Lymphovenous Insufficiency: Pathophysiology, Etiology, Management and Skin Care

This essay provides an overview of the pathophysiology, aetiology, prevalence, and prognosis of lymphovenous insufficiency. It discusses the management of lymphovenous insufficiency based on grade, classification, and severity, and provides a detailed plan of skin management. The essay also identifies the healthcare professionals who may need to be consulted in the holistic management of a patient with lymphovenous insufficiency.

Running head: LYMPHOVENOUS INSUFFICIENCY 1
LYMPHOVENOUS INSUFFICIENCY
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Introduction
Lymph-venous insufficiency is a defect of the lymphatic and venous system that
presents with pain, swelling, varicose veins, changes in the skin color (brown or red
pigmentations, ulcers, dry scaling, and infection. This essay will provide an overview of the
pathophysiology, aetiology, prevalence, and prognosis of lymphovenous insufficiency. The
paper will give an overview of the management of lymphovenous insufficiency based on
grade, classification, and severity. Lastly, the essay will discuss a detailed plan of skin
management and other professionals who may need to be referred to or consulted in the
management of a client with lymphovenous insufficiency.
Etiology, and pathophysiology of Lymphovenous insufficiency
Lymphovenous insufficiency commonly results from failure of the veins to return
blood properly back to the heart leading to a back-up of blood in the veins at the legs hence
raising the venous pressure. Increased venous pressure forces the lymphatic fluid in the blood
to leak out into the body tissues leading to edema. The elevated venous pressure forces the
blood to flow back into the smaller blood veins of the subcutaneous tissue beneath the skin
leading to varicose veins. Varicose veins are associated with pain and delayed healing
especially if they are located under wounds or ulcers (Gainutdinov, Pushkarev, &
Perevozchikova, 2013)
There are two major types of lymphovenous namely: primary (deep) lymphovenous
insufficiency which affects the deep veins of the legs causing swelling and skin changes. On
the other hand, superficial venous insufficiency affects the small and great saphenous veins
resulting to swelling, reticular and spider veins, painful varicose veins, impaired healing of
wounds, ulcers, and wounds, infections and changes in skin color and integrity (Gainutdinov
et al, 2013)

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Lymphovenous insufficiency is caused by trauma, nerve injury and previous surgery.
Surgical interventions may be implemented to remove some sections of the lymphatic system
in treatment of cancer. Damage of the lymphatic system interferes with the lymphatic flow of
blood and other fluids leading to insufficiency. In cancer treatment, use of radiotherapy can
destroy cancerous cells and tissues and health tissues since it uses high-energy controlled
doses of radiation. Use of radiotherapy in the destruction of cancerous cells in the lymphatic
system is associated with a greater risk of permanent damage of the lymphatic system.
Consequently, permanent damage to the lymphatic system may lead to its inability to
properly drain the lymphatic fluid leading to lymphovenous insufficiency (Armer et al, 2013).
Infections are also key contributors to lymphovenous insufficiency. For example,
cellulitis is commonly associated with lymphoedema which leads to damage to the
surrounding tissues of the lymphatic system leading to scarring. Filariasis, which is an
infection caused by thread-like worms affects the lymphatic system by blocking lymph
drainage. Blockage of the lymphatic system by the worms leads to lymphoedema which then
results in insufficiency (Kaczmar et al, 2016).
Lymphatic inflammation due to hypersensitivity reactions, injuries, infections, and
other medical conditions can cause redness and swelling of tissues causing permanent
damage to the lymphatic system. The damaged lymphatic system is unable to drain the
lymphatic fluid to various body tissues leading to venous insufficiency. Some of the
conditions that cause inflammation of the lymphatic system are rheumatoid arthritis and
eczema which is associated with skin itching, redness, dryness and cracking (Olszewski,
2013).

