Interaction of Veins and Lymphatics with Lipedema

The Venous and Lymphatic circulation system are intimately intertwined. The pressure in the venous system is the single largest driving force for the production of lymph. Venous disorders such venous hypertension and venous reflux can cause excess lymph production and overwhelm the lymphatic circulation. The venous system and lymphatic circulation rely on the same passive contractions to clear fluid from limbs. The following slides were prepared to explain the interaction of the venous and lymphatic circulation for a talk at 2016 Fat Disorders Research Society annual conference on lipedema and dercums disease held in 2016 in St Louis, Missouri.

When to Treat Vein Problems

  • Vein insufficiency can add to or worsen symptoms of lipedema (also known as Lipoedema, Lipodema, and Lipodem)
  • Significant vein problems means saphenous vein insufficiency not spider veins
  • It is important to treat significant vein problems prior to surgical treatment of Lipedema

Diagnosis

Gold standard for DX/Rx of CVI

Is a DIFFERENT study than venous ultrasound for DVT

Venous Reflux Ultrasound DVT Ultrasound
Anatomic & functional information provided Information Re: Thrombus
Interrogates deep, superficial & perforator vein systems Primary interrogates deep venous system
Performed in upright position Performed in supine position

When investigating CVI, you must specifically request “reflux ultrasound” study or only DVT study may be performed


Venous Reflux Ultrasound (VRU)

VRU: Identifies Venous Reflux as Reversed Flow

Normal Abnormal-venous reflux

Credit: American College of Phlebology (ACP)


Venous Reflux Ultrasound (VRU)

Abnormal-Venous Reflux
Venous Reflux Leads to Venous Hypertension

Credit: American College of Phlebology (ACP)


Lipedema with Vein Changes

Credit: American College of Phlebology (ACP)


Consequences of Venous Hypertention

  • Venous hypertension can lead to venous lymphedema [veno-lymphedema] or aggravate existing lymphedema or lipedema
  • Leads to poor wound healing
  • Leg inflammation can lead to aggravated leg pain
  • Increases the risk of blood clots
  • All of these complications aggravate the symptoms and treatment of Lipedema

In Conclusion

  • All efforts should be made to reduce risk and optimize outcomes of lipedema therapy
  • The first step is a comprehensive vein evaluation
  • Treatment of significant venous reflux is recommended
Credit:

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Meet Dr. Wright

Dr. Wright

Meet Dr. Thomas Wright, medical director of Laser Lipo and Vein Center. Dr. Wright is a board certified Phlebologist and cosmetic surgery specialist, with over 15 years of practicing experience. A graduate of the University of Missouri Columbia medical program, Dr. Wright was one of the first two hundred surgeons to become a diplomate in Phlebology.

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