Dependency syndrome

Picture of chronic venous insufficiency as a result of obesity and (relative) immobility of the leg vein muscle pump in a predominantly sedentary lifestyle. The result is an increase in pressure in the inguinal fold with a consecutive increase in pressure in the leg veins (so-called venous hypertension).

possible at any age and for both sexes. Frequency and severity increase as the BMI increases. First changes can be measured from a BMI of 25 kg/m2 KOF.

All signs of chronic venous insufficiency (CVI) even without the presence of varicosis and/or thrombosis. These include edema, hyperpigmentation, telangiectasia, lipodermatosclerosis and ulcerations of the lower legs and feet.

Diagnosis is made by taking the patient's medical history, clinical examination and duplex sonographic examination of the leg veins to exclude a hemodynamically relevant venous disease.

A reduction in weight and an increase in mobility would have to be considered and aimed at as a causal factor. In practice, however, this is very difficult to implement or achieve. For this reason, symptomatic therapy is usually carried out with medical compression stockings (classes 1-3, depending on the concomitant diseases) with high material strength and low elasticity. If necessary - in the case of considerable oedema - decongestion therapy with padded compression bandages and manual lymph drainage may also be necessary before the medical compression stockings are adjusted. If obesity persists and mobility is reduced, the therapy is required for life.

1. Doerler M. Altmeyer P, Stücker M. Venous leg ulcer caused by obesity-associated dependency syndrome. Case report and discussion of the pathogenesis and treatment. Phlebology 2013; 42: 205-208. 3

2. Menser S. Exceptions become the rule. Difficult fittings in compression therapy. http://www.venenzentrum-uniklinik.de/aktuelles/docs/2013_04_MTD_Menser.pdf