Phlebolymphedema
(Chronic Lymphovenous Insufficiency)

The blood circulatory and lymphatic systems in the human body maintain a delicate balance.  If the venous system is damaged, it usually affects the lymphatic vessel system.

It is not unusual for legs to be swollen in the evening. The volume of the lower leg can increase by up to 100ml after a long working day or up to 200ml after a long-haul flight without moving.

Edema that does not disappear spontaneously within a few hours or after a walk is categorized as pathological.  Bilateral and marked edema with few symptoms is mostly caused by systemic circulatory dysfunction (heart, kidneys, liver).  

Venous edema is virtually always associated with symptoms and/or clinical signs such as dilated superficial veins, varicose veins and skin changes.

Chronic venous edema is only partially reversible and soon becomes hard which is mainly confirmed on palpation.  All skin structures are affected and the lower leg then takes on the appearance of an upside down champagne bottle.  Secondary lymphedema may develop, in many cases accompanied by thickening of skin folds, hyperkeratosis and papillomatosis.

Sigvaris – Venous Disorders (Diagnosis and Treatment)

It is a chronic disorder that always progresses if not treated properly. Therefore, it is necessary to remove the venous cause and thus reduce progression.  Consistent treatment of all forms is important.  If this advice is not followed, typical consecutive symptoms of chronic venous insufficiency such as corona phlebectatica paraplantaris, deterioration of edema, dermatolipofasciosclerosis, white atrophy, microbial eczema, allergic contact eczema, development of leg ulcer, and lymph circulation impairment must be expected.  Additionally, erysipelas develops more frequently because of associated interdigital mycosis.  Each incidence of erysipelas causes lymph transport disturbance in the affected regions and therefore results in deterioration of the already existing lymphostasis.

Treatment

The primary therapeutic goal is the elimination of the venous insufficiency in order to avoid the manifestation of a lymphatic lesion.

Strategic guidelines for chronic lymphovenous insufficiency:

• Correct diagnosis
• Combined decongestive therapy
• Treatment of venous insufficiency
• Post surgical treatment similar to lymphedema (surgery, sclerotherapy)
• Long term compression therapy

Lymphedema Diagnosis and Therapy, Horst Weissleder and Christian Schuchhardt, 4th edition, 2008