Venous dynamics in leg lymphedema.
To determine whether there is anatomical and/or functional impairment to venous return in patients with lymphedema, we examined venous dynamics in 41 patients with unilateral leg lymphedema. A Volometer was used for computer analysis of leg volume, a color Duplex Doppler scanner was used to determine deep vein patency and skin thickness, and Air-plethysmography was used to assess ambulatory venous pressure, venous volume, venous filling index and the ejection fraction. In the lymphedematous leg, volume and skin thickness were uniformly increased (126.4 +/- 21.3% and 156.9 +/- 44.5%) (mean +/- S.D.), respectively. The ambulatory venous pressure was also increased (134 +/- 60.7%) as was the venous volume (124.5 +/- 37.5%), and the venous filling index (134.5 +/- 50.5%). The ejection fraction was decreased (94.9 +/- 26.1%). Greater leg volume correlated with increased venous volume and venous filling index (values = 0.327, 0.241, respectively) and decreased ejection fraction (r = -0.133). Increased subcutaneous thickness correlated with increased venous filling index and venous volume (r = 0.307, 0.126, respectively) and decreased ejection fraction (r = -0.202). These findings suggest that soft tissue edema from lymphatic stasis gradually impedes venous return which in turn aggravates the underlying lymphedema.
Kim
D I
DI
Division of Vascular Surgery, Samsung Medical Center, College of Medicine, Sung kyun kwan University, Seoul, Korea.
Huh
S
S
Hwang
J H
JH
Kim
Y I
YI
Lee
B B
BB
D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008209:Lymphedema / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010991:Plethysmography; D012039:Regional Blood Flow / Q000502:physiology; D018616:Ultrasonography, Doppler, Duplex; D014689:Venous Insufficiency / Q000209:etiology* / Q000503:physiopathology; D014690:Venous Pressure / Q000502:physiology