Venous dynamics in leg lymphedema

To determine whether there is anatomical and/or functional impairment to ve nous return in patients with lymphedema, we examined venous dynamics in 41 patients with unilateral leg lymphedema. A Volometer(R) was used for comput er analysis of leg volume, a color Duplex Doppler scanner was used to deter mine 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 increas ed (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 v enous 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 volu me 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 eje ction fraction (r = -0.202). These findings suggest that soft tissue edema from lymphatic stasis gradual ly impedes venous return which in turn aggravates the underlying lymphedema .