Recurrent lymphangitis, deep trauma, malignancy, and related treatments (ie surgery and radiotherapy) are usually considered the commonest causes of lymphedema. The role of chronic venous disease in this context is often overlooked; yet, all patients with advanced venous disease (stasis dermatitis) have some degree of lymph circulation impairment.1 Venous edema is assumed to be the sole consequence of increased capillary filtration from venous hypertension. Because lymph drainage is the main buffer against the formation of edema, a compensation for the increased lymph load does occur at the beginning. In the long run, however, when the transport capacity is exceeded, the lymphatics fail to keep their buffer function, and interstitial fluid accumulates. This leads to a clinical condition of mixed venous and lymphatic insufficiency that causes a progressive swelling of soft tissues, which is termed phlebolymphedema.2 There is clinical and laboratory evidence confirming the presence of microangiopathy of the lymphatic network in patients with chronic venous disease.3 Further causes of phlebolymphedema are vein stripping (saphenectomy) for varicosities, vein-harvesting procedures for coronary bypass grafting or other vascular surgery, orthopedic surgery, or penetrating trauma involving the medial aspect of a lower limb (Brodell syndrome).4 In all of these conditions, lymph stasis occurs in the involved district as a consequence of the almost inevitable surgical cutting of the lymph collectors