Evaluation the Subclinical Lymphedema in Chronic Venous Disease a Critical Overview of Its Pathophysiology

The lymphatic and venous systems are closely interconnected and many patients with  chronic venous disease (CVD) develop lymphedema. Early lymphatic dysfunction can be detected. The aim of our study was to evaluate the subclinical stage of lymphedema in patients with CVD  C4-C6 and determine whether involvement and/or degradation of lymphatic function could be by multiple factors.

Methods:

We evaluated thirty patients with chronic venous disease, five with C6, ten with C5 and fifteen with C4. Body mass index (BMI), clinical scales and kinematic parameters coming from the gait analysis and skin changes  were evaluated. Near-infrared fluorescence lymphatic imaging (NIRFLI), Lymphoscintigraphy and  lymphangiogram was employed to assess lymphatic function. Observations included different types of  dermal backflow, lymph leaks and ascent rate.

Results:

Different patterns of dermal back flow was observed in all patients,  predominantly the diffuse type. An increase of BMI in twenty overweight/obese patients were observed with gait impaired, dysmetria 
and scoliosis and a delayed rate of lymphatic ascent with trophic skin changes. Lymph leaks was detected in all cases of patients with C6.

Conclusions:

Differences between CVD and correlations between BMI, skin changes, gait parameters and lymphatic function were evaluated. The impairment of the lymphatic system in advanced CVD is evident, nevertheless involving multiple causes. Early lymphatic abnormalities plays an important role in comprehensive assessment of lymphedema pathophysiology in CVD.