Trump Diagnosed With Vein Disorder. A Doctor Explains

Forbes

7 days ago

From left: First lady Melania Trump, President Donald Trump, FIFA President Gianni Infantino and his ... More wife Leena Al Ashqar watch the second half of the Club World Cup final soccer match between Chelsea and PSG in East Rutherford, N.J., Sunday, July 13, 2025. (AP Photo/Pamela Smith)
President Trump was just diagnosed with venous insufficiency. He had noticed swelling in his legs, prompting an examination by his physician, Sean Barbabella. The doctor reported that Trump was otherwise well, with no serious cardiovascular problems or blood clots. Recurrent bruising of his hand was dismissed as simply due to handshaking.
Chronic venous insufficiency means that the veins that carry blood back to the heart aren't working well. One-way valves in the legs may become damaged with age, causing blood to pool in the legs and leading to visible swelling. CVI becomes more common as people get older and, according to the Cleveland Clinic, affects one in twenty adults.
Early on, people may have no symptoms or only a mild feeling of heaviness. The swelling may go down fairly readily if the legs are elevated. As the condition worsens, the legs may become more visibly discolored, with the development of 'spider veins,' or varicose veins. When the pressure in the legs increases further, tiny capillary vessels can rupture and leak fluid, resulting in a more woody texture and brown discoloration. At this stage, poorly healing ulcers can develop from minor abrasions. This is when an infectious disease physician, like myself, might get involved, as these ulcers can take months to heal. If the infection spreads further into the tissue, it is called cellulitis, and it can become life-threatening, especially with the rise in antibiotic-resistant bacteria.
Who Is At Risk For Venous Insufficiency
The risk rises with age. Having a prior blood clot, which causes tissue damage and swelling, is the other major risk, as is obesity. These are also risk factors for other cardiovascular disease, so your doctor should check that your peripheral arteries aren't blocked and that you don't have heart disease. Physical examination and ultrasound can detect peripheral vascular disease (blood vessel disease in your extremities).
Prevention
Try to keep your legs from swelling if possible, by not sitting or standing all day. If you have a job that prevents that, then it's good to wear compression stockings. Some you can buy over the counter; others require a prescription and are custom fitted to you.
Obesity, smoking, wearing tight, restrictive clothes around your torso, and lack of exercise are the other risk factors you have some control over.
Swollen, edematous legs are more susceptible to infection. It's essential to pay attention to and care for your feet. Athlete's foot, in particular, is often overlooked by patients and physicians, but can lead to terrible cellulitis.
Treatment
Reducing swelling is critical in preventing ulceration and worsening disease. The first step is to elevate your legs at least several times a day, and as much as possible when not working.
Gentle leg exercises and walking can help pump blood back to your heart. Improving blood return is especially important if you are sitting for a long time, as on a plane. Exercise your legs, even while seated, by frequently flexing and extending your legs and feet.
Compression stockings should be put on before getting out of bed in the morning and worn all day.
If symptoms worsen, pneumatic compression stockings might be prescribed to mechanically pump fluid out of your legs. These are expensive and not available to many. At Mahidol Hospital in Bangkok, Thailand, I observed patients using a 'twisting tourniquet' technique, which involves repetitively wrapping Ace wraps and around a broomstick to tighten the wrap, then releasing it. It was remarkably effective, but required very motivated patients who actively participated in their care.
If ulcers develop, the first step is often an Unna boot, a compression stocking impregnated with a zinc oxide gel.
Further progression to cellulitis likely involves treatment with oral or intravenous antibiotics.
Hand Bruises
WASHINGTON, DC - FEBRUARY 24: Makeup covers a bruise on the back of U.S. President Donald Trump's ... More hand as he hosts French President Emmanuel Macron for meetings at the White House on February 24, 2025 in Washington, DC. Macron is meeting with Trump in Washington on the third anniversary of Russia's full-scale military invasion of Ukraine. (Photo by)
Trump was seen again this week with a large bruise on his hand. Similar bruises were noted in December, February, April, and June. Bruising like this is not related to venous insufficiency.
A memo from Barbabella said, "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.' He concluded that the President 'is in excellent health.'
These explanations are highly unlikely. Normal handshaking does not typically cause bruising. It is doubtful that it would happen to him repeatedly. Trump is a self-described germaphobe, reluctant to engage in handshakes, though they are a political necessity. Trump has long been known for his aggressive handshakes, viewed 'as a struggle for dominance.' On one occasion, for example, he left French President Emmanuel Macron's knuckles white.
In photos, Trump's bruises look like those caused by intravenous catheters. Other possibilities include actinic purpura from excessive sun exposure or a vasculitis. His bruises look different than those latter two possibilities typically do.
Barbabella's memo is odd, stating that aspirin is 'standard cardiovascular prevention regimen.' That's not quite accurate. Daily aspirin is recommended for secondary prevention—that is, for someone who has known heart disease, to prevent a heart attack or stroke. If you don't have known disease, the benefits of aspirin is debated. Aspirin use carries significant risks. For example, aspirin use increases overall GI bleeding risk by 60%.
In fact, 'the United States Preventive Services Task Force recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults 60 years or older.' This position against aspirin is also 'consistent with the most recent guidelines from the American College of Cardiology and American Heart Association, and the European Society of Cardiology.'
Why is Trump on aspirin?
Implications
It's unclear if the White House is minimizing problems with the President's health. The venous insufficiency is unsurprising given Trump's age, obesity, and sedentary lifestyle. If he stumbles again, as he did in June, and were to hit his head, he risks a brain bleed, which could leave him with serious neurologic deficits.
If he takes care of himself, his venous insufficiency could be controlled with things like compression stockings. If he doesn't, then he could face a host of complications, some
of which could be serious enough to compromise his presidency.