Lymphedema & Venous Congestion

Chronic venous insufficiency is common, especially in older adults, people who stand for long periods, and people with past leg blood clots.

Lymphedema is less common. It often follows cancer treatment that removed or damaged lymph nodes, but it can also be present from birth or develop later in life.

• Primary lymphedema: caused by lymph vessels that didn't form normally; it may show up at birth, in the teen years or later.
• Secondary lymphedema: caused by damage to the lymph system, such as from cancer surgery or radiation, infection, injury, obesity or long-term venous disease.
• Chronic venous insufficiency: from weak vein valves, often after a past blood clot (DVT) or with varicose veins.
• Swelling from heart failure or other causes (kidney or liver disease, certain medicines) can look similar and needs its own treatment.

• Cancer treatment that removed or radiated lymph nodes
• Past blood clots in the legs
• Varicose veins or family history of vein problems
• Standing or sitting for long periods
• Obesity
• Getting older, and pregnancy
• Heart failure
• Repeated skin infections (cellulitis) in the same limb

• Swelling in one or both legs (or an arm), often worse at the end of the day
• Heavy, achy or tight-feeling legs
• Skin that feels thick or firm
• Brown or reddish skin color near the ankles, itching or dry, scaly skin (common in CVI)
• Varicose veins
• Open sores near the ankles that heal slowly (venous ulcers)
• At your visit, your provider looks at both legs, measures swelling, presses the skin to see if it leaves a dent, checks for thickened skin (including whether the skin on the second toe can be pinched), checks pulses, and looks for signs of infection, varicose veins and heart failure.

Diagnosis starts with your history and exam. Your provider will look for causes like heart failure, kidney or liver disease, a blood clot, or a medicine side effect.

Lab tests your provider may order include: a comprehensive metabolic panel (kidney and liver function, albumin), a complete blood count (CBC), thyroid tests (TSH), BNP or NT-proBNP (if heart failure is a concern), and a urine test for protein. A D-dimer blood test may help when a clot is suspected.

A venous duplex ultrasound checks for vein valve problems and blood clots. Other tests may include an echocardiogram or a lymph scan. We don't do imaging at our office; we refer you to a trusted outside center and review the results with you.

These tools are used by clinicians. Bring your results to your visit; they don't replace a medical evaluation.

• Wells' Criteria for DVT ↗ (opens in a new tab)Helps clinicians judge how likely a swollen leg is caused by a blood clot.

Treatment can't always make swelling go away completely, but it can control it and protect your skin. Your plan may include:

• Compression: stockings, wraps or sleeves fitted for you. Before starting compression on the legs, we check blood flow with an ankle-brachial index (ABI) or screening Doppler in our office, because compression can be unsafe with poor circulation. Also ask first if you have heart failure.
• Raising your legs above heart level when resting.
• Walking and leg exercises to help the calf muscles pump fluid.
• Daily skin care: wash gently, moisturize, and check for cuts, cracks or redness.
• For lymphedema, therapy with a trained therapist, including special massage (manual lymphatic drainage) and bandaging. Some people use a pneumatic compression pump.
• Treating heart failure, managing weight, and reviewing medicines that cause swelling.
• Vein treatments by a specialist for some people with CVI or varicose veins.
• Wound care for venous ulcers.

Lymphedema and CVI are usually long-term. Daily care is what keeps them under control.

Many people reduce swelling and avoid skin problems with steady compression, movement and skin care. Results vary, and some swelling may remain.

Your primary care team at Moaddel Medical looks for the cause of your swelling, orders the right tests and treats related conditions like heart failure.

We help you get fitted compression and refer you to lymphedema therapy, vein specialists or imaging when needed. For venous ulcers and other slow-to-heal wounds, Royal Wound Care, part of Moaddel Medical, provides full-scope wound care in house, and our networking partners offer home nursing for dressing changes and medication management.

We're at 7230 Medical Center Dr, Suite 100, West Hills, CA 91307.