Venous and Lymphatic Disorders

An estimated 50 percent of all Americans are believed to have some sort of venous (vein) or lymphatic disorder. Left untreated, these conditions can lead to significant pain, itching, swelling and medical complications.

Most vein and lymphatic disorders fall into one of three categories:

  • Varicose veins are enlarged veins that are visible through the skin and may appear as blue or purple, twisted, knot-like cords. Varicose veins can occur anywhere in the body, but are more commonly found on the legs.
  • Lymphedema is localized fluid retention that is caused by inadequate drainage of lymph fluid. The poor lymph drainage causes collection of extravascular fluid and a firm swelling of the affected limb (arm or leg).
  • Venous thrombosis occurs when blood clots obstruct or block veins (blood vessels that carry blood from the body back into the heart). Deep vein thrombosis (DVT) is a type of venous thrombosis.

Brigham and Women’s Hospital’s (BWH) Department of Vascular Medicine uses a multidisciplinary approach to evaluate and treat patients with venous and lymphatic disorders. Specialists in vascular medicine, surgery and radiology provide an integrated program of diagnostic care and treatment.  

Venous and Lymphatic Disorders Topics

Risk Factors for Venous and Lymphatic Disorders

Varicose veins

  • Obesity
  • Family history
  • Repetitive, prolonged periods of standing or sitting
  • Gender – women are at greater risk
  • Pregnancy
  • Age – 30 to 70 years old

Lymphedema

  • Breast cancer surgery followed by radiation and chemotherapy
  • Family history
  • Flesh injuries - cuts, bruises, scratches, burns and animal or bug bites
  • Infections, including filariasiscellulitis, and lymphangitis  
  • Obesity

Venous thrombosis

  • Autoimmune disorders that predispose a patient to blood clotting
  • Disease or injury to the veins in the legs
  • Family history
  • Fracture
  • Immobility
  • Medications, such as certain contraceptives, that increase the risk of clotting 
  • Obesity

Learn more about risk factors for deep vein thrombosis (DVT).

Symptoms of Venous and Lymphatic Disorders

Varicose veins

  • Color changes in the skin
  • Sores on the legs
  • Rash
  • Sensations in the legs, such as a heavy feeling, burning and/or aching

Lymphedema

  • Feeling of fullness or tightness in the affected arm, chest or armpit area
  • Aching or pain in the affected arm
  • Swelling in the hand (may be evidenced by rings that no longer fit)
  • Weakness in the affected arm

Venous thrombosis

  • Pain isolated to one leg (usually the calf or inner thigh)
  • Swelling in the extremity
  • Chest pain
  • Numbness or weakness on one side of the body
  • Acute mental status changes 

Learn more about symptoms of deep vein thrombosis (DVT).

Diagnosis of Venous and Lymphatic Disorders

Varicose Veins and Venous Thrombosis

In addition to a complete medical history and physical examination, diagnostic procedures for varicose veins may include any, or a combination, of the following:

  • Venous duplex ultrasound to assess blood flow and the structure of the leg veins.
  • Magnetic resonance venography (MRV)

Learn more about diagnosis of deep vein thrombosis (DVT).

Lymphedema

Along with a complete a medical history and physical examination, lymphedema can be diagnosed using:

  • Lymphoscintigraphy, a nuclear medicine study used for imaging lymph vessels and lymph nodes
  • Measures of volume
  • Electrical conductance testing
Venous and Lymphatic Disorders Treatment

Specialists at BWH develop individualized treatment plans for patients with venous and vascular disorders based on:

  • Age
  • Overall health
  • Medical history
  • Severity and form of the disease
  • Tolerance for specific medications or procedures
  • Expectations for course of the disease
  • Presence of other conditions

Varicose Veins

  • Endovenous Laser Treatment (EVLT®) is a safe, effective non-surgical laser procedure that eliminates varicose veins at the source. Using laser energy to close the faulty varicose veins, this minimally invasive procedure is quick and painless. Once the problem veins are closed off, blood re-routes through the normal veins and flows more efficiently. 
  • Sclerotherapy is a non-surgical procedure that uses a very fine needle to inject a solution into the varicose veins to seal them shut. The solution causes the lining of the vein to swell, sealing off the blood vessel and preventing blood flow. Each vein may require several injections and most varicose veins disappear in two weeks to two months. 
  • Ambulatory Phlebectomy is a micro-extraction procedure that removes large surface varicose veins through skin incisions as small as 1 mm. It does not require any stitches and does not leave any scars.

Vascular Thrombosis

Learn more about treatment for deep vein thrombosis (DVT).

Lymphedema

Treatment is focused largely on control and prevention and may include:

  • Manual lymphatic drainage, a form of massage therapy used regularly to promote lymph drainage
  • Exercise to help improve drainage and restore flexibility and strength
  • Customized compression sleeve or elastic bandage to help prevent an accumulation of fluid
  • Arm pump to increase fluid flow in the lymphatic vessels and keep the fluid from collecting in the arm
  • Elevate arm above heart, whenever possible, to help drain accumulated fluid
  • Control body weight
  • Preventive measures, such as good skin care, to protect the affected arm from infection and skin breakdown
What You Should Expect

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from BWH’s main 75 Francis Street entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

If you are having a procedure, you will likely be scheduled for a visit to the Watkins Clinic for pre-operative information and tests.

The day of the procedure, you care will be provided by physicians, anesthesiologists and nurses who specialize in surgery for patients with venous and lymphatic disorders.

During your procedure, family and friends can wait in the Shapiro Family Center. Staff members will provide updates and caregivers who leave the hospital will be contacted by cell phone.

Multidisciplinary Care

Patients benefit from the teamwork of vascular medicine physicians, vascular and endovascular surgeons, radiologists and anesthesiologists, all experts in venous and lymphatic disorders. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.

Resources

Learn more about vascular conditions in our health library.

Visit the Kessler Health Education Library in the Bretholtz Center where patients and families can access computers and knowledgeable staff.

Access a complete directory of patient and family services.

 

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