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Venous diseases interfere with blood flow through the veins leading to edema and
damage of veins. Some of these venous diseases are Deep Vein Thrombosis (DVT), enlarged
and swollen veins due to varicose veins. Damaged and abnormal veins cause an overflow of
the lymphatic fluid from veins into the tissues spaces. Consequently, this overwhelms and
exhausts the lymphatic part of the lymphatic system that is responsible for drainage of the
lymph fluid (Olszewski, 2013).
Obesity is a potential cause of lymphovenous insufficiency. Obesity is associated with
a high risk of development of swellings in body parts. Injuries and trauma can lead to
accidental damage to the lymphatic system. Immobility may lead to lymphatic insufficiency
since exercise and movement enhance drainage of the lymph. During physical activity, the
activity of the muscles around the lymphatic vessels usually massages the lymph along them.
Immobility, therefore, leads to lymphatic insufficiency since the lymph becomes stagnant in
the lymphatic tissues. Other risk factors of lymphovenous insufficiency include; pregnancy,
blood clots, muscle weakness, leg injury, smoking, family history, phlebitis, standing or
sitting for long periods (Todd, 2014).
The signs and symptoms of lymphovenous insufficiency ae edema at the legs and
ankles, leg cramps, itchy and weak legs, throbbing, aching and heaviness of client’s legs, leg
ulcers, varicose veins, skin changes in color, skin thickening at the ankles and legs, tightness
at client’s legs (Whitaker, 2012).
Prevalence of Lymphovenous insufficiency
Prevalence of lymphovenous insufficiency widely varies based on geographical
location, but the highest rates are reported in Western Countries whereby it ranges from 1%--
17% in men and 1%-40% in the female gender. The most common risk factors include;

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pregnancy, physical inactivity, obesity, female gender, older age, diet, family history of
lymphovenous disease and occupations that involve orthostasis (Hayes et al, 2011).
Prognosis of Lymphovenous insufficiency
The client should always be reassured that Lymphovenous insufficiency is not always
life-threatening. The patient should be put on lifelong graded compression and other therapies
which lead to marked improvement but do not eliminate the sequelae. Non-compliance with
prescribed treatment modalities is commonly associated with recurrence and complications
(Whitaker, 2012).
Management of Lymphovenous Insufficiency
Lymphovenous insufficiency usually has various stages in which it progresses. Stage
0 (sub-clinical stage)-the lymphatic system is in a position to compensate for an increased in
tissue fluid due to venous hypertension making the affected areas not to develop edema. The
management strategies for this stage is observation and self-monitoring for any changes in
skin color. In this stage, it is also important to encourage physical exercises and skin care as
preventative measures of further complications (Todd, 2012).
Stage 1 (phlebo-lympho-dynamic insufficiency)-the lymphatic system functions to its
maximum capacity but fails to drain the increased amount of tissue fluid leading to the
development of ambulatory venous hypertension. In this stage, edema develops due to
dynamic insufficiency following overload in the lymphatic system. In this stage, the most
effective management strategies are compression hosiery, elevation, physical exercises, skin
care and self-lymphatic drainage (Todd, 2013).
Compression therapy in this stage is important in the reduction of swelling by
reducing the flow of the excess fluid to the interstitial tissues (Capillary filtration) hence

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reducing the lymphatic load. Compression increases the interstitial pressure hence enhancing
reabsorption of excess amount of fluid into the lymphatic and facilitates break down of
fibrotic tissues. Compression facilitates movement of the excess fluid into the body areas
which are non-compressed. This technique uses pressure which assists the venous pump of
the legs and supports the weak valves hence improving their function. Improved functioning
of these valves helps in reduction of venous hypertension (Todd, 2014).
Compression technique uses pressure which prevents dilatation of veins when
standing or walking hence stopping backflow of blood into the veins. Compression approach
works by increasing the speed of venous blood flow. Increased venous flow prevents trapping
of leucocytes hence reducing inflammation. Reduction of valvular insufficiency in
compression helps in preventing venous backflow in lymphovenous insufficiency. Lastly,
compression technique helps in improvement of the flow of blood hence improving
transportation and supply of nutrients to the skin (Lasinski, 2013).
Stage 2 (phlebo-lympho-static insufficiency)-This stage involves damage of blood
capillaries due to elevated pressure and overworking of the lymph vessels. The Red Blood
Cells (RBCs) leak from the blood capillaries via their stretched walls leading to reddish-
brown color of the skin because of deposition of hemosiderin (tissue storage form of iron).
Subsequently, elevated lymphatic pressure makes the walls of the lymph vessels be fibrotic
along with inefficiency of the valves inside the larger vessels resulting in lymphatic system
impairment to the extent that it can no longer carry out its basic roles and functions (Murdaca
et al, 2012).
Consequently, this does not only cause fluid accumulation in tissues, but also
proteins. In this stage, compression technique may also be applied to the reduction of
swelling. Elevation and physical exercises are also effective in the management of this stage

