

Primary Causes of EDEMA (Leg Swelling)
Venous insufficiency leads to backup of blood and increased pressure in the veins thereby resulting in edema of legs and feet. Edema of the legs also can occur with an episode of deep vein thrombosis, which is a blood clot within a vein. A clot in the deep vein blocks the return of blood and then increases back-pressure in the leg veins.
It is also postulated that venous insufficiency can be an independent risk factor for deep vein thrombosis, which can be a very dangerous condition. Venous insufficiency is a problem that is localized to the legs, ankles and feet. One leg may be more affected than the other (asymmetrical edema). Often both legs are simultaneously affected as the underlying anatomic pathology often mimics bilaterally.
In contrast, systemic diseases that are associated with fluid retention (congestive heart failure) almost always causes the same amount of edema in both legs and can also cause edema and swelling elsewhere in the body.
The response to diuretic drugs in patients with venous insufficiency tends to be unsatisfactory.
This is because the continued pooling of fluid in the lower extremities makes it difficult for the diuretics to mobilize the edema fluid. Elevation of the legs periodically during the day and the use of compression stockings may temporarily help the condition, but ultimately venous insufficiency is a mechanical problem that responds to mechanical solutions commonly performed today, such as endovenous thermal ablation.
There are several conditions that can cause the valves and veins to work improperly.Any problem that increases pressure in the veins can stretch the veins, and damage the valves, which leads even to higher pressures and worsened vein function. A clot in a vein will block blood flow, which increases the pressures and damages veins or valves, even after the clot has dissolved.
Leg injury like a bite, bone fracture or surgery can damage the veins or valves. Increased body weight (pregnancy, obesity, etc) can increase pressure in the veins of legs and this lead to irreparable damage to the veins and valves.
The muscles in the legs play an important role in the circulation of blood, acting as a pump. Standing or sitting for prolonged periods without walking can decrease the movement of blood out of the legs and lead to increased pressures in the veins and pooling of blood.
COMMON CAUSES OF CONGESTIVE HEART FAILURE
The most common diagnosis for hospital admission is congestive heart failure,
and one of the most common signs of congestive heart failure is leg swelling or edema.
The term edema is not a diagnosis but a term referring to excess fluid in tissue.
The underlying cause must be diagnosed because the excess fluid is a barrier to oxygen
and nutrient transportation to the skin.
Edema makes legs feel heavy and patients, naturally, want the problem fixed.
There is also transient peripheral edema, sometimes called normal edema, which is common
and relates to posture, climatic conditions and age.
- Coronary Artery Disease
- High Blood Pressure
- Diseases of Heart Muscle
- Disorders of the Heart Valves
CHRONIC LEG SWELLING – THE BASICS
Chronic swelling is complex and challenging for physicians to make a diagnosis and if the cause is not found it leave patients confused and disappointed. The healthcare worker charts the diagnosis as edema.
Sometimes the swelling is due to increased adipose tissue called lipedema the swelling is unilateral or bilateral, and to check the symmetry. Edema of the legs is a very common and
uncomfortable sign of underlying disease.
With the advent of Doppler Ultrasonography, accurate diagnosis and appropriate treatment can be readily administrated.
As the causes and treatment paradigms are very different for the two most common causes of edema (congestive heart failure and venous insufficiency), it is very important that proper diagnosis is made.
Edema of the lower extremity in persons over 50 years is most commonly due to venous insufficiency. But leg edema in women that are younger than 50 years is often idiopathic edema which can relate to monthly menstrual cycles.
Both of these diseases can cause leg edema before becoming apparent in other ways. While taking the history, another cause that must be considered is medications. There are two diagnostic considerations that must not be overlooked – pulmonary hypertension and early congestive heart failure.

UNDERSTANDING EDEMA
Starling’s hypothesis includes four basic mechanisms of edema:
Increased hydraulic (hydrostatic) pressure gradient:
Which refers to pushing fluid out of blood vessels into interstitial space (space between cells).
Decreased oncotic or osmotic pressure gradient
Refers to a pulling of fluid into blood vessels to equalize the concentration of solutes across a membrane. Remember veins and lymphatics work as a team to remove fluid.
Increased capillary permeability
Hydraulic pressure can occur at the arterial or venous end of the capillary. There is medication and also inflammation that can cause arteriole sphincter relaxation. Calcium channel blockers are notorious for causing lower extremity edema.
Decreased oncotic or osmotic pressure gradient
Decreased lymphatic flow. The vasodilator Hydrazine is a good drug to keep in mind, while Pletal, a phosphodiesterase inhibitor used for claudication, is another medication to consider.
