Venous interventions reduce the risk of lymphedema in chronic venous insufficiency

Introduction: Chronic venous insufficiency (CVI) significantly increases the risk of developing secondary lymphedema and related infections. This study tested the hypothesis that lower-extremity venous procedures can reduce the 5-year incidence of lymphedema in adults with CVI. Methods: A multicenter retrospective cohort study was conducted using the TriNetX Research Network. Adults (⩾ 18 years) diagnosed with CVI between Jan 1, 2005, and Jan 1, 2020, were identified and followed for at least 5 years. Patients were stratified into those undergoing venous procedures, including saphenous vein ligation, phlebectomy, sclerotherapy, and endovenous ablation, and matched controls managed without intervention. Propensity score matching was performed 1:1 on demographics, comorbidities, and infection-related variables. The primary outcome was new-onset lymphedema, assessed using Cox proportional hazards models and Kaplan–Meier analysis. Results: After matching, 17,703 patients were included in each cohort. At 5 years, new-onset lymphedema occurred in 5.1% of controls versus 4.0% of patients who underwent venous procedures (hazard ratio [HR] 1.26, 95% CI 1.14–1.40). Phlebectomy showed the strongest association with risk reduction (4.0% vs 1.5%; HR 2.60, 95% CI 1.33–5.06), followed by varicose vein sclerotherapy (5.3% vs 3.6%; HR 1.49, 95% CI 1.02–2.16). Conclusions: Venous interventions may reduce the risk of developing lymphedema in patients with chronic venous insufficiency.