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

References

  1. ↵
    Menzoain JO, Doyle JE. Venous insufficiency of the leg. Hosp Pract 1989; 24: 109–16.
    OpenUrl
  2. ↵
    Alguire PC, Mathes BM. Chronic venous insufficiency and venous ulceration. J Gen Intern Med 1997; 12: 374–83.
    OpenUrlCrossRefPubMedWeb of Science
  3. ↵
    Kannel WB. Epidemiological aspects of heart failure. Cardiol Clin 1989; 7: 1–9.
    OpenUrlPubMed
  4. ↵
    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.
    OpenUrlCrossRefPubMedWeb of Science
  5. ↵
    Streeten DH. Idiopathic edema. Curr Ther Endocrinol Metab 1997; 6: 203–6.
    OpenUrlPubMed
  6. ↵
    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.
    OpenUrlFREE Full Text
  7. ↵
    Mortimer PS. Swollen lower limb-2: lymphoedema. BMJ 2000; 320: 1527–9.
    OpenUrlFREE Full Text
  8. ↵
    Rudkin GH, Miller TA. Lipidema: a clinical entity distinct from lymphedema. Plast Reconstr Surg 1994; 94: 841–7.
    OpenUrlPubMedWeb of Science
  9. ↵
    Ciocon JO, Fernandez BB, Ciocon DG. Leg edema: clinical clues to the differential diagnosis. Geriatrics 1993; 48: 34–40, 45.
    OpenUrlPubMed
  10. ↵
    Merli GJ, Spandorfer J. The outpatient with unilateral leg swelling. Med Clin North Am 1995; 79: 435–47.
    OpenUrlPubMed
  11. ↵
    Young JR. The swollen leg. Clinical significance and differential diagnosis. Cardiol Clin 1991; 9: 443–56.
    OpenUrlPubMed
  12. ↵
    Yale SH, Mazza JJ. Approach to diagnosing lower extremity edema. Compr Ther 2001; 27: 242–52.
    OpenUrlCrossRefPubMed
  13. ↵
    Topham EJ, Mortimer PS. Chronic lower limb oedema. Clin Med 2002; 2: 28–31.
    OpenUrlFREE Full Text
  14. ↵
    Cho S, Atwood JE. Peripheral edema. Am J Med 2002; 113: 580–6.
    OpenUrlCrossRefPubMedWeb of Science
  15. ↵
    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.
    OpenUrlCrossRefPubMedWeb of Science
  16. ↵
    Messerli FH. Vasodilatory edema: a common side effect of antihypertensive therapy. Curr Cardiol Rep 2002; 4: 479–82.
    OpenUrlCrossRefPubMed
  17. ↵
    Frishman WH. Effects of nonsteroidal anti-inflammatory drug therapy on blood pressure and peripheral edema. Am J Cardiol 2002; 89: 18D–25D.
    OpenUrlPubMedWeb of Science
  18. ↵
    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.
    OpenUrl
  19. L’Hermitte F, Behar A, Paries J, Cohen-Boulakia F, Attali JR, Valensi P. Impairment of lymphatic function in women with gynoid adiposity and swelling syndrome. Metabolism 2003; 52: 805–9.
    OpenUrlPubMed
  20. 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.
    OpenUrlPubMedWeb of Science
  21. ↵
    Szuba A, Rockson SG. Lymphedema: classification, diagnosis, and therapy. Vasc Med 1998; 3: 145–6.
    OpenUrlAbstract/FREE Full Text
  22. ↵
    Stemmer R. Ein klinisches zeichen zur gruhund differential diagnose des lymphodems. [A clinical symptom for the early and differential diagnosis of lymphedema]. German. Vasa 1976; 5: 261–2.
    OpenUrlPubMed
  23. ↵
    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.
    OpenUrlCrossRefPubMedWeb of Science
  24. ↵
    Powell AA, Armstrong MA. Peripheral edema. Am Fam Physician 1997; 55: 1721–6.
    OpenUrlPubMedWeb of Science
  25. ↵
    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.
    OpenUrlCrossRefPubMedWeb of Science
  26. 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.
    OpenUrlAbstract/FREE Full Text
  27. 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.
    OpenUrlPubMedWeb of Science
  28. ↵
    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.
    OpenUrlCrossRefPubMedWeb of Science
  29. ↵
    Szendro G, Nicolaides AN, Zukowski AJ, et al. Duplex scanning in the assessment of deep venous incompetence. J Vasc Surg 1986; 4: 237–42.
    OpenUrlCrossRefPubMedWeb of Science
  30. ↵
    Marks AD. Intermittent fluid retention in women. Is it idiopathic edema? Postgrad Med 1983; 73: 75–83.