To mention a few other drugs:
Antihypertensive drugs: Calcium Channel Blockers | Beta Blockers | Clonidine, Hydralazine | Minoxidil | Methyldopa
Hormones: Corticosteroids | Oestrogen | Progesterone | Testosterone
Others: NSAIDs | Pioglitazone, Rosiglitazone | Monoamine oxidase inhibitors
Moving to the venous side of the capillary, simple limb dependency can cause normal physiologic swelling, while the most common cause of pathologic swelling relates to venous insufficiency.
There is a variety of medical conditions causing excess fluid volume that must be considered, such as congestive heart failure and renal disease.
Hormones, especially oestrogen and progesterone, can affect the venous end of the capillary and NSAID’s, which affect the arteriole end of capillary.
Two relatively new terms are Obesity Related Chronic Lymphedema-Like Swelling and Elephantiasis Nostras Verrucosa which refers to the monstrous leg swelling and lipodermatosclerosis seen in morbid obese patients. The weight of the abdomen causes venous compression in sitting position. A decreased plasma colloid osmotic pressure can result from any protein wasting condition, such as malnutrition; enteropathies, such as Crohn’s disease protein-losing nephropathy; and hepatic disease (deceased plasma protein production).
An increase in the interstitial oncotic pressure due to an accumulation macromolecules in the interstitium from lymphatic obstruction or the deposition of other active substances. For example, mucopolysaccharide deposits related to hypothyroidism. Increased capillary permeability like allergy, inflammation, and endothelial damage from burns, toxins, or trauma.
Allergic reactions result in histamine release that cause endothelial cells to shrink, which increases distance between cell margins and lead to increased capillary permeability. Inflammation can occur with infections or systemic conditions (lupus, vasculitis). Just prior to menstruation, fluid retention can occur due to capillary permeability, termed idiopathic edema.
There are also other causes for idiopathic edema like chronic consumption of diuretics and re-feeding in women who drastically cut down on food consumption to lose weight.
Decreased lymphatic flow related to obstruction or disruption of lymphatic system from tumours, surgery, trauma, infection/inflammation or radiation. Clinically looks like ‘pillow feet’ and ‘sausage toes’. Complications of lymphedema include recurrent cellulitis, lymphangitis and lymphangiosarcoma (looks like a non-healing ulcer).
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What our patients say
I had a blood clot and then a big vein developed – you could see it on my leg. Then this vein popped and it made a very big deep ulcer and it would not heal. I went from doctor to doctor, and they couldn’t help me. I would have lost my leg, but thanks to Dr van Wyk, my life has changed. Cornelia
After 36 years, then thirty procedures, I heard about Dr van Wyk from a supplier and had an appointment with him. I can say that my legs have all healed, and I can only rejoice and be thankful for the care I received from Dr van Wyk at #Vein Solutions! NO MORE PAIN! JOHAN
I am an 82 year old female patient with severe swelling of right leg, and venous ulcers. Duplex Dopplers show venous reflux. Radio frequency was done, as well as lymph drainage by a Sequential Circulator. The results from Dr. G Van Wyk was #Amazing! Linique
Frequently Asked Questions
What happens at the first consultation?
One of our specialists will assess your medical history and perform a clinical examination of your areas of concern. Clinical photographs of these areas of concern will also need to be obtained for your medical file.
However, clinical examination alone is insufficient, to accurately ‘map out the problem veins’ so patients will also require a duplex ultrasound scan on the legs.
Does the procedure hurt?
The amount of discomfort felt will vary with the individual. The needles used are extremely fine (similar to acupuncture needles) and many are hardly felt at all. The injected solution can sting slightly for short periods of time. If EVLA is used, then minimal discomfort is experienced as it is performed under local anesthetic.
How many treatments will I require?
Your treatment protocol, which includes the number of treatments required, will be determined at your first consultation.
Will vein treatment interfere with my work or home duties?
This is a walk-in, walk-out procedure. Most treatments take about 30 minutes to perform. Following treatment, your daily routine should not be disrupted, normal duties can be resumed.
Does vein treatment require a stay in hospital?
No hospital admission is necessary for our leg vein treatments. Sclerotherapy, ultrasound guided sclerotherapy, endovenous laser ablation, VenaSeal vein glue, etc – all these procedures are performed in clinic.
What are the costs of treatment?
The expected cost for treatment varies between individuals and will be provided in writing following your assessment. All payments are to be made on the day of review/treatment, either by medical aid (medical aid rates – and covered by most medical aids or by cash, eft/pos, credit card or cheque.