Phlebolymphedema: Modern Views and Methods of Correction

Objective. To summarize the available data on the role of lymphatic insufficiency in CVI and its correction using CVD treatment approaches. Material and methods. We reviewed the PubMed and eLibrary databases using the keywords «phlebolymphedema», as well as analyzed available articles. Results. Revising the Starling’s law excluding fluid reabsorption at the venous end of the capillary and placing responsibility for fluid drainage on lymphatic system is important for the concept of phlebolymphedema. Progressive venous hypertension and increased plasma filtration can lead to functional insufficiency and damage to lymphatic system. Available data confirm progressive impairment of lymphatic outflow in parallel with progression of CVD. Modern methods of morphofunctional assessment of superficial lymphatic system, in particular ICG lymphography, allows us to take a new look at pathogenesis of CVI. Standard methods of CVD treatment can have a positive effect on lymphatic outflow, but available data are contradictory. Therapeutic effect of compression therapy is mainly limited to fluid movement through the interstitium towards intact lymphatic vessels. Various drugs including micronized purified flavonoid fraction demonstrate a positive effect on lymphatic drainage. Appropriate therapy is followed by effective relief of venospecific subjective symptoms, chronic edema and trophic disorders. Surgery for superficial and deep veins can improve lymphatic drainage, but clinical results are naturally worse in case of lymphatic insufficiency. Conclusion. Damage to lymphatic system is essential for progressive forms of CVD that emphasizes the need for further study of this issue and development of prevention methods.