[Obesity and secondary lymphedema]

Obesity causes all types of lymphedema to deteriorate. Obesity-associated lymphedema is by now the most frequent secondary lymphedema and constitutes an entity in its own right. Obesity and its comorbidities, due to mechanical and inflammatory effects, decrease lymphatic transport and create a vicious circle of lymph stasis, local adipogenesis, and fibrosis. The therapeutic strategy must therefore address both lymphedema and obesity and its comorbidities.

Chronic venous insufficiency in a geriatric collective

Aim: Investigation of symptoms of chronic venous insufficiency (CVI) in geriatric patients > 65 years and their relation to activities of daily life and locomotion.

Methods: This monocenter pilot study collects data from patients of a geriatric hospital. We qualified Activities of daily live by Barthel Index, locomotion via Timed-Up-and-Go-test and clinical CEAP levels and included data from the Venous Clinical Severity Score and the patient questionnaire of the German Society of Phlebology. Additionally a duplex-sonographic screening was performed. Identified CEAP levels were correlated with results of the scores mentioned above.

Results: 42 patients with an average age of 80.5 (64–93) years were included. 76.2 % of them had a CEAP-score of ≥3. CEAP-score 5-6 correlated with limited locomotion and independence in activities of daily life. 81 % of the patients had previous venous therapies.

Conclusion: CVI is an underestimated disease in elder patients. In our collective a great part of patients showed relevant clinical symptoms of CVI which were aggravated by limitations of higher age. Early diagnostic and therapy of CVI are indicated to reduce complicated clinical courses.

Diagnostics of ulcus cruris venosum

Clinical diagnostics of venous leg ulcers set the course for efficient therapy. Precise clinical findings with an objectification of signs and symptoms of chronic venous insufficiency are essential. Duplex ultrasound investigations of the leg veins are necessary in the very early stages after the appearance of leg ulcers. Furthermore, not only a clinical investigation of the arterial perfusion but also the determination of the ankle-brachial-index is obligatory. Microbiological diagnostics are currently seen as useful in Germany, due to discussions on MRSA, even though they don´t have an immediate therapeutic consequence without the presence of clinical signs of infection. Therapeutic achievements can be objectified by a continuous documentation of the wound size, the wound bed, the wound exudate and signs of infection as well as the life quality of patients with chronic wounds.