정맥질환에 기인한 림프부종 - Phlebolymphedema

It is known that approximately 20-30% of the advanced chronic venous disease have lymphatic dysfunction due to the increased lymphatic load. Phlebolymphedema is defined as a unique disorder of lymphatic dysfunction caused by a chronic venous insufficiency, resulting in overload of lymphatic transport capacity due to a venous hypertension. The higher incidence of chronic venous disease suggests that the prevalence of phlebolymphedema is also high; however, due to the lack of awareness of phlebolymphedema, it is frequently diagnosed as primary lymphedema. The clinical significance of phlebolymphedema is that, it is a curable disease through the correction of venous disease and the treatment of lymphedema in itself. Therefore, in patients with both the clinical manifestations of chronic venous insufficiency and lymphedema, in addition to diagnostic test for lymphedema such as lymphoscintigraphy, the assessment for venous disease using the duplex ultrasonography or the CT venography must be performed to ensure the presence or absence of chronic venous disease. As a cause of phlebolymphedema, venous occlusion and venous reflux should be differentiated because each treatment strategy is completely different. The treatment for venous occlusion/stenosis is performed by an angioplasty or a stenting. In the case of venous reflux, foam slcerotheray or endovenous laser/radiofrequency ablation can be treated by the closure of the refluxed segments. However, the treatment for venous disease alone may not improve the symptoms of phlebolymphedema that has already occurred. Therefore, the treatment of lymphedema, complex decongestive physical therapy or compression therapy, should be performed in parallel in order to cure phlebolymphedema.