From the Guidelines
Venous stasis and lymphedema are primarily caused by impaired circulation and drainage in the venous and lymphatic systems, respectively, with compression therapy being a crucial treatment approach to reduce venous stasis and improve lymphatic drainage, as evidenced by the most recent study in 2023 1. The causes of venous stasis include deep vein thrombosis, chronic venous insufficiency, varicose veins, prolonged immobility, obesity, pregnancy, or heart failure, which damage venous valves or obstruct blood return to the heart, causing blood to pool in the lower extremities. Key factors contributing to lymphedema include compromised lymphatic drainage, which may be primary (congenital abnormalities of the lymphatic system) or secondary (acquired damage), with secondary causes encompassing surgical lymph node removal, radiation therapy, infection, trauma, obesity, and chronic venous disease. Both conditions lead to fluid accumulation in tissues, causing swelling, discomfort, skin changes, and increased risk of infection, and they often coexist and can exacerbate each other, as the venous and lymphatic systems are interconnected. Management focuses on addressing underlying causes, with compression therapy being recommended at a minimum pressure of 20 to 30 mm Hg, and pressures of 30 to 40 mm Hg advised for more severe disease, as supported by the 2023 study 1. Additionally, elevation, exercise, and meticulous skin care are crucial to prevent complications, and adherence to compression therapy should be encouraged with proper fitting, education, and detailed instructions, as highlighted in the study 1. It is also important to note that improved ejection fraction in refluxing vessels and higher extrinsic pressures were achieved when higher pressures were exerted at the calf over the distal ankle, and improved pressures and ejection fractions were also observed when placing the compression bandage over the calf versus the distal leg, as demonstrated in the study 1.
From the Research
Venous Stasis Causes
- Venous stasis is caused by the accumulation of fluid in the interstitial space, which occurs when capillary filtration exceeds the limits of lymphatic drainage 2
- Chronic venous insufficiency is a common cause of venous stasis, especially in the presence of dependent edema and hemosiderin deposition 2
- Venous stasis can be treated with compression therapy, which provides a means to reduce swollen limbs to minimum size, maintain that size, and allow patients to participate in their care 3
Lymphedema Causes
- Lymphedema is caused by the accumulation of fluid in soft tissue, resulting in swelling of the affected limb or area 4
- Lymphedema may be primary, resulting from a genetic abnormality, or secondary, resulting from injury, infection, or treatments such as radiotherapy and/or surgery 4, 5
- Cancer, infection, chronic venous disease, and surgery are risk factors for secondary lymphedema 5
- Venous lymphedema is sometimes misdiagnosed as primary lymphedema and does not receive optimal treatment 6
Common Causes of Venous Stasis and Lymphedema
- Chronic venous disease (CVD) is a common cause of secondary lymphedema 6
- Venous obstruction can cause lymphedema, and iliac-caval venous stenting can yield satisfactory clinical relief and sometimes reverse abnormal lymphangiographic findings 6
- Obstructive sleep apnea may cause bilateral leg edema even in the absence of pulmonary hypertension 2
- Tumor, trauma, previous pelvic surgery, inguinal lymphadenectomy, and previous radiation therapy are possible secondary causes of lymphedema 2