Lymphedema of venous etiology (LOVE) is a condition that deserves a lot more attention. Many people living with LOVE—and sometimes their providers—don’t know what it is. But LOVE affects everyone with a wound caused by a venous condition.
Wound care specialist Matthew M. Melin, MD, FACS, RPVI, FACCWS, treats people with lower extremity ulcers and lymphedema at the Mayo Clinic in Rochester, Minnesota. Dr. Melin explains what LOVE is, the link between leg ulcers and lymphedema, and why LOVE is so underdiagnosed.
Understanding Lymphedema of Venous Etiology
Lymphedema can have different causes, but “lymphedema of venous etiology” refers to any lymphedema that results from vein problems. Varicose veins, a venous disease, occur when veins become twisted and enlarged. In the wound clinic, Dr. Melin observes LOVE in people who have venous leg ulcers, which are sores or wounds caused by leaky varicose veins.
Dr. Melin describes what causes LOVE and why many people living with it don’t receive a complete diagnosis:
What Causes Lymphedema of Venous Etiology?
LOVE develops because of chronic venous insufficiency (CVI), where valves in leg veins can’t effectively keep blood flowing up toward the heart. This venous disease is the “venous etiology” part of LOVE. When blood pools in the lower extremities, it leads to varicose veins, swelling, and tissue damage that eventually causes ulcers.
“By definition, anyone who has a venous ulcer has lymphatics that aren’t working properly,” Dr. Melin says. This is why lymphatic dysfunction (lymphedema) always accompanies CVI leg ulcers.
Why is LOVE Underdiagnosed?
Dr. Melin notes that providers are well-trained to recognize and treat venous conditions. However, physicians receive minimal education about lymphatic conditions. He believes this lack of education is one of the main reasons why leg ulcer-related lymphedema often goes undiagnosed and untreated.
Is Phlebolymphedema Related to LOVE?
Phlebolymphedema is the more formal name for LOVE. Dr. Melin and other providers and researchers saw how underrecognized phlebolymphedema was and wanted to make it easier to recall. They began using the LOVE acronym to help raise awareness.
Another reason phlebolymphedema/LOVE is underrecognized in wound clinics is partly because the condition doesn’t have a diagnosis code. Without a phlebolymphedema code for providers to enter into medical records and medical insurance claims, LOVE remains underdiagnosed.
Who Is at Risk for LOVE?
People with vein conditions are at risk of developing LOVE. The more severe the venous disease, the higher the risk of LOVE. Excess weight, prior history of deep venous clots, Type 2 diabetes, and lack of physical activity also raise the risk.
What is the Treatment for Lymphedema of Venous Etiology?
Leg ulcers require proper wound care. “Treatment for lower extremity ulcers includes cleaning the wound. We also may do an ultrasound to determine which vein may need to be surgically closed to get the wound to heal,” says Dr. Melin.
At the same time, lymphedema treatment supports wound healing by reducing the fluid and pressure contributing to the ulcer. LOVE treatment is the same as typical lymphedema treatment, which includes:
- Compression: Bandages or elastic compression garments worn over swollen areas to help reduce swelling and prevent more lymph fluid from collecting.
- Exercises and physical activity: Decongestive exercises and activities that help move fluid away from swollen areas.
- Manual lymphatic drainage (MLD): Specialized massage performed by a therapist or at home to move fluid toward your lymph nodes to reduce swelling.
- Skincare: Preventing dryness, cracks, and wounds in your skin to lower your risk of cellulitis—a serious bacterial infection often associated with lymphedema.
Dr. Melin emphasizes the importance of physical activity because a sedentary lifestyle worsens LOVE. He also notes that elevating the leg with the ulcer as much as possible reduces swelling and helps lymph drainage.
Lympha Press Compression Pumps and Garments for LOVE
Intermittent pneumatic compression (IPC) devices like Lympha Press are helpful for treating LOVE. These devices include a garment that fits over the swollen area and connects to a pump that applies gentle waves of pressure. The pressure helps move lymph fluid away from the areas affected by LOVE to reduce swelling.
IPC can jumpstart the healing of wounds caused by vein disease. Lympha Press lower body garments ideal for treating LOVE include:
- Leg garments: Sleeves that fit over each leg from the hip down.
- Lympha Pants™: Pants that treat the entire lower body from abdomen to feet.
- LymphaPod®: A specially designed size-inclusive garment that fits over the lower body.
Complete LOVE Treatment Is Critical
It’s challenging to get leg ulcers to heal without treatment to address lymphedema. “Even if you get the ulcer to heal, the recurrence rate is really high if you don’t also treat lymphedema,” says Dr. Melin. Leg ulcers are incredibly painful, challenging to care for, and can severely impact movement, so proper treatment is critical for overall quality of life.
In addition to compression, MLD, and decongestive exercises, treatment must include eating a nutritious diet, decreasing salt intake, and increasing water intake. Additionally, a drug that reduces inflammation and improves microcirculation is now included in several U.S. treatment guidelines as part of the standard of care for LOVE. MPFF (micronized purified flavonoid fraction) is made up of a combination of flavonoids such as diosmin and hesperidin. It has been used successfully in Europe for over 40 years.
All edema swelling is due to accumulated lymphatic fluid. With the right lymphedema treatments, it’s possible to significantly improve LOVE and your quality of life. And, if your leg ulcer heals, you’re less likely to develop another.
Learn more about LOVE in the article Diagnosing LOVE: Lymphedema of Venous Etiology.
