The prevalence of venous disease in primary lymphoedema

Objective: To assess the prevalence of venous incompetence in primary lymphoedema. Design: Retrospective study. Setting: Outpatients attending St George's Hospital, London, UK. Patients: Forty-six patients (61 limbs) with primary lymphoedema extracted from a consecutive series of patients presenting with swollen legs. Only those with clinical and lymphoscintigraphic evidence of lymphoedema were included. Patients with any clinical evidence of venous disease were excluded. Controls: Seventeen subjects (33 limbs) with no history or clinical evidence of either lymphoedema or venous disease. Methods: Light reflective rheography (LRR) and quantitative isotopic lymphoscintigraphy. Main outcome measures: Venous refilling times (RT) with and without tourniquet control. Statistical analysis: Prevalence of venous incompetence in lymphoedema patients compared with normal controls and literature values. Results: In the patients, seven of 61 limbs (11.5%) had a venous RT of less than 25 s; eight Limbs (13.1%) had a venous RT between 25 and 40 s. An above-knee tourniquet corrected the RT in all 15 limbs indicating superficial venous incompetence. In the controls, one of 33 limbs (3%) had a venous RT between 25 and 40 s. An above-knee tourniquet corrected the RT indicating superficial venous incompetence. Conclusion: Covert venous insufficiency may complicate primary lymphoedema. This has implications for both the pathophysiology of the oedema and its management.