Lymphovenous disease and its effects on the lower limb5th May 2015
This article highlights the normal and abnormal physiology of fluid circulation in the lower limb with particular reference to venous and lymphatic flow.
Consideration is given to the assessment and diagnosis of disease and its severity, particularly the impact on the patient including chronic oedema, ulceration, cellulitis and loss of mobility. Options for disease management and prevention such as compression bandaging and hosiery are also discussed, and the gaps between theory and practice are highlighted to provide community nurses with the most up-to-date information and practical solutions.
Historically, lymphovenous disease has been an under-diagnosed condition due in part to the misdiagnosis of chronic oedema. Overlooking chronic oedema purely as a symptom of cardiac disease, renal disease or hypertension can mean that only a part of the underlying disease is managed. Poor diagnosis has meant that there is a lack of strong prevalence data. This, in turn, means that the extent of chronic oedema and, more specifically, the prevalence of lymphovenous disease, remain largely unknown.
However, there is a knowledge base around the pathology of both venous and lymphovenous disease and a range of therapies can be used to support disease management. It is the responsibility of the clinician to determine the underlying disease process and select appropriate management options in collaboration with the patient. Whether surgical or non-invasive management options such as compression are used, the therapy goals should be evaluated with the patient and monitored to ensure success. Where wounds are present or where treatment is used specifically with the prevention of ulceration in mind, strategies for improving patient concordance should be considered, such as intensive patient education, the use of hosiery application aids and kits, or in some cases simply offering a choice of hosiery colour and/or texture.
While the disease process is fairly well understood, further work to establish the cost and clinical effectiveness of different types of compression therapy would be beneficial. It would also be useful to understand the degree to which both surgery and compression can correct underlying pathology in the lymphovenous circulation. This would enable clinicians to better explain the pathology and support patients to make improved treatment choices.
Picture credit: http://wellcomeimages.org