The role of operative management of varicose veins in patients with lymphedema and/or lipedema of the legs

The role of operative management of "symptomatic" varicose veins in patient s with lower extremity lymphedema or lipedema is controversial. We reviewed the clinical outcome of 261 patients between 1989-1997 at the Foldiclinic with lower extremity lymphedema (68 patients), lipo-lymphedema or lympho-li pedema (103 patients) or lipedema (90 patients) who had undergone operation for varicose veins. In each group, the results were dismal as leg swelling worsened or was unchanged in greater than 90% whereas symptoms such as hea viness, fatigue, cramps (termed varicogenic symptomatology) were improved i n less than 10%. These findings support that operations for varicose veins in the legs of patients with lymphedema, lipedema, or combinations of these disorders should be undertaken only if there is an absolute indication pre sent (ascending phlebitis and/or bleeding). Otherwise, complete decongestiv e physiotherapy is still the best treatment approach for these groups of pa tients.