Chronic venous insufficiency (CVI) isn’t a medical condition you normally hear much about. But it was in the news recently after President Trump was diagnosed with the condition.
In this Q&A, Prakash Krishnan, MD, FACC, System Director of Endovascular Services, at the Mount Sinai Health System, explains what causes this condition, which causes swelling and pain in the legs and primarily affects older adults. He says it is important for people with CVI to seek treatment to prevent possible complications.
“This condition may cause discomfort. However, with early initiation of conservative therapy with compression stockings, lifestyle modifications, and surveillance with a vascular physician, you can continue to lead an active lifestyle without limitations,” says Dr. Krishnan, who is also Professor of Medicine (Cardiology), and Radiology at the Icahn School of Medicine at Mount Sinai and Director of Endovascular Services and the Endovascular Intervention Fellowship at The Mount Sinai Hospital.
Prakash Krishnan, MD, FACC
What is chronic venous insufficiency, what causes it, and who is primarily affected?
Chronic venous insufficiency is a vascular condition in which the veins are unable to efficiently circulate blood back to the heart from the legs, causing blood to pool in the lower limbs. This is due to dilated or damaged valves that are in the veins found in the lower limbs. Common causes are aging, prolonged standing or sitting, obesity, pregnancy, or a history of blood clots. CVI primarily affects older adults and people with a family history of vein disorders.
Is CVI a serious health issue? What kind of symptoms or complications can it cause?
If left untreated, serious complications may arise. Patients usually have symptoms such as leg swelling, pain, heaviness, cramping, difficulty walking, varicose veins, and skin changes. Advanced untreated disease may cause painful wounds and skin ulcers that are difficult to heal. In severe cases, CVI increases the risk of infection and blood clots in the limbs, which is a potentially life-threatening condition. Early diagnosis and proper management are important to prevent the disease from progressing and to improve a patient’s quality of life.
Do you need to make lifestyle changes or take specific steps to manage the condition?
The primary goals of treatment for CVI focus on improving blood flow, relieving symptoms, and preventing complications. Initial treatments are less invasive, which includes wearing compression stockings to reduce swelling and support vein function, as well as elevating your legs regularly to help blood return to the heart. Lifestyle changes play a key role and may include maintaining a healthy weight, exercising regularly—especially walking—to boost circulation, and avoiding prolonged sitting or standing. In more advanced cases, minimally invasive procedures to treat the veins such as sclerotherapy, laser therapy, or ablations may be necessary. Consistent care and lifestyle adjustments can greatly improve symptoms and slow disease progression. For those who lead an active life that includes traveling and outdoor activities such as golf, compression stockings would be recommended as an initial step in treatment.
Does chronic venous insufficiency require ongoing monitoring?
Yes, CVI typically requires ongoing monitoring by physicians trained to manage and treat vascular disease. Consistent medical supervision ensures that the condition remains under control and that more serious complications, such as infections or deep vein thrombosis, are promptly addressed.