Chronic Venous Insufficiency and Lymphedema

Introduction

Functioning of the valves in veins. (Normal vein of the right side. A damaged valve on the left side))

Chronic venous insufficiency (CVI), and lymphedema are similar in that both conditions involve swelling of the feet and legs. Beyond that similarity, their causes, symptoms, and treatment are very different. Recognizing these differences is important in understanding how each of these conditions is treated.

Chronic Venous Insufficiency (CVI), which is more common in older individuals, is a condition in which the veins have problems sending blood from the legs back for the heart due to a combination of these conditions:

• Damage to the valves of the veins. These damaged valves do not close completely. This leaking of the valves allows blood to leak backward away from the heart. This results in swelling as fluid pools in the legs and feet.
• CVI diminishes the capacity of the venous system. This increases the workload for the lymphatic system in the affected area. To compensate for this excess fluid in the tissues, the lymphatic system must transport larger volumes of water and protein to reduce the fluid load in the affected tissues of the legs.
• This is a serious circulatory disorder that usually becomes worse over time. This painful condition can result in disability and even death.

Symptoms of CVI and Lymphedema Compared
CVI Symptoms	Lymphedema Symptoms
Pain, particularly after walking or standing, is a major characteristic of CVI.	Pain is associated with lymphedema but not after walking or standing.
In early stages of CVI, the swelling usually occurs in the ankles and lower legs. This increases during the day and is reduced naturally at night during sleep.	The swelling of lymphedema affects the entire limb and foot. This swelling does not reduce naturally at night.
As CVI becomes more severe, the swelling increases and it no longer resolves at night.	If lymphedema is not treated, the swelling of increases and the tissues become fibrotic (hardened).
The swelling of CVI is caused by protein-poor fluid. This fluid does not increase the risk of infection.	The swelling of lymphedema is caused by protein-rich fluid. This fluid increases the risk of infection if there is a break in the skin.
Skin changes occur as the CVI progresses. The skin covering the swollen tissues becomes thin and shiny. In the early stages the skin color changes to blue-purple (like bruising that doesn’t go away). As circulation in the area decreases, the skin color becomes white.	In the later stages of untreated lymphedema, skin and tissue changes occur; however, the skin color does not change. The tissue changes include fibrosis (hardening), greater swelling that cause deep folds. The skin within the folds cracks and fungal infections develop.
Chronic leg ulcers develop as the CVI progresses. These open sores are difficult to heal and may become infected.	Infections related to lymphedema, such as cellulitis, often have sudden onset. When folds are involved, open sores may also be present.
Increasingly serious leg ulcers in the later stages of CVI can become gangrenous and amputation may be required to save the patient's life.	Increasingly serious infections, including open wounds and skin cracks, may develop in untreated stage 3 lymphedema.

References:

[1] Living Well with Lymphedema by A. Ehrlich MA, A. Vinjé-Harrewijn PT, CLT-LANA, and E. McMahon PhD. Lymph Notes 2005, pages 90-91

[2] Lymphedema Diagnosis and Therapy 2nd ed, edited by Weissleder and Schuchhardt. Kagerer Kommunikation, 1997. Chapter 8 Chronic Venous-Lymphatic Insufficiency by Hartmann and Weissleder, pages 207-221.

[3] Lymphedema Management: The Comprehensive Guide for Pactitoners, 2 ed by J.E. Zuther, C.I., M.L.D., C.D.T., C.L.T. Thieme, 2009.

[4] Lymphoedema Methods of Treatment and Control: A guide for Patients and Therapists 5th ed by Földi and Földi. Reprinted by Medicina Biologica, 1991.

[5] Lymphedema Caregiver's Guide by M. K. Kearse, PT, CLT-LANA, E. McMahon PhD., and A. Ehrlich MA. Lymph Notes 20059 pages 25-27.

© LymphNotes.com 2009. This information does not replace the advice of a qualified health care professional.

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Category: Lymphedema and Other Conditions Updated: 2009-11-13