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), many Americans had the same reaction: “What is that?” This widespread confusion is precisely why this high-profile case matters to healthcare entrepreneurs and investors. Trump’s diagnosis has inadvertently spotlighted a massively underserved market that affects billions worldwide yet remains virtually invisible in medical education and healthcare investment landscapes.
In a recent interview for our “What’s Up Doc” series, I spoke with Dr. Deepak Sudheendra of 360 Vascular in Ohio, a leading expert on venous and arterial disease. What he revealed about the gaps in CVI diagnosis, treatment, and reimbursement exposes not just a healthcare failure but a substantial market opportunity for innovative companies.
The $3B+ Market Hiding in Plain Sight
“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.”
This translates to potentially billions of people worldwide with a condition that significantly impacts quality of life but receives minimal attention in healthcare systems. The global compression therapy market alone is projected to reach $3.9 billion by 2026, growing at a CAGR of 5.2% from 2021, according to Markets and Markets research.
The Education Gap Creating Market Inefficiency
Unlike peripheral artery disease (PAD), which we discuss frequently at the Global PAD Association, CVI isn’t commonly taught in medical schools or residency programs. Dr. Sudheendra’s experience highlights this systemic failure: “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 creates a market inefficiency where patients often go undiagnosed or misdiagnosed for years. For entrepreneurs and investors, this represents a classic opportunity: a large, underserved population combined with a systemic failure to address their needs.
The Diagnostic Obstacle Course: A Technology Opportunity
Proper diagnosis of CVI requires a standing venous reflux ultrasound—a test many facilities don’t perform correctly. “If you’re doing a proper venous ultrasound, it will be about a 45-minute to one-hour exam,” Dr. Sudheendra noted. “The vast majority of places will do it lying down, and then you don’t get the information you need.”
Why don’t more facilities perform this test correctly? Dr. Sudheendra identified a key market failure: “When you order a standing reflux ultrasound, there is no separate code for it. It is the same code as a DVT study. Now, the DVT study takes 15 minutes. A reflux ultrasound takes about 70 minutes to do properly. And you get the same payment.”
This reimbursement disparity creates a disincentive for proper diagnosis—a problem ripe for disruption through technology that could make standing ultrasounds more efficient or through advocacy for updated reimbursement codes.
The $50B Chronic Disease Management Opportunity
What makes CVI particularly interesting from a business perspective is its chronic nature and progression. Dr. Sudheendra outlined six stages of vein disease, from purple spider veins to ulcers, noting: “It can take maybe 40 years to go from stage one to stage six. But what amazes me is in 40 years, not one physician addressed venous disease.”
This lengthy progression represents a massive opportunity in the chronic disease management space, which Grand View Research values at over $50 billion globally. Companies developing long-term monitoring solutions, patient engagement platforms, or even specialized wearable devices could capture significant value in this untapped market.
Prevention Economics: The Business Case for Early Intervention
The economics of CVI prevention are compelling. Compression stockings—which Dr. Sudheendra recommends for “everybody on Earth”—represent a simple, non-invasive intervention that could prevent or delay the need for more expensive procedures.
“In general, we don’t want to do unnecessary procedures on people,” he explained. “So if there are things that we can do to minimize our chances of having to get a procedure later on in our life, why not take it?”
This prevention-focused approach aligns perfectly with value-based care models gaining traction throughout healthcare. For businesses developing consumer health products or preventive care solutions, the CVI market offers substantial opportunity with relatively low regulatory barriers compared to more invasive interventions.
The Innovation Gap in Treatment Options
While current treatments for CVI include compression therapy, lifestyle modifications, and various minimally invasive procedures like vein ablation and venous seal, the field lacks the innovation we’ve seen in other specialties.
“Vein stripping surgery, which I have done—the last one I did, I think, was 2001 or 2002—is rarely done now,” Dr. Sudheendra noted. “What’s considered the gold standard is vein ablation or thermal ablation.”
However, these procedures still have limitations and side effects. The relative stagnation in treatment innovation points to opportunities for medical device companies and pharmaceutical developers to create next-generation solutions for this massive patient population.
The Business Imperative: Addressing CVI as a Workforce Health Issue
For business leaders, CVI’s impact on workforce productivity deserves attention. Dr. Sudheendra shared a telling anecdote about a cardiac surgeon colleague who considered early retirement due to leg pain from undiagnosed CVI: “He said, ‘I may have to retire from surgery in the next couple years. I thought I would make it to 65. I’m 57. I just cannot stand. My legs ache so bad.’”
This productivity impact multiplied across billions of potential sufferers represents a substantial economic burden—and an opportunity for workplace health programs and benefits innovations that specifically address vascular health.
The Path Forward for Entrepreneurs and Investors
President Trump’s diagnosis brings momentary attention to CVI, but creating lasting change—and capturing the associated market opportunity—requires sustained innovation and advocacy.
For entrepreneurs entering this space, several avenues appear particularly promising:
Diagnostic technology innovations that make standing venous reflux tests more efficient or create new diagnostic approaches
Reimbursement and healthcare policy advocacy to address the payment disparities that discourage proper diagnosis
Consumer-friendly compression therapy products that overcome the adoption barriers Dr. Sudheendra noted
Digital health platforms for long-term CVI monitoring and management
Workplace health programs specifically addressing vascular health
Next-generation minimally invasive treatments that improve upon current procedures
The Bottom Line: A Blue Ocean Opportunity
President Trump’s CVI diagnosis, while seemingly minor in the context of his overall health, illuminates a blue ocean opportunity in healthcare. The combination of high prevalence, low awareness, diagnostic challenges, and treatment gaps creates ideal conditions for disruptive innovation.
“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 healthcare investors and entrepreneurs. Those who recognize the scale of the CVI opportunity now have a chance to create significant value—both financially and in terms of improved quality of life for the countless people affected by this overlooked condition.
References:
Markets and Markets. (2021). “Compression Therapy Market by Technique, Product, Application - Global Forecast to 2026.”
Grand View Research. (2022). “Chronic Disease Management Market Size Report, 2022-2030.”
Eberhardt, R. T., & Raffetto, J. D. (2014). “Chronic venous insufficiency.” Circulation, 130(4), 333-346.
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.
American Venous Forum. (2020). “Guidelines for Management of Venous Disorders.”
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