18-07-2025
Donald Trump has chronic venous insufficiency - what is it?
As Malaysia moves closer to becoming an aged nation by 2030, many adults over 60 are noticing leg discomfort, swelling and skin discolouration.
These changes are often brushed off as part of growing old, but they may actually signal a medical condition that deserves attention: chronic venous insufficiency (CVI).
'Many people think leg pain and swelling are just part of ageing, so they try to live with it,' says consultant general and vascular surgeon Dr Syaiful Azzam Sopandi.
'But when veins in the legs stop working properly, it can lead to more than just discomfort.
"If left untreated, the complications can be serious.'
Damage to the veins
CVI happens when the valves in the leg veins weaken or become damaged.
These valves are meant to ensure that blood flows upward to the heart.
As we grow older, the structure of our veins changes.
The valve flaps that once closed firmly may now leak.
The vein walls, once elastic, become stiff.
'Think of your veins as rubber tubes with one-way doors,' explains Dr Syaiful.
'As we age, the doors don't shut completely and the tube walls stretch."
The calf muscles, which help pump blood back up to the heart, may also lose strength due to reduced physical activity.
'Older adults may not walk as much or stay as active as they used to,' he says.
'That loss of movement slows down blood circulation and makes venous disease more likely."
This combination of factors contributes to slower blood flow, leading to blood pooling in the lower limbs and increasing pressure within the veins.
As the condition progresses, venous pressure continues to build up – a condition known as venous hypertension.
Initially, this causes the veins to leak fluid into the surrounding tissues, leading to swelling under the skin.
In more advanced stages, the veins begin to leak red and white blood cells.
When red cells break down, they release iron, which gets trapped in the tissue and causes a dark staining effect on the skin.
'This is why some patients notice a brownish discolouration on their lower legs,' Dr Syaiful shares.
'It is not just a skin issue, but a sign of ongoing inflammation inside the tissue.'
Over time, this inflammation weakens the skin, making it more fragile and prone to ulcers, which are slow to heal, especially in older adults.
Common, yet overlooked
Despite its seriousness, CVI is often underdiagnosed in older adults. Varicose veins are one of the common early warning signs of CVI. — Dr TAN KIA LEAN
Globally, chronic venous disease affects an estimated 20% to 40% of the adult population, with its occurence increasing significantly with age.
In Malaysia, a 2021 study under the Vein Consult Programme Malaysia found that more than 30% of Malaysians over the age of 50 show signs of chronic venous disease.
'Among those aged 60 and above, the numbers are likely even higher, possibly up to 40% or 50%,' Dr Syaiful says.
'This is especially true for people with risk factors like obesity, a history of prolonged standing, previous deep vein thrombosis or a sedentary lifestyle.'
He adds that as Malaysia's elderly population continues to grow, vein-related problems will become more common and should not be overlooked as just a part of ageing.
Some patients delay care due to fear of hospitals or believing nothing can be done.
Others face language barriers, limited mobility or financial concerns.
In some cases, reduced sensitivity in the legs can cause patients to overlook pain altogether.
He recalls the case of a 60-year-old woman who had been living with a chronic leg ulcer for six months.
She had been dressing the wound at home with the help of her family, unaware that the root cause was a treatable vein condition.
An ultrasound assessment showed that she had bilateral CVI with significant venous reflux and damaged skin.
Following a minimally-invasive laser treatment, the ulcer healed completely within a month.
Types of treatment
The warning signs of CVI can appear gradually.
Leg pain that worsens with standing or walking, swelling around the ankles and visible varicose veins are among the most common early indicators.
Skin around the lower leg may become darker or feel tight and itchy.
In more advanced cases, ulcers may form, usually near the inner ankle.
'These are more than skin deep,' says Dr Syaiful.
'If you notice them, especially after 50, you should speak to a doctor.
"Early treatment can make a huge difference.'
When a patient presents with leg swelling, pain or skin changes, the first step is a quick and painless ultrasound scan.
'It is a safe, non-invasive way for us to assess blood flow and valve function in real time,' he explains.
'It gives us a clear picture of what is going on.'
Once diagnosed, there are a range of minimally-invasive treatments that are suitable even for older patients.
The most common approach is endovenous ablation therapy, which has two main forms.
Thermal ablation uses heat, through either laser or radiofrequency energy, to seal off the diseased vein.
Non-thermal methods include medical-grade glue, mechanical ablation and sclerotherapy, which involves injecting a chemical solution into the vein.
These procedures are typically performed under local anaesthesia.
Recovery is fast and minimally disruptive to daily routines.
'Most patients can walk in and walk out the same day and return to their normal routine shortly after,' Dr Syaiful says.
Debunking common myths
Despite advancements in treatment, myths and misinformation continue to delay care.
One of the most persistent beliefs is that varicose veins are purely cosmetic.
In reality, they may signal an underlying disease.
Another common myth is that older adults are too frail for surgery or that vein removal will disrupt blood flow.
'Age is not a barrier,' says Dr Syaiful.
'We tailor our treatments to suit the patient's condition and needs.
"And no, removing or sealing a diseased vein won't harm your circulation, other veins will take over.'
He also warns against relying solely on compression stockings.
While helpful in managing symptoms, they do not address the root cause.
And without proper treatment, CVI tends to worsen over time.
'Vein disease is progressive,' he says.
'The earlier we catch it, the easier it is to manage.'
Left untreated, CVI can result in open ulcers that take months to heal, frequent infections, and in severe cases, deep vein thrombosis, or even limb amputation.
This condition may also lead to cellulitis, a painful bacterial skin infection that can require hospitalisation.
'Delaying treatment is like ignoring a leak in your roof,' says Dr Syaiful.
'It might seem small initially, but eventually the damage becomes extensive and costly to fix.'
Additional self-care tips
While medical treatment is necessary for more advanced cases, adopting good daily habits can help maintain healthy veins and manage early symptoms.
Dr Syaiful recommends regular walking to strengthen the calf muscles, elevating the legs a few times a day to reduce swelling, and avoiding long periods of sitting or standing.
Wearing compression stockings in the morning, maintaining a healthy weight, eating a fibre-rich diet, and avoiding tight clothing that restricts circulation can also make a difference.
Daily leg care is also important.
Moisturising the skin, especially around the ankles, helps prevent cracks, while regular self-checks can catch early signs of swelling, wounds or discolouration.
'Smoking damages blood vessels and worsens circulation,' he notes, 'so quitting is one of the best things you can do for your vascular health.'
