Prevalence and Clinical Characteristics of Chronic Venous Insufficiency among Individuals with Lower Extremity Lymphoedema: A Systematic Review and Meta-analysis.
meta_analysis · Level I
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- Record sourced from PubMed, PMID 42431576.
- Also identified by DOI 10.1016/j.ejvs.2026.07.012.
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Abstract
Lower extremity lymphoedema is increasingly recognised as a multifactorial condition in which chronic venous insufficiency (CVI) may play an important role. This study aimed to estimate the pooled prevalence of CVI among individuals with lower extremity lymphoedema and to summarise clinical characteristics of patients with combined disease. PubMed, Web of Science, and the Cochrane Library were searched from database inception through 13 November 2025. Observational studies reporting CVI among individuals with lower extremity lymphoedema were included. Study selection, data extraction, and risk of bias assessments were performed independently by two reviewers. Pooled prevalence was estimated using a random effects generalised linear mixed model. Eighteen studies were included; 12 contributed to the prevalence meta-analysis, comprising 1 563 individuals with lower extremity lymphoedema, of whom 570 had coexisting CVI. The pooled prevalence was 45.7% (95% confidence interval [CI] 31.0 - 61.2%; GRADE, very low certainty evidence), with substantial heterogeneity (I<sup>2</sup> = 95.6%). In a restricted analysis limited to five studies with clearer case definitions, systematic venous assessment, and well defined denominators, pooled prevalence was 48.8% (95% CI 23.1 - 75.1%; very low certainty evidence), with persistent heterogeneity (I<sup>2</sup> = 92.2%). Ten studies reported descriptive data, including 1 111 individuals with combined disease. The pooled female proportion was 66.3%. Age and body mass index varied widely. Diagnostic criteria and clinical characteristics were inconsistently reported. Quality of life outcomes were assessed infrequently and inconsistently. Most studies demonstrated moderate to high risk of bias. CVI was present in approximately half of patients with lower extremity lymphoedema across diverse clinical settings. Marked heterogeneity reflects differences in diagnostic criteria, study populations, and reporting practices. Routine evaluation of venous disease in patients with lower extremity lymphoedema should be considered. Standardised diagnostic and reporting frameworks are needed in future research.