Lymphedema Compared with Chronic Venous Insufficiency
Right side, normal vein and valve.
Left side damaged valve and vein.
Chronic venous insufficiency (CVI) and lymphedema are similar in that both are swelling conditions of the feet and legs. Beyond that, the causes, symptoms and treatment can be different. Many older people develop a combination of CVI and lymphedema known as phlebo-lymphedema or phlebolymphedema.
Many factors other than CVI can cause chronic lower extremity edema and--in some cases—contribute to lymphedema. See [Farrow 2010] for more information.
Lower extremity swelling often develops gradually over time. Swelling, pain, and serious health risks can be reduced by early diagnosis, treatment, and self-care including careful skin care for the feet. Improved nutrition can help improve symptoms (see Nutrition for Lymphedema and Lipedema).
Infection is a serious risk in swollen areas and should be treated promptly to avoid having the infection spread into other body systems and cause life-threatening sepsis. Swelling makes infections very difficult to control because it interferes with the body’s normal infection fighting mechanisms.
Swollen feet and legs increase the risk of developing two types of infections:
- Tissue infections or cellulitis (see Cellulitis is Serious) that affects the skin without a visible wound or break in the skin should be treated as a medical emergency. Lower extremity cellulitis in areas with impaired circulation can be difficult to treat and may require intravenous antibiotics.
- Wounds or ulcers in affected areas that do not heal normally (chronic ulcers). Treatment by wound care specialists may be required to reduce swelling and promote healing.
- CVI is a serious circulatory disorder that usually becomes worse over time. This painful condition can result in disability and even death from uncontrolled infections.
- CVI is caused by damaged valves in the veins of the leg that are not able to close completely, allowing blood to flow backward (away from the heart). This results in diminished blood flow (venous stasis) and swelling, as excess fluid escapes into in the tissues of the legs and feet.
- CVI increases the tissue fluid in the affected areas resulting in abnormally high volumes of lymph protein-rich lymph. The lymphatic system may not be able to drain the extra fluid, resulting in lymphedema of the affected areas.
Obesity, high blood pressure, and diabetes increase the risk of developing CVI and phlebolymphedema.
Contrasting CVI and Lymphedema
Age or timing of onset:
- CVI occurs most frequently in older people. Incidence is approximately 6% to 7% of patients at 50 years of age, with an increase to >20% at age 70.
- Lymphedema due to defective lymphatics, known as primary lymphedema, may appear at any age. Some types of primary lymphedema become noticeable at birth, in childhood, adolescence, or middle-age.
- Acquired or secondary lymphedema caused by damage to the lymphatic system may appear soon after the damage or anytime later. Cancer treatment, other surgeries, or injuries are common causes of lower extremity lymphedema.
- Lipedema related foot and leg swelling occurs in the more advanced stages of this condition. See Lipedema.
- CVI related PAIN typically occurs during or after walking or standing and is relieved by elevating the legs.
- PAIN related to lymphedema may not be associated with walking or standing. Pain may be caused by swelling, joint issues, and increased limb weight.
- CVI swelling usually occurs in the ankles and lower legs and is generally similar in both legs. CVI swelling increases during the day and reduces overnight during sleep, although it will not go away completely.
- CVI frequently causes Inflammatory skin disease (stasis dermatitis) on the lower extremities of patients with CVI, followed by development of reddish-brown skin discoloration and hyperpigmentation (hemosiderin stains).
- Lymphedema swelling affects the entire limb and foot but is seldom symmetric. This swelling does not usually reduce during the night (except in very earliest stage).
- Lymphedema swelling is indicated by a positive Kaposi-Stemmer sign, however a negative sign does not rule out lymphedema. A positive Kaposi-Stemmer sign occurs when the skin on the dorsum of the second toe base cannot be pinched as a fold between the fingers.
CVI treatment (in the absence of lymphedema) may include:
- Compression stockings to improve blood flow in your legs, help prevent leg swelling and, to a lesser extent, blood clots.
- Skin care treatments including drugs or medicines.
- Wound care for skin sores that do not heal or recur cause of poor blood flow in the veins.
- Procedures to damage or remove leaky veins (sclerotherapy, phlebectomy, vein stripping, etc.).
Treatment for lymphedema and phlebolymphedema is complex decongestive therapy (CDT). See How Lymphedema is Treated. Use of diuretics solely for reduction of swelling in patients with lymphedema may be contraindicated because diuretics can speed up inflammatory processes that lead to irreversible skin and soft tissue changes and increased risk of cellulitis by increasing the concentration of proteins and macromolecules in the tissue fluid.
© LymphNotes.com 2014-2017 all rights reserved. This information does not replace the advice of a qualified health care professional.
Category: Lymphedema and Other Conditions Updated: 2017-08-14
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