Managing Lymphedema

Lower extremity edema, the medical term for swelling, can have many causes.  Bilateral leg edema can arise from problems related to the heart, kidneys, or liver. Lymphedema is defined as the abnormal accumulation of protein rich fluid, called lymph, in the extremities that occurs due to injury, infection, or congenital abnormalities of the lymphatic system.  The lymphatic system is part of our immune system and has many functions.  The lymphatics are a network of tissues, vessels, and organs that work together to move a colorless, watery fluid (lymph) back into the bloodstream.  Lymphedema is swelling caused by obstruction or reflux in these lymphatic vessels.  It is a common condition and is estimated that there are over 100 million people worldwide with lymphedema.  Lymphedema most commonly affects the extremities but can also occur in other areas of the body including the abdomen, face, and neck.  Here at Vascular Surgery Associates, we see many patients daily with lower extremity edema.  Untreated edema can lead to wounds, ulcerations, or infections.  Our goal at VSA is to hopefully find the causes of a patient’s lower extremity edema and prevent complications that can be time consuming and costly.

The cause of lymphedema may be primary or secondary, however, secondary is much more common in the lower extremities.  Secondary lymphedema is associated with treatment of malignancy, trauma, or infections.  Primary lymphedema presents without an inciting factor.  Examples include congenital lymphedema which is lymphedema that is present and birth and occurs within the 1st year of life.  Secondary lymphedema develops as a result of another condition or treatment.

Lymphedema shares many features with chronic venous insufficiency (please see previous blog on venous disease).  When a patient comes to our office for lower extremity edema, our goal is to hopefully delineate a cause of the swelling and provide treatment options.  We will likely first obtain a lower extremity venous duplex or ultrasound.  This is a noninvasive test that usually takes between 35-45 minutes.  We perform these tests in our fully accredited vascular labs that are in our offices or our outpatient surgical centers.

The initial approach for management of lower extremity lymphedema begins with conservative measures.  These include a combination of self-care (skin care/ weight management), compression, and possible physical therapy at a lymphedema clinic.  Patients with lymphedema have an accumulation of protein rich fluid which can cause inflammation and skin changes.  Skin changes include drying of the scan and decreased elasticity making the patient more susceptible to infection and ulceration.  Patients are advised to maintain good hygiene and keep the limb adequately moisturized.

Compression therapy is vital in the treatment of lymphedema and varies depending on the stage of the disease.  For patients with mild lymphedema, compression stockings/garments are usually preferred.  Physical therapy with a lymphedema specialist along with compression therapy is recommended for patients with moderate to severe lymphedema.  Some patients are also prescribed lymphedema pumps also called pneumatic compression.  These pumps assist the drainage function of the lymphatic system and are proven to decrease the size of the limb and improve lymphatic function.  Decongestive therapy is also a treatment option.  This therapy is used by a lymphedema specialist to reduce extremity swelling.  An example of decongestive therapy is manual lymphatic massage.  These therapies are used in conjunction with compression.  There also surgical options for treatment lymphedema.  Advancements in the field a micro surgery have improved options and the reliability of treatment, although surgery is rarely needed for lymphedema.

In summary, lymphedema is a common medical problem and occurs when the lymphatic system is unable drain protein rich fluid (lymph) from the extremities.  Lymphedema can result from injury, infection, or congenital abnormalities cause debilitating edema and discomfort.  For patients with lower extremity edema, it is vital to try to elicit the cause or multiple causes of the edema to prevent wounds, infections, and to relieve discomfort.  If you or a family member has concerns over edema of the extremities, please do not hesitate to call Vascular Surgery Associates (1-855-648-9982) for a consultation.

Author

Brad Russell, PA-C Mr. Russell joined Vascular Surgery Associates in 2014. He has extensive experience in cardiovascular surgery. Mr. Russell previously worked in the cardiac surgery department at University of Maryland/St. Joseph Medical Center.