    OpenUrl
  31. ↵
    Streeten DH. Idiopathic edema. Pathogenesis, clinical features, and treatment. Endocrinol Metab Clin North Am 1995; 24: 531–47.
    OpenUrlPubMedWeb of Science
  32. ↵
    Rockson SG. Lymphedema. Am J Med 2001; 110: 288–95.
    OpenUrlCrossRefPubMedWeb of Science
  33. ↵
    Mortimer PS. Managing lymphedema. Clin Exp Dermatol 1995; 20: 90–106.
    OpenUrl
  34. ↵
    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.
    OpenUrlPubMedWeb of Science
  35. ↵
    Seippel L, Eriksson O, Grankvist K, von Shoultz B, Backstrom T. Physical symptoms in premenstrual syndrome are related to plasma progesterone and desoxycorticosterone. Gynecol Endocrinol 2000; 14: 173–81.
    OpenUrlPubMed
  36. ↵
    Zlatnik FJ. Hypertension in pregnancy. The Iowa Perinatal Letter 2004; 25: 5–9.
    OpenUrl
  37. ↵
    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.
    OpenUrlCrossRefPubMedWeb of Science
  38. 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.
    OpenUrlCrossRefPubMedWeb of Science
  39. 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.
  40. 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.
    OpenUrlCrossRefPubMedWeb of Science
  41. ↵
    Rehn D, Unkauf M, Klein P, Jost V, Lucker PW. Comparative clinical efficacy and tolerability of oxerutins and horse chestnut extract in patients with chronic venous insufficiency. Arzneimittelforschung 1996; 46: 483–7.
    OpenUrlPubMed
  42. Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev 2002 (1):CD003230.
  43. Pittler MH, Ernst E. Horse-chestnut seed extract for chronic venous insufficiency. A criteria-based systematic review. Arch Dermatol 1998; 134: 1356–60.
    OpenUrlCrossRefPubMedWeb of Science
  44. 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.
    OpenUrlCrossRefPubMedWeb of Science
  45. ↵
    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.
    OpenUrlCrossRefPubMed
  46. ↵
    Kay A, Davis CL. Idiopathic edema. Am J Kidney Dis 1999; 34: 405–23.
    OpenUrlPubMedWeb of Science
  47. MacGregor GA, Markandu ND, Roulston JE, Jones JC, de Wardener HE. Is “idiopathic” edema idiopathic? Lancet 1979; 1: 397–400.
    OpenUrl
  48. Idiopathic edema: role of diuretic abuse. Kidney Int 1981; 19: 881–91.
    OpenUrlCrossRefPubMedWeb of Science
  49. ↵
    Rose BD. Idiopathic edema. Available from UpToDate.com. Accessed on 26 February 2005.
  50. ↵
    Lip GYH, Hull RD. Treatment of deep vein thrombosis. Available from www.UpToDate.com. Accessed on 5 November 2004.
  51. Boyd DA. Unilateral lower extremity edema in May-Thurner syndrome. Mil Med 2004; 169: 968–71.
    OpenUrlPubMed
  52. ↵
    Streeten DHP. Orthostatic disorders of the circulation. New York: Plenum Press; 1987.
  53. Coon WW, Willis PW 3rd, Keller JB. Venous thromboembolism and other venous disease in the Tecumseh community health study. Circulation 1973; 48: 839–46.
    OpenUrlAbstract/FREE Full Text
  54. Rose BD. Approach to the adult with edema. Available from UpToDate.com. Accessed 11 October 2004.
  55. Niemeyer NV, Janney LM. Thiazolidinedione-induced edema. Pharmacotherapy 2002; 22: 924–9.
    OpenUrlCrossRefPubMedWeb of Science
  56. 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.
    OpenUrlPubMedWeb of Science
  57. 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.
    OpenUrlCrossRefPubMedWeb of Science
  58. 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.
    OpenUrlCrossRefPubMedWeb of Science
  59. 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.
    OpenUrlPubMedWeb of Science
  60. Partsch H. Compression therapy of the legs. A review. J Dermatol Surg Oncol 1991; 17: 799–805.
    OpenUrlPubMedWeb of Science
  61. ↵
    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.
    OpenUrlPubMedWeb of Science
  62. Brater DC. Diuretic therapy. N Engl J Med 1998; 339: 387–95.
    OpenUrlCrossRefPubMedWeb of Science
  63. Such J, Runyon BA. Initial therapy of ascites in patients with cirrhosis. Available from UpToDate.com. Accessed on 27 September 2004.
  64. 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.
    OpenUrl
  65. Shichiri M, Shiigai T, Takeuchi J. Long-term furosemide treatment in idiopathic edema. Arch Intern Med 1984; 144: 2161–4.
    OpenUrlCrossRefPubMedWeb of Science
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