By Kym McNicholas, Emmy Award-winning Journalist and CEO of the Global PAD Association
When news broke about former President Donald Trump’s diagnosis of chronic venous insufficiency (CVI), I watched as Americans collectively asked: “What is that?” As someone who’s spent years advocating for better awareness of vascular diseases, I wasn’t surprised. Despite affecting one in four adults during their lifetime, CVI remains virtually invisible in medical education and public health discussions.
Let me be absolutely clear from the start: This isn’t about politics. I don’t care whether you love or hate Trump. I have no political affiliation—only advocacy in mind. High-profile medical cases like this create rare opportunities to spotlight overlooked conditions that affect millions of Americans regardless of their political beliefs. Vascular disease doesn’t discriminate based on party lines, and neither should our conversations about health.
This case creates a perfect opportunity to help you understand a condition that might be causing those heavy, tired legs you’ve been dismissing as “just getting older.” In a recent interview for our “What’s Up Doc” series with the Global PAD Association, I spoke with Dr. Deepak Sudheendra of 360 Vascular in Ohio, a leading expert on venous and arterial disease. What he revealed about CVI diagnosis, treatment, and its relationship to other vascular conditions could be life-changing for millions suffering in silence.
The Hidden Condition Affecting One in Four Adults
“One in four adults will develop CVI in their lifetime,” Dr. Sudheendra explained during our conversation. “But when you add in risk factors like being overweight, having multiple pregnancies, or working in occupations where you’re sitting or standing all day—which is most of us—and include genetics, then it could be up to 90% of the population depending on the demographic you’re studying.”
Those numbers shocked me. We’re talking about potentially billions of people worldwide with a condition that significantly impacts quality of life but receives minimal attention in healthcare systems. A 2018 international study published in International Angiology found that among over 91,000 people across 20 countries, 60% of women and 50% of men reported symptoms of chronic venous disease.
Beyond Varicose Veins: The Symptoms You Shouldn’t Ignore
Unlike peripheral artery disease (PAD), which we discuss frequently at the Global PAD Association, CVI symptoms are often dismissed as normal aging or simply cosmetic concerns. But Dr. Sudheendra emphasized that varicose veins are just one sign of CVI.
“You could have hip pain, groin pain, heaviness and fatigue in your leg, throbbing pain in your legs, cramps at night, Charlie horses, restless legs—extremely common,” he explained. “Most people diagnosed with restless leg syndrome actually get sent to the neurologist for treatment because it’s thought to be due to a dopamine deficiency. We don’t have billions of people with a dopamine deficiency problem. It’s actually a vein problem.”
Other symptoms include ankle swelling, calf tightness, itching of the skin in your legs, skin discoloration, pins and needles, and in advanced cases, ulcers. If you’re experiencing any of these symptoms, particularly if they worsen after long periods of sitting or standing, CVI might be the culprit.
Why Your Doctor Might Miss This Diagnosis
What truly stunned me during my conversation with Dr. Sudheendra was learning that most doctors receive virtually no training on CVI. “It is not discussed or even taught in medical school or training programs,” he revealed. “When I have medical students rotate with me, I ask them questions about chronic venous insufficiency. Nine times out of ten, nobody can answer any questions other than, ‘Oh, I have seen varicose veins.’”
This education gap means you often need to be your own advocate. Even if your doctor orders an ultrasound, it might not be the right kind. “If you’re doing a proper venous ultrasound, it will be about a 45-minute to one-hour exam,” Dr. Sudheendra noted. “It is first done laying down because we look for clots first. And then we stand the patient up. The vast majority of places will do it lying down, and then you don’t get the information you need.”
If you’re experiencing symptoms, specifically ask for a “standing venous reflux ultrasound”—not just a DVT study, which only checks for blood clots and won’t detect CVI.
The Connection Between Vein and Artery Disease You Need to Know
One critical insight from my discussion with Dr. Sudheendra particularly relevant to older adults: if you have CVI, you should consider getting checked for peripheral artery disease (PAD) as well, especially if you’re over 60.
“One in five people over the age of 60 has PAD,” I noted during our conversation. “If he [President Trump] has CVI and he’s over 80, he should be checked for PAD as well. It’s likely he has poor circulation in his legs and the arteries as well.”
Dr. Sudheendra calls this combination “VAM disease”—Venous and Arterial Mix disease. The relationship between these conditions is complex. While PAD (artery disease) doesn’t cause swelling, CVI (vein disease) does. If your legs are swollen and you have other risk factors like diabetes, smoking, or high blood pressure, you might have both conditions requiring different approaches.
“When a patient complains of pain, you can have claudication pain [from PAD], but you could also have pain from venous insufficiency,” Dr. Sudheendra explained. “How do you separate that out? There’s no way to quantify that.”
