Trump keze zúzódása megújítja a figyelmet egészségére

President Trump’s bruised hand and his apparent use of makeup to cover the discolored patch of skin have renewed attention to his health in general and his cardiovascular health in particular. His case also highlights an often underrecognized and undertreated condition.

It’s called chronic venous insufficiency, or CVI for short, and by some estimates approximately 2.5 million people in the United States may live with its signature symptom of swollen legs, whether they’ve received a diagnosis or not. Bruised hands are another matter, experts told STAT.

People don’t necessarily know that they have CVI, thinking their leg swelling at the end of a day spent on their feet is normal. While that can be true, pooling of blood in the legs can also be caused by CVI, in which the blood doesn’t return to the heart as efficiently as it would if valves in the veins were working properly.

“It’s a common problem, and the vast majority of patients can be treated successfully with very low-tech treatments,” Gregory Magee, chief of vascular and endovascular surgery for NYU Langone Health, told STAT, commenting in general, not on the president’s case and not specifically about the president’s bruised hand. 

Peter Henke, immediate past chair of the American Heart Association’s Council on Peripheral Vascular Disease, did say bruising on the president’s hand is highly unlikely to be directly related.      

“Hand bruising has nothing to do with venous insufficiency in the legs,” he told STAT. “I don’t know his personal medical record, obviously, but if he is on aspirin, that can certainly lead to easy bruising.”

In fact, in July when the White House disclosed the had been diagnosed with CVI, it included a letter from his physician that mentioned minor bruising on the back of his hand, calling it consistent with frequent handshaking and “the use of aspirin, which is taken as part of a standard cardiovascular prevention program.” 

Aspirin, of course, isn’t the only possible cause of such bruises. Sometimes, it’s just age. After people reach 65 or 70, the skin gets a bit thinner so that a bump that wouldn’t bother a 30-year-old might lead to some bruising in a 70-year-old. Trump is 79.

What is CVI? 

CVI develops when oxygenated blood circulates through the body from arteries to capillaries to veins, but stalls on its return trip to the heart. Ordinarily, when muscles contract and squeeze the veins, valves in the veins prevent the blood from pooling in the legs, and thus send blood back to the heart. But in CVI, the valves do not function properly. The blood then travels two ways in a state of reflux: up to the heart but also back into the legs.

Low-tech treatment in the form of compression stockings can help people overcome the problem, defying gravity by exerting extra pressure to push blood up toward the heart. Although it’s uncommon, in the minority of patients who have painful varicose veins, severe swelling, or bleeding issues from veins that burst, medical procedures can remove the veins from circulation. Magee called them minimally invasive techniques, “like drawing blood.”

CVI is often found in people who have cardiovascular risk factors, including older age, obesity, smoking, a sedentary lifestyle, and another cardiovascular disease, the American Heart Association says. Many cases are genetically caused. It’s more common in older adults, Henke said, meaning it’s likely many Americans over 50 have CVI, usually to a minor degree. 

Treatments typically help manage symptoms, with compression stockings being the mainstay. Exercise helps blood in the legs flow better, and losing weight can take strain off the legs, too. 

CVI doesn’t lead to the much more serious deep vein thrombosis, but CVI can develop in the aftermath of deep vein thrombosis, in which a blood clot formed in the legs travels to the lung, where it can be fatal if not stopped. Henke strongly urges patients who feel sudden leg pain to seek medical testing, including an ultrasound, which could reveal a medical emergency. That’s unlike CVI’s much milder signs; the more serious deep vein thrombosis is more likely to strike people in the 40s or 50s, not 60s or 70s.

In July, the White House physician described Trump’s CVI as a “benign and common condition.” He noted diagnostic vascular studies and lab testing also ruled out renal failure and systemic illnesses.

If people don’t know they have CVI, what are some clues?

Symptoms beyond leg swelling are varicose veins or spider veins. Other signs include darker spots on the shin where iron-rich blood has pooled. 

Much more serious are wounds on the legs that don’t heal, forming ulcers in about 5% of people with CVI.

“People do lose their legs in the most severe forms if they have really bad ulcers that never heal, never get treated adequately,” Magee said. “That’s very rare, but wounds need to be treated rapidly to prevent them from getting worse.” 

In mild cases of CVI, it helps to keep the legs elevated when there is some leg swelling. Avoiding a high-salt diet helps, too, in order to prevent fluid retention that leads to swelling in the legs.

“If you know you have venous insufficiency — or your parents do — wearing compression socks during the day can be helpful,” Magee said. “And we always tell patients with heart conditions to have a low-salt diet.” 

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.