The Prevalence of Venous Disease in Primary Lymphoedema

Objective:

To assess the prevalence of venous incompetence in primary lymphoedema.

Design:

Retrospective study.

Setting:

Outpatients attending St George's Hospital, London, UK.

Patients:

Forty-six patients (61 limbs) with primary lymphoedema extracted from a consecutive series of patients presenting with swollen legs. Only those with clinical and lymphoscintigraphic evidence of lymphoedema were included. Patients with any clinical evidence of venous disease were excluded.

Controls:

Seventeen subjects (33 limbs) with no history or clinical evidence of either lymphoedema or venous disease.

Methods:

Light reflective rheography (LRR) and quantitative isotopic lymphoscintigraphy.

Main outcome measures:

Venous refilling times (RT) with and without tourniquet control.

Statistical analysis:

Prevalence of venous incompetence in lymphoedema patients compared with normal controls and literature values.

Results:

In the patients, seven of 61 limbs (11.5%) had a venous RT of less than 25 s; eight limbs (13.1%) had a venous RT between 25 and 40 s. An above-knee tourniquet corrected the RT in all 15 limbs indicating superficial venous incompetence. In the controls, one of 33 limbs (3%) had a venous RT between 25 and 40 s. An above-knee tourniquet corrected the RT indicating superficial venous incompetence.

Conclusion:

Covert venous insufficiency may complicate primary lymphoedema. This has implications for both the pathophysiology of the oedema and its management.