The critical distinction: PAD often indicates wider cardiovascular issues that could affect your heart, while CVI may be more isolated to the legs. However, having PAD increases the likelihood of having CVI, while the reverse isn’t necessarily true. This is why comprehensive vascular evaluation is so important.
Treatment Options: From Simple Solutions to Advanced Procedures
The good news? Treatment often starts with simple, non-invasive approaches. Dr. Sudheendra recommends compression stockings for almost everyone—not just those diagnosed with CVI.
“I think everybody on Earth should be wearing stockings,” he emphasized. “I have been wearing stockings for 25 years. Because none of us can escape gravity, and that plays a big role.”
He recommends medical-grade stockings (20-30 mmHg compression) even for young, healthy individuals as prevention. For those already experiencing symptoms, additional treatments include:
- Weight loss, which reduces downward pressure on veins
- Regular exercise to activate calf muscles that help pump blood upward
- Leg elevation above heart level
- Flavonoid supplements like Vasculera (which worked remarkably well for my own father)
- Minimally invasive procedures like vein ablation or venous seal for advanced cases
For severe cases, procedures like vein ablation (using heat to close problematic veins) or venous seal (using medical adhesive) have largely replaced the older vein stripping surgeries of the past. “Vein ablation has about a 98% success rate,” Dr. Sudheendra noted.
Why Proper Diagnosis Matters: The Progressive Nature of CVI
What makes CVI particularly concerning is its progressive nature. Dr. Sudheendra outlined six stages of vein disease, from purple spider veins to debilitating ulcers.
“It can take maybe 40 years to go from stage one to stage six,” he explained. “But what amazes me is in 40 years, not one physician addressed venous disease. How do you go from stage one to stage six over 40 years and no one says anything?”
This progression isn’t inevitable. Early intervention can slow or halt the disease’s advancement. A 2018 review in the Journal of Vascular Surgery found that proper compression therapy alone reduced the recurrence of venous ulcers by 50%.
A Call to Action: Don’t Wait Until Symptoms Worsen
President Trump’s diagnosis provides a crucial reminder: vascular health affects everyone, regardless of status, position, or political affiliation. As Dr. Sudheendra emphasized when discussing how the media has portrayed the President’s condition: “To me, that’s exactly the sort of attitude that leads to all of this being ignored… Yes, in the whole broad scheme of things, venous disease is not something that is going to affect your longevity. It is not going to kill you, but it really affects your quality of life depending on what stage you’re in.”
If you’re experiencing any symptoms of CVI—from simple varicose veins to leg heaviness, swelling, or skin changes—don’t wait for your doctor to connect the dots. Ask specifically about CVI and request a standing venous reflux ultrasound.
For additional information or help finding a vascular specialist in your area, call the Global PAD Association’s Vascular Health Hotline at 1-833-PAD-HELP (1-833-723-4357). Our specialists can help you understand your symptoms, connect you with appropriate testing facilities, and provide resources for both venous and arterial vascular conditions.
Remember: your vascular health isn’t just about longevity—it’s about quality of life. Don’t let CVI symptoms become your new normal when treatments are available.
The Bottom Line: Knowledge Is Power
President Trump’s CVI diagnosis has opened a rare window to discuss a condition affecting millions of Americans across all walks of life. I’ve spent my career fighting to raise awareness about vascular diseases, not political battles. This isn’t about who’s in the White House—it’s about who’s sitting in your house right now, perhaps with legs that ache after a long day, wondering if that’s just part of getting older.
The combination of high prevalence, low awareness, and diagnostic challenges means many people live with progressive symptoms that could be managed effectively. “For a condition that affects literally billions and billions of people around the world,” Dr. Sudheendra remarked, “it’s still amazing to me that it’s just not taught.”
This education gap extends beyond medical schools to patients themselves. By understanding CVI’s symptoms, diagnosis challenges, and treatment options, you’re equipped to advocate for your vascular health and potentially avoid years of unnecessary discomfort or complications—regardless of which side of the political aisle you sit on.
If you have questions about CVI or PAD and want to talk about symptoms you can call the Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS.
References:
Rabe, E., et al. (2018). “Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program.” International Angiology, 37(1), 32-42.
- Eberhardt, R. T., & Raffetto, J. D. (2014). “Chronic venous insufficiency.” Circulation, 130(4), 333-346.
- O’Donnell, T. F., et al. (2018). “Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum.” Journal of Vascular Surgery, 60(2), 3S-59S.
- Davies, A. H. (2019). “The Seriousness of Chronic Venous Disease: A Review of Real-World Evidence.” Advances in Therapy, 36(1), 5-12.
- Gloviczki, P., et al. (2011). “The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum.” Journal of Vascular Surgery, 53(5), 2S-48S.
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