OtherEvidence-Based Clinical Medicine
Approach to Leg Edema of Unclear Etiology
John W. Ely, Jerome A. Osheroff, M. Lee Chambliss and Mark H. Ebell
The Journal of the American Board of Family
Medicine March 2006, 19 (2) 148-160; DOI: https://doi.org/10.3122/jabfm.19.2.148
John W. Ely
MD, MSPH
Jerome A. Osheroff
MD
M. Lee Chambliss
MD, MSPH

References
- ↵Menzoain JO, Doyle JE. Venous insufficiency of the leg. Hosp Pract 1989; 24: 109–16.
- ↵Alguire PC, Mathes BM. Chronic venous insufficiency and venous ulceration. J Gen Intern Med 1997; 12: 374–83.
- ↵
- ↵Blankfield RP, Finkelhor RS, Alexander JJ, et al. Etiology and diagnosis of bilateral leg edema in primary care. Am J Med 1998; 105: 192–7.
- ↵
- ↵Gorman WP, Davis KR, Donnelly R. ABC of arterial and venous disease. Swollen lower limb-1: general assessment and deep vein thrombosis. BMJ 2000; 320: 1453–6.
- ↵Mortimer PS. Swollen lower limb-2: lymphoedema. BMJ 2000; 320: 1527–9.
- ↵Rudkin GH, Miller TA. Lipidema: a clinical entity distinct from lymphedema. Plast Reconstr Surg 1994; 94: 841–7.
- ↵
- ↵
- ↵
- ↵
- ↵Topham EJ, Mortimer PS. Chronic lower limb oedema. Clin Med 2002; 2: 28–31.
- ↵Cho S, Atwood JE. Peripheral edema. Am J Med 2002; 113: 580–6.
- ↵Tiwari A, Cheng KS, Button M, Myint F, Hamilton G. Differential diagnosis, investigation, and current treatment of lower limb lymphedema. Arch Surg 2003; 138: 152–61.
- ↵
- ↵Frishman WH. Effects of nonsteroidal anti-inflammatory drug therapy on blood pressure and peripheral edema. Am J Cardiol 2002; 89: 18D–25D.
- ↵Padberg F Jr, Cerveira JJ, Lal BK, Pappas PJ, Varma S, Hobson RW 2nd. Does severe venous insufficiency have a different etiology in the morbidly obese? Is it venous? J Vasc Surg 2003; 37: 79–85.
- Ageno W, Piantanida E, Dentali F, et al. Body mass index is associated with the development of the post-thrombotic syndrome. Thromb Haemost 2003; 89: 305–9.
- ↵Szuba A, Rockson SG. Lymphedema: classification, diagnosis, and therapy. Vasc Med 1998; 3: 145–6.
- ↵
- ↵Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347: 161–7.
- ↵Powell AA, Armstrong MA. Peripheral edema. Am Fam Physician 1997; 55: 1721–6.
- ↵Stein PD, Hull RD, Patel KC, et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med 2004; 140: 589–602.
- Palareti G, Legnani C, Cosmi B, et al. Predictive value of D-dimer test for recurrent venous thromboembolism after anticoagulation withdrawal in subjects with a previous idiopathic event and in carriers of congenital thrombophilia. Circulation 2003; 108: 313–8.
- Palareti G, Legnani C, Cosmi B, Guazzaloca G, Pancani C, Coccheri S. Risk of venous thromboembolism recurrence: high negative predictive value of D-dimer performed after oral anticoagulation is stopped. Thromb Haemost 2002; 87: 7–12.
- ↵Brotman DJ, Segal JB, Jani JT, Petty BG, Kickler TS. Limitations of D-dimer testing in unselected inpatients with suspected venous thromboembolism. Am J Med 2003; 114: 276–82.
- ↵Szendro G, Nicolaides AN, Zukowski AJ, et al. Duplex scanning in the assessment of deep venous incompetence. J Vasc Surg 1986; 4: 237–42.
- ↵Marks AD. Intermittent fluid retention in women. Is it idiopathic edema? Postgrad Med 1983; 73: 75–83.
- ↵Streeten DH. Idiopathic edema. Pathogenesis, clinical features, and treatment. Endocrinol Metab Clin North Am 1995; 24: 531–47.
- ↵Rockson SG. Lymphedema. Am J Med 2001; 110: 288–95.
- ↵Mortimer PS. Managing lymphedema. Clin Exp Dermatol 1995; 20: 90–106.
- ↵Bull RH, Gane JN, Evans JE, Joseph AE, Mortimer PS. Abnormal lymph drainage in patients with chronic venous leg ulcers. J Am Acad Dermatol 1993; 28: 585–90.
- ↵
- ↵Zlatnik FJ. Hypertension in pregnancy. The Iowa Perinatal Letter 2004; 25: 5–9.
- ↵Brandjes DP, Buller HR, Heijboer H, et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997; 349: 759–62.
- Ginsberg JS, Hirsh J, Julian J, et al. Prevention and treatment of postphlebitic syndrome: results of a 3-part study. Arch Intern Med 2001; 161: 2105–9.
- Kolbach DN, Sandbrink MW, Hamulyak K, Neumann HA, Prins MH. Non-pharmaceutical measures for prevention of post-thrombotic syndrome. Cochrane Database Syst Rev 2004 (1):CD004174.
