Interaction of Venous and Lymphatic Circulation on Lipedema

How Do Veins and Lymph Interact?

The Venous and Lymphatic circulation systems are intimately intertwined. The pressure in the venous system is the single largest driving force for the production of lymph. Venous disorders such as venous hypertension and venous reflux can cause excess lymph production and overwhelm 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 the 2016 Fat Disorders Research Society annual conference on lipedema lipo 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 disease (also known as Lipoedema, Lipodema, and Lipodem)
Significant vein problems mean saphenous vein insufficiency not spider veins
It is important to treat significant vein problems prior to Lipedema lipo

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 the deep venous system
Performed in an upright position	Performed in the 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 Hypertension

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 lipo
The first step is a comprehensive vein evaluation
Treatment of significant venous reflux is recommended

Credit:

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Meet 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.