Guideline sources The following summarized guidelines for the evaluation and management of peripheral edema are prepared by our editorial team based on guidelines from the American Association of Family Physicians (AAFP 2013). 1 Calculator NYHA functional classification f Guidelines 1. Diagnostic investigations Magnetic resonance venography: obtain MRV of the lower extremity and pelvis in patients with unilateral left leg swelling and negative results on duplex ultrasound, if there is high clinical suspicion for DVT (in the context of suspected May-Thurner syndrome). B Echocardiography: obtain echocardiography to evaluate pulmonary arterial pressures in patients with obesity, obstructive sleep apnea, and edema. B Ankle-brachial index: obtain ABI measurement in patients with chronic venous insufficiency and cardiovascular risk factors before initiating compression therapy, which is contraindicated https://web.pathway.md/diseases/recRqt9F86PGLHzsC 1/2 6/29/23, 11:04 PM Peripheral edema Pathway in peripheral arterial disease. B 2. Medical management Topical therapies: advise daily hydration with emollients and prescribe short courses of topical corticosteroid creams for severely inflamed skin to treat eczematous (stasis) dermatitis associated with chronic venous insufficiency. B 3. Nonpharmacologic interventions Compression stockings: offer compression stockings for patients following DVT to prevent post-thrombotic syndrome. A 4. Therapeutic procedures Pneumatic compression devices: consider pneumatic compression devices in conjunction with standard therapy in patients with lymphedema. C Studies 2020 ICTOC In patients with chronic edema of the leg and recurrent cellulitis, compression was superior to control with respect to recurrence of cellulitis. Elizabeth Webb et al. N Engl J Med. 2020 Aug 13. References 1. Kathryn P Trayes, James S Studdiford, Sarah Pickle et al. Edema: Diagnosis and Management. Am Fam Physician. 2013 Jul 15;88 2 102 10. Open https://web.pathway.md/diseases/recRqt9F86PGLHzsC 2/2