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of lymphovenous insufficiency. Elevation and exercise help in improvement of lymphatic
drainage by pumping the lymph fluid out of the inflamed areas hence reducing lymphovenous
insufficiency (Olszewski, 2013).
Stage 3 of Lymphovenous insufficiency involves severe changes in sub-cutaneous
tissues and the skin. Reduced nutrition and oxygenation of tissues may lead to the
development of ulcerations. Apart from edema and ulcers, there is also lipodermatosclerosis
which includes; increased skin hyperpigmentation, moderate skin redness, pain, small and
white scarred areas and localized skin thickening. The applicable techniques of management
in this stage are surgical intervention, Complete Decongestive Therapy (CDT) and wound
care. CDT encompasses Manual Lymphatic Drainage (MLD), skin care, compression,
exercise, training, and self-care management (Maksimov, Feiskhanov, Makarimov, &
Feiskhanova, 2015).
Skin Management
Healthy skin involves lipid and water balance which maintains skin moisture and
supple. In correction of lymphovenous impairment, skin optimization through leave on
emollient and washes is important. The client should be encouraged on daily and regular
washing of the skin with warm water and application of emollients or cream to prevent skin
deterioration (Bianchi, 2013).
Daily skin care helps in the prevention of fungal and bacterial manifestations through
the removal of dead skin and enhancing superficial lymphatic drainage. Emollients help in re-
establishment of the protective lipid layer of the skin surface hence enhancing rehydration
which prevents fluid loss and bacterial invasion. The client should be encouraged not to
vigorously rub the skin since it causes irritation and epidermal changes. The dry skin should

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be gently pat not forgetting the skin folds, creases and between fingers and toes (Ridner et al,
2012).
One should avoid injections and ensure immediate and proper treatment of scratches
and cuts with antiseptic cream. To prevent insect bites, the patient should use protective
repellants. The client can use gloves for household tasks or when gardening to prevent skin
cuts especially if the upper limbs are affected. Use of antifungal powder is important in
prevention of fungal infections on the affected areas of both lower and upper limbs. The
patient should be encouraged on keeping his nails short and putting on loosely-fitting jewelry
and clothes and properly fitting shoes (Nowicki, & Siviour, 2013).
Professionals who may need to be consulted in the management of Lymphovenous
Insufficiency.
The healthcare professionals who may be needed in the holistic management of a
patient with lymphovenous insufficiency are; dermatologist, physiotherapist, vascular
surgeon, psychologist, dietician, and social worker. In this instance, the dermatologist has a
role in provision of consultation services, dermatological screening, the performance of
diagnostic tests, prescription of medications, the performance of dermatological procedures
and educating the patient on the management of the condition and best skin, nail and hair care
(Whitaker, 2012).
The vascular surgeon would help in the surgical intervention of the patient’s
condition. Lymphovenous insufficiency is associated with psychological consequences such
as depression, distress, social inhibition/isolation and concerns on sexuality and physical
appearance due to disfigurement. Therefore, a psychologist would be important in the
provision of psychological care and support to the client hence enhancing effective coping
with his or her health condition (Papadopoulou et al 2012).

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A social worker can work in collaboration with the psychologist to provide social
support and rehabilitative services to the patient. Psychosocial support is also important in
promotion of skills of self-management by the client. The physiotherapy is also an important
aspect of patient management for lymphovenous insufficiency. The role of the
physiotherapist is the implementation of physiotherapy techniques such as Complex
Decongestive Therapy (CDT), Laser Therapy, High Voltage Electrical Stimulation, and
Pneumatic Compression. These techniques help in the reduction of edema and improvement
of lymph drainage hence relieving lymphovenous insufficiency. Lastly, a dietician would
help in the provision of nutritional and dietary prescriptions and recommendations for the
client to ensure proper skin hydration and moisturization, fluid balance and weight control
(Papadopoulou et al, 2012).
Conclusion
Lymphovenous insufficiency is a defect of the lymphatic and venous system that is
caused by varicose veins, blood clots, infections, Deep Vein Thrombosis (DVT), obesity,
smoking, trauma, injuries, muscle weakness, and pregnancy. Some of the effective
approaches of managing Lymphovenous insufficiency are; compression, physical exercises,
skincare, elevation, diet, and prevention of infections. For holistic management of
lymphovenous insufficiency, members of the multidisciplinary team such as dermatologist,
vascular surgeon, physiotherapist, dietician, psychologist, and social workers should be
involved in client management.

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