Venous OedemaVenous oedema refers to leg swelling that happens from veins. Veins carry blood that is low in oxygen out of the legs and back to the heart and lungs to get more oxygen. If one has varicose veins or chronic venous disease, then the veins do not carry this blood properly and there is ‘backflow’ of blood. The veins then distend and fluid seeps out of the veins into the tissue resulting in leg swelling.
Veins carry blood against gravity, thus, if they are not working properly applying gravity puts more strain on them – hence swelling results from standing for long periods, and elevating the legs relieves the swelling.
Leg swelling is problematic from a health concern.
Firstly, it is uncomfortable for a patient and symptoms such as a bursting sensation, burning, numbness, itching, throbbing and heaviness can be described. Leg swelling has been shown to affect quality of life.
Additionally, if there is fluid retention for a prolonged period this can lead to skin pigmentation, skin damage and even wound formation. Once skin becomes pigmented and damaged or hard (known as sclerosis), it is irreversible. Thus this process needs to be stopped early.
Lymphatics also drain fluid out of a leg, however, lymph vessels work on negative pressure. Thus, if there is fluid retention from veins, the pressure in the legs goes up and the lymphatics are unable to drain properly, thus aggravating the fluid and in some cases aggravating inflammation and conditions such as eczema.
This is why, when fluid has been present for a long period, we work closely with lymphoedema therapists to ‘kickstart’ the lymphatics to work again, only once we have treated the vein problem.
This is known as secondary lymphoedema.
Veins and lymphatics always need to be looked at hand in hand.
Whole Leg swelling – thigh swelling or pain in exerciseSome patients – often see in active individuals, or athletes, may get leg swelling that involves the thigh as well. This is often aggravated by exercise and a pateints will describe the leg as wanting to ‘burst’ after exercise.
Typically, this occurs on the left hand side.
This is related to veins obstruction in the pelvis.
There may be narrowing of the veins, where the veins lie against the spine and where the arteries cross over the veins. Athletes, spinal surgery, pregnancy and age may all result in some additional pelvic change which causes this narrowing to become significant and not allow venous blood to drain from the leg.
In this case, the veins need to be scanned, sometimes with a CT scan and a vein stent inserted to keep the narrowing open. (More about Vein Stenting)