Overview of Phlebolymphedema: Role of Surgery, Intervention

Phlebolymphedema is the unavoidable complication of the unique hemodynamic relationship between the venous and lymphatic system. This study describes the pathophysiology and appropriate diagnosis and treatment strategy of phlebolymphedema. It is hoped that this study will draw attention to the evaluation and treatment of venous disease in patients with lymphedema in actual clinical practice. The clinical manifestations of phlebolymphedema occur as variety of skin symptoms such as stasis dermatitis, lipodermatosclerosis, lymphedema rubra. Basically, the diagnosis of phlebolymphedema is based on detail history taking and physical examination. Duplex ultrasound is the most essential test for venous disease and is useful for evaluating the valvular insufficiency and venous obstruction. However, duplex ultrasound is less accurate due to the location and anatomical complexity of the abdominal/ pelvic veins, computed tomography and magnetic resonance imaging is used. In addition, intravascular ultrasound has not been introduced in many centers, but it is expected to be more widely used in the future because it is superior to venography for compressive and obstructive lesion of vein and can be guided during endovascular intervention. Treatment should prioritize the treatment of chronic venous insufficiency (CVI) over the treatment of lymphedema. In recent years, the active introduction of endovascular intervention to CVI, treatment and research using it are in progress. Among the many causes of lymphedema, Phlebolymphedema is the only disease that can be cured by treatment of venous lesion accompanying lymphedema treatment. Therefore, it is thought important to consider the possibility of associated venous lesions in lymphedema patients.