Venous Lymphedema Research Articles

Porównanie skuteczności sekwencyjnego masażu uciskowego o różnym ciśnieniu w leczeniu pierwotnego obrzęku żylno-chłonnego kończyn dolnych u pacjentek w okresie menopauzalnym

Introduction: The primary lymphedema and chronic venous insufficiency are important medical problems in women during menopause. Intermittent pneumatic compression has been accepted as a supplemental therapy for many years. However, due to the diversity of the clinical view of venous lymphedema and difficulties in the diagnosis, there is still no uniform and fully reliable treatment algorithm and international consensus. Aim of the study: To compare the efficacy of pneumatic compression of various pressure for the treatment of lower extremity venous lymphedema in menopausal patients. Material and methods: The study included 33 patients with chronic venous insufficiency and bilateral primary lymphedema of the lower limbs. Group A consisted of 10 patients aged from 46 to 56 years (mean age 51.2 years) who had used monthly therapy, treatments consisting of manual lymphatic drainage, multi-layer bandaging and intermittent pneumatic compression with a pressure of 120 mm Hg. Group B consisted of 10 patients aged from 45 to 58 years (mean age 53.3 years) who had identical basic treatment as group A, and intermittent pneumatic compression with a pressure of 60 mm Hg. Group C (control) consisted of 13 patients aged from 44 to 57 years (mean age 52.8 years) who were using only primary treatment without intermittent pneumatic compression. Results: It was found out that the greatest reduction in edema in patients undergoing compression settings with a pressure of 120 mm Hg. Comparison of the percentage reduction in edema showed a statistically significant advantage for group A to groups B and C, both for changes in the right (p = 0.01) and left limb (p = 0.01). Results in patients undergoing intermittent pneumatic compression with a lower pressure (60 mm Hg) were similar to those obtained in the control group. Conclusions: Intermittent pneumatic compression with a pressure of 120 mm Hg significantly helps to reduce the venous lymphedema in patients with menopause. It appears that the procedures with a pressure of 60 mm Hg are ineffective.

Diagnosis and treatment of venous lymphedema

Diagnosis and treatment of venous lymphedema

Diagnosis and treatment of venous lymphedema

Chronic venous disease (CVD) is a common cause of secondary lymphedema. Venous lymphedema is sometimes misdiagnosed as primary lymphedema and does not receive optimal treatment. We have routinely used intravascular ultrasound (IVUS) imaging in all cases of limb swelling. The aim of this study is to show that (1) routine use of IVUS can detect venous obstruction missed by traditional venous testing, and (2) iliac-caval venous stenting can yield satisfactory clinical relief and can sometimes reverse abnormal lymphangiographic findings. The study comprised CVD patients who underwent iliac vein stenting. Lymphangiography was abnormal in 72 of 443 CEAP C(3) limbs, with leg swelling as the primary complaint (abnormal lymphangiography group). Clinical features and stent outcome were compared with a control group of 205 of 443 with normal lymphangiography (normal lymphangiographic group). Clinical features were a poor guide to the diagnosis of lymphedema. Isotope lymphangiography was not helpful in differentiating primary from secondary lymphedema. Venography had 61% sensitivity to the diagnosis of venous obstruction. IVUS had a sensitivity of 88% for significant (≥50% area stenosis) venous obstruction. At 40 months, cumulative secondary stent patency was similar for the abnormal (100%) and normal lymphangiographic (95%) groups. Swelling improved significantly after stent placement in the abnormal lymphangiographic group (mean [standard deviation] swelling grade improvement 0.8 ± 1.1) but was less (P < .004) than in the control group (1.4 ± 1.3). Complete swelling relief was 16% and 44% (P < .001) and partial improvement (≥1 grade of swelling) was 45% and 66% (P < .01) in the abnormal and normal lymphangiographic groups, respectively. Associated pain was present in 50% and 36% of the swollen limbs in the abnormal and normal lymphangiographic groups. Pain relief (≥3 visual analog scale) at 40 months was 87% and 83%, respectively (P = .3), with 65% and 71%, experiencing complete pain relief. Quality of life criteria improved after stent placement in both groups but to a better extent in the normal lymphangiographic group. Abnormal lymphangiography improved or normalized in 9 of 36 (25%) of those tested after stent correction. Prevailing practice patterns and diagnostic deficiencies probably result in the misdiagnosis of many cases of venous lymphedema as "primary" lymphedema. IVUS is recommended to rule out venous obstruction as the associated or initiating cause of lymphedema. Iliac venous stenting to correct the obstruction has excellent long-term patency and good clinical outcome, although results are not as good as in those with normal lymphatic function.

Venous Lymphedema

Lymphatic dysfunction found in swollen limbs with chronic venous disease (CVD), including iliac venous outflow obstruction (venous lymphedema), is often mistaken for primary lymphedema because of an inability to differentiate the etiology by present investigations. The diagnosis of primary lymphedema is often based solely on clinical features, as radioisotope lymphangiogram may be abnormal in both types.