This is a hormone that's released by the heart, and essentially it rises in response to heart damage. It is an indicator of heart failure and is best thought of as a bit of a distress signal. The higher the BNP, the higher the potential for heart failure. It's important to note that President Trump had a normal D-dimer and a normal BNP. So he does not have a serious blood clot and he does not have heart failure. But it's interesting because both of these investigations were mentioned, and they're worth discussing.

Press briefing: Additionally, recent photos of the president have shown minor bruising on the back of his hand. This is consistent with minor soft tissue irritation from frequent handshaking and the use of aspirin, which is taken as part of a standard cardiovascular prevention regimen. This is a well-known and benign side effect of aspirin therapy, and the president remains in excellent health.

Dr Choong: Aspirin works by making your blood a little bit less sticky. It affects one of the components of blood called platelets. And so, as a result, people who take long-term antiplatelet agents (aspirin is one, clopidogrel is another common one […]) are slightly more prone to bruises. As for whether this is caused by repeated handshaking, that's not for me to say, but if you are on aspirin or you are on clopidogrel or an antiplatelet agent, then yes, you are definitely more prone to bruising.

So, back to the topic of chronic venous insufficiency. As I said earlier, there are two main systems of circulation in the body: the arterial system, which takes pumped blood from the heart around the body, and then the venous system, which returns blood to the heart. Now, when the venous system is affected, it is insufficient, and if it happens over a long time, then it is chronic. And that's really all chronic venous insufficiency is: it is the venous system not working as well as it normally does.

Now, this can present with minor lower limb swelling. It can present as varicose veins. But, and this is the point I was trying to make earlier, it can also present as really severe non-healing ulcers and discolouration of the leg, particularly around the ankle bone on the inside of the leg. That's why I said there should be a caveat when they said that chronic venous insufficiency is benign. Most of the time, sure, it is. But it is a spectrum of disease, and venous disease can be serious and can be associated with significant morbidity.

So if you're concerned, go and find your local vascular specialist, your local vascular surgeon. Go and have your own diagnostic vascular studies. In our clinic, that would be a bilateral lower limb venous reflux scan. That would be a duplex scan, which is Doppler and ultrasound, so we look at the blood flow and we look at the structure and the anatomy of the veins in your leg. I really hope you enjoyed this. Please leave comments below. Tell me if you have any questions and I'll do my best to answer them. Tell me if there are any other topics that you might want me to cover. And like, subscribe, and I'll see you on the next one. Thanks very much.