Seasonal variation in swelling of lower extremity edema in patients with chronic venous insufficiency

Abstract

ObjectiveWe had observed that some patients with chronic venous insufficiency (CVI) had reported their lower extremity edema was worse during warmer weather. Limited research is available regarding the seasonal variation in lower extremity edema. Patients with CVI were questioned to determine whether they had experienced significant seasonal variation in their lower extremity edema and which factors might be associated with such variation. MethodsConsecutive patients with lower extremity edema were asked whether the edema was worse in the summer or warmer weather. Data was collected between June 2017 and August 2020. A total of 1683 patients (age range, 16-102 years; mean ± standard deviation, 62 ± 14.3 years). Of the 1683 patients, 1157 were female (mean age, 62 ± 14.13 years) and 526 were male (mean age, 62.5 ± 13.82 years). Data were also collected on the presenting symptoms, degree of venous reflux of the great saphenous vein (GSV) reported from the most recent duplex ultrasound, and the season at the time of questioning. For statistical analysis, χ2 goodness-of-fit tests and one-way analysis of variance tests were used. ResultsOf the 1683 patients, 56.6% had reported worsening of their lower extremity edema during warmer weather, including 62.7% of the female patients and 37.3% of the male patients. The female patients had reported significantly more worsening of their lower extremity edema (P = 7.06e-18). Female patient age was associated with whether they had experienced worsening (P = .02), with more younger patients reporting worsening. Male patient age was not associated with whether they had reported worsening (P = .97). No significant differences were found in the degree of presenting symptoms between those who had and had not reported worsening (P = .58). Also, no significant differences were found in the degree of venous reflux between the right (P = .61) and left (P = .89) GSV between those who had and had not reported worsening. The season in which the patients had presented during the study period was associated with whether they had reported worsening edema. The patients who had been questioned in the winter (December, January, February) and summer (June, July, August) had reported more worsening of their edema in the warmer months (P = .008 and P = .0002, respectively). The patients who had been questioned in the spring (March, April, May) and fall (September, October, November) had not reported significantly more worsening of their edema in the warmer months (P = .167 and P = .119, respectively). ConclusionsOf the 1683 patients surveyed, 56.6% had reported worsened edema in the warmer weather. The women (especially the younger women) in the present study had experienced significant worsening, although the men had not. The degree of GSV venous reflux and severity of the presenting symptoms of the patients was not associated with whether worse edema had been reported. However, the season in which the patients had been questioned was associated with the report of worsening edema. The patients questioned in the coldest and warmest months had reported significantly more worsening. The patients questioned in the milder months had not reported significantly more worsening. These findings suggest that a sex and age bias exists in the seasonal variation of lower extremity edema in patients with CVI.