Venous reflux and CEAP clinical class in patients with lipedema: Prevalence, duplex ultrasonographic patterns, and clinical associations

Objectives To determine the prevalence of chronic venous insufficiency (CVI) in patients with lipedema, characterize venous reflux patterns and CEAP clinical classes, and evaluate associations with demographic and lipedema-related characteristics. Methods This retrospective, single-center observational study included adults with lipedema evaluated between January 2023 and December 2025. Of 120 patients screened, 50 were excluded because of incomplete venous Doppler ultrasonography, clinical, or demographic data, leaving 70 patients for analysis. Demographic and clinical characteristics and lower-extremity venous duplex ultrasonography findings were reviewed. Superficial, deep, and perforator reflux; segment-specific reflux; great saphenous vein (GSV) and small saphenous vein (SSV) diameters; laterality; and CEAP clinical class were recorded. Pathological reflux was defined as reversed flow lasting >0.5 s in superficial truncal veins and >1.0 s in the common femoral, femoral, and popliteal veins. Univariable and multivariable logistic regression analyses examined factors associated with CVI. Results CVI was identified in 38 of 70 patients (54.3%; 95% confidence interval, 41.9%-66.3%). Venous reflux predominantly involved the superficial system, with GSV reflux as the most frequent segment-specific finding, whereas deep venous reflux was uncommon. Patients with CVI had greater GSV and SSV diameters than those without CVI (both p < 0.001), while age, body mass index (BMI), and disease duration did not differ between groups. CVI frequency increased across BMI categories, although the overall categorical association was not significant. Lipedema stage was not associated with CVI or individual reflux patterns; however, increasing lipedema stage showed a weak positive association with higher CEAP clinical class. Age, BMI, and lipedema stage were not independently associated with CVI in multivariable analysis. Conclusions Venous insufficiency was frequently observed in patients with lipedema and predominantly involved the superficial venous system. Greater saphenous vein diameters provided an objective ultrasonographic correlate of venous involvement. Because an appropriately matched local control population was not available, the present study cannot establish whether venous reflux is more frequent in patients with lipedema than in the general population. The observed relationship between lipedema stage and CEAP clinical class should therefore be considered hypothesis-generating and warrants confirmation in prospective controlled studies.