- Prandoni P, Lensing AW, Prins MH, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med 2004; 141: 249–56.
- ↵
- Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev 2002 (1):CD003230.
- Pittler MH, Ernst E. Horse-chestnut seed extract for chronic venous insufficiency. A criteria-based systematic review. Arch Dermatol 1998; 134: 1356–60.
- Diehm C, Trampisch HJ, Lange S, Schmidt C. Comparison of leg compression stocking and oral horse-chestnut seed extract therapy in patients with chronic venous insufficiency. Lancet 1996; 347: 292–4.
- ↵Facino RM, Carini M, Stefani R, Aldini G, Saibene L. Anti-elastase and anti-hyaluronidase activities of saponins and sapogenins from Hedera helix, Aesculus hippocastanum, and Ruscus aculeatus: factors contributing to their efficacy in the treatment of venous insufficiency. Arch Pharm (Weinheim) 1995; 328: 720–4.
- ↵Kay A, Davis CL. Idiopathic edema. Am J Kidney Dis 1999; 34: 405–23.
- MacGregor GA, Markandu ND, Roulston JE, Jones JC, de Wardener HE. Is “idiopathic” edema idiopathic? Lancet 1979; 1: 397–400.
- Idiopathic edema: role of diuretic abuse. Kidney Int 1981; 19: 881–91.
- ↵
- ↵Lip GYH, Hull RD. Treatment of deep vein thrombosis. Available from www.UpToDate.com. Accessed on 5 November 2004.
- ↵Streeten DHP. Orthostatic disorders of the circulation. New York: Plenum Press; 1987.
- Coon WW, Willis PW 3rd, Keller JB. Venous thromboembolism and other venous disease in the Tecumseh community health study. Circulation 1973; 48: 839–46.
- Niemeyer NV, Janney LM. Thiazolidinedione-induced edema. Pharmacotherapy 2002; 22: 924–9.
- Bounameaux H, de Moerloose P, Perrier A, Reber G. Plasma measurement of D-dimer as diagnostic aid in suspected venous thromboembolism: an overview. Thromb Haemost 1994; 71: 1–6.
- Lensing AW, Prandoni P, Brandjes D, et al. Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med 1989; 320: 342–5.
- Mattos MA, Londrey GL, Leutz DW, et al. Color-flow duplex scanning for the surveillance and diagnosis of acute deep venous thrombosis. J Vasc Surg 1992; 15: 366–75; Discussion 375–6.
- Monreal M, Montserrat E, Salvador R, et al. Real-time ultrasound for diagnosis of symptomatic venous thrombosis and for screening of patients at risk: correlation with ascending conventional venography. Angiology 1989; 40: 527–33.
- Partsch H. Compression therapy of the legs. A review. J Dermatol Surg Oncol 1991; 17: 799–805.
- ↵Ebell MH, Siwek J, Weiss BD. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. J Fam Pract 2004; 53: 111–20.
- Brater DC. Diuretic therapy. N Engl J Med 1998; 339: 387–95.
- Such J, Runyon BA. Initial therapy of ascites in patients with cirrhosis. Available from UpToDate.com. Accessed on 27 September 2004.
- Fogel MR, Sawhney VK, Neal EA, Miller RG, Knauer CM, Gregory PB. Diuresis in the ascitic patient: a randomized controlled trial of three regimens. J Clin Gastroenterol 1981; 3(Suppl 1): 73–80.
- Shichiri M, Shiigai T, Takeuchi J. Long-term furosemide treatment in idiopathic edema. Arch Intern Med 1984; 144: 2161–4.
In this issue
The Journal of the American Board of Family
Medicine
Vol. 19, Issue 2
March-April 2006
Approach to Leg Edema of Unclear Etiology
John W. Ely, Jerome A. Osheroff, M. Lee Chambliss, Mark H. Ebell
The Journal of the American Board of Family
Medicine Mar 2006, 19 (2) 148-160; DOI: 10.3122/jabfm.19.2.148
Jump to section
Related Articles
Cited By...
- Cross-sectional study investigating the relationship between pit recovery time and serum albumin levels in bilateral lower extremity pitting oedema
- The Most Frequently Read Articles of 2021
- Combined Use of Calcium-channel Blockers With Ombitasvir/Paritaprevir/Ritonavir Exacerbates Peripheral Edema in Elderly Japanese Patients
- The Most Frequently Read Articles of 2020
- The Most Frequently Read Articles of 2019
- Content Usage and the Most Frequently Read Articles of 2018
- Phlegmasia cerulea dolens from radiation-induced venous stenosis
- Adrenocortical carcinoma presenting as bilateral pitting leg oedema
- Unilateral lower extremity swelling as a rare presentation of non-Hodgkin's lymphoma
- Swollen right leg: Is it deep vein thrombosis?
- Content Usage and the Most Frequently Read Articles in 2010
- Content Usage and the Most Frequently Read Articles in 2009
- A 79 year old woman with a swollen right leg
- Introduction of More Editorial Board Members and New Guest Commentary Feature
- Reliability and Feasibility of Methods to Quantitatively Assess Peripheral Edema
- Introduction of More Editorial Board Members and the Most Frequently Read Articles in 2008
- Inside the March/April 2008 Issue and the Most Frequently-Read Articles in 2007