Anatomy of the subcutaneous lymph vascular network of the human leg in relation to the great saphenous vein.

Anatomy of the subcutaneous lymph vascular network of the human leg in relation to the great saphenous vein.

Anat Rec (Hoboken). 2009

Schacht V, Luedemann W, Abels C, Berens von Rautenfeld D.
Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany. vivien.schacht@uniklinik-freiburg.de

The anatomical relationship between lymphatic collectors and veins is of clinical importance for preventing lymphedema secondary to lymphatic collector injury during surgical procedures. To identify areas at risk during surgical interventions, we performed an anatomical study of human legs. The lymphatic collectors of 42 legs of human cadavers were injected with Berlin Blue solution or contrast medium. After fixation, the collectors were dissected and their distances from the great saphenous vein were determined. We found that the lymphatic collectors on the dorsum of the foot ran in close parallel with the corium, whereas in the groin a greater number of lymphatic collectors clustered around the great saphenous vein. The ventromedial bundle that drains into the superficial inguinal nodes included 5-20 lymphatic collectors. The average width of the ventromedial bundle varied between 116 mm at the middle of the lower leg and 32 mm at the groin. Our study cannot confirm the previous observation of a bottleneck of the ventromedial bundle occurring at the knee, but does support the finding of an elongated bottleneck at the thigh and groin draining into the superficial inguinal lymph nodes. In addition, the idea of one sentinel lymph node for a specific region of the leg is not supported by these data. These observations will help surgeons to plan incisions and dissections with respect to lymphatic collectors, thereby minimizing damage to them and reducing complications resulting from unnecessary lymphatic excisions. Anat Rec, 2009.

PubMed

Interventions for varicose veins and leg lymphedema in pregnancy.

Interventions for varicose veins and leg lymphedema in pregnancy.
Cochrane Database Syst Rev. 2007 Jan

Bamigboye AA, Smyth R.
Mediclinic Private Hospital and Department of Obstetrics and Gynaecology, University of Witwatersra, PO Box 15184, Nelspruit, Mpumalanga, South Africa, 1200. bami@medinet.co.za

BACKGROUND: Pregnancy is presumed to be a major contributory factor in the increased incidence of varicose veins in women, which can in turn lead to venous insufficiency and leg oedema. The most common symptom of varicose veins and oedema is the substantial pain experienced, as well as night cramps, numbness, tingling, the legs may feel heavy, achy, and possibly be unsightly. Treatment of varicose veins are usually divided into three main groups: surgery, pharmacological and non-pharmacological treatments. Treatments of leg oedema comprise mostly of symptom reduction rather than cure and use pharmacological and non-pharmacological approaches.

OBJECTIVES: To assess any form of intervention used to relieve the symptoms associated with varicose veins and leg oedema in pregnancy.

SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2006).

SELECTION CRITERIA: Randomised trials of treatments for varicose veins or leg oedema, or both, in pregnancy.

DATA COLLECTION AND ANALYSIS: Both review authors independently assessed trials for eligibility, methodological quality and extracted all data.

MAIN RESULTS: Three trials, involving 159 women, were included.

VARICOSE VEINS: One trial, involving 69 women, reported that rutoside significantly reduced the symptoms associated with varicose veins (relative risk (RR) 1.89, 95% confidence interval (CI) 1.11 to 3.22). There were no significant differences in side-effects (RR 0.86, 95% CI 0.13 to 5.79) or incidence of deep vein thrombosis (RR 0.17, 95% CI 0.01 to 3.49).

EDEMA: One trial, involving 35 women, reported no significant difference in lower leg volume when compression stockings were compared against rest (weighted mean difference -258.80, 95% CI -566.91 to 49.31). Another trial, involving 55 women, compared reflexology with rest. Reflexology significantly reduced the symptoms associated with oedema (reduction in symptoms: RR 9.09, 95% CI 1.41 to 58.54). There was no evidence of significant difference in the women's satisfaction and acceptability with either intervention (RR 6.00, 95% CI 0.92 to 39.11).

AUTHORS' CONCLUSIONS: Rutosides appear to help relieve the symptoms of varicose veins in late pregnancy. However, this finding is based on one small study (69 women) and there are not enough data presented in the study to assess its safety in pregnancy. It therefore cannot be routinely recommended. Reflexology appears to help improve symptoms for women with leg oedema, but again this is based on one small study (43 women). External compression stockings do not appear to have any advantages in reducing oedema.

Plain language summary

Not enough evidence on treatments for varicose veins and leg oedema in pregnancyVaricose veins, sometimes called varicosity, occur when a valve in the blood vessel walls weakens and the blood stagnates. This in turn leads to problems with the circulation in the veins and to oedema or swelling. The vein then becomes distended, its walls stretch and sag, allowing the vein to swell into a tiny balloon near the surface of the skin. The veins in the legs are most commonly affected as they are working against gravity, but the vulva (vaginal opening) or rectum, resulting in haemorrhoids (piles), can be affected too. Pregnancy seems to increase the risk of varicose veins and they cause considerable pain, night cramps, numbness, tingling, the legs may feel heavy, achy, and they are rather ugly. Treatments for varicose veins are usually divided into three main groups: surgery, pharmacological treatments and non-pharmacological. The review identified three trials involving 159 women. Although the drug rutoside seemed to be effective in reducing symptoms, the study was too small to be able to say this with real confidence. Similarly, with compression stockings and reflexology, there were insufficient data to be able to assess benefits and harms, but they looked promising. More research is needed.

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