NON-SURGICAL TREATMENTS OF LYMPHEDEMA OF THE LOWER LIMBS
DOI:
https://doi.org/10.48750/acv.272Keywords:
lymphedema, lower limbs, medical treatmentAbstract
Background: LLL is characterized by protein-rich interstitial fluid accumulation due to lymphatic system insufficiency, resulting in progressive non-pitting edema. Primary and secondary lymphedema are distinguished by the absence or presence of an external trigging factor, respectively. Diagnosis is based on clinical examination combined with imaging modalities. The non-surgical approach of LLL is based on preventive measures, lifestyle interventions and life-long compression modalities, aiming to reduce
the edema congestion and to improve patient quality of life.
Objectives: The present literature review aims to compile current scientific knowledge on the various domains of the non-surgical treatments of LLL.
Methods: Search was performed in PubMed database, using the following medical subjects heading (MeSH) terms: “lymphedema”, “lower limbs” and “medical treatment”. Research and review articles indexed in the last 10 years and written in English language were selected. Animal experimentation works and single case-reports were excluded. Other materials searched comprised reference books in the area of Vascular Surgery, namely Rutherford Vascular Surgery — 9th Edition, 2018.
Development: The non-surgical treatment of LLL is characterized by a multifaceted approach, including mechanical reduction of limb swelling, alternative medical devices and pharmacological therapy. Complex decongestive therapy is recognized as the standard of treatment and its compression modalities include drainage massages, pneumatic compression, bandaging systems, compression garments and physical exercise. Compression therapies differ in the degree and time of pressure applied and can be performed by healthcare professionals or by the patient himself. The duration of treatment stages varies and it may
include hospital and outpatient regimens. Positive treatment outcomes include increased skin elasticity, limb volume reduction, pain relief, increased functional capacity and improved quality of life.
Conclusions: Compression modalities have been shown to be effective in reducing limb volume, increasing tissue elasticity and improving the physical, psychological and aesthetic aspects of patient life. However, sustained volume reductions depend mostly on patient diligence. Intensive and outpatients approaches do not compromise treatment efficacy and high pressures therapies are effective and well tolerated. Current lymphedema non-surgical treatment lacks long-term results and urges more effective therapeutic alternatives.
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oncology. 2003;13(3):214-25.
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Association with venous and lymphatic compromise. The American
journal of medicine. 1985;79(2):155-9.
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Epidemiological Factors Involved in Cellulitis in Korean Patients With
Lymphedema. Annals of rehabilitation medicine. 2016;40(2):326-33.
16. Dixon JB, Weiler MJ. Bridging the divide between pathogenesis and
detection in lymphedema. Seminars in cell & developmental biology.
2015;38:75-82.
17. Scarsbrook AF, Ganeshan A, Bradley KM. Pearls and pitfalls of radionuclide
imaging of the lymphatic system. Part 2: evaluation of extremity
lymphoedema. The British journal of radiology. 2007;80(951):219-26.
18. Unno N, Inuzuka K, Suzuki M, Yamamoto N, Sagara D, Nishiyama M, et al.
Preliminary experience with a novel fluorescence lymphography using
indocyanine green in patients with secondary lymphedema. Journal
of vascular surgery. 2007;45(5):1016-21.
19. Cornish BH, Bunce IH, Ward LC, Jones LC, Thomas BJ. Bioelectrical impedance
for monitoring the efficacy of lymphoedema treatment programmes.
Breast cancer research and treatment. 1996;38(2):169-76.
20. Cemal Y, Jewell S, Albornoz CR, Pusic A, Mehrara BJ. Systematic review of
quality of life and patient reported outcomes in patients with oncologic
related lower extremity lymphedema. Lymphatic research and biology.
2013;11(1):14-9.
21. Damstra RJ, Halk A-B, Damstra RJ, Halk B, van den Berg JP, Born Y, et
al. The Dutch lymphedema guidelines based on the International
Classification of Functioning, Disability, and Health and the chronic
care model. Journal of Vascular Surgery: Venous and Lymphatic
Disorders. 2017;5(5):756-65.
22. The diagnosis and treatment of peripheral lymphedema. Consensus
document of the International Society of Lymphology. Lymphology.
2003;36(2):84-91.
23. Hodgson P, Towers A, Keast DH, Kennedy A, Pritzker R, Allen J. Lymphedema
in Canada: a qualitative study to help develop a clinical, research, and
education strategy. Current oncology (Toronto, Ont). 2011;18(6):e260-4.
24. Schaverien MV, Aldrich MB. New and Emerging Treatments for Lymphedema.
Seminars in plastic surgery. 2018;32(1):48-52.
25. Zhou Q, Guo R, Wood R, Boyce BF, Liang Q, Wang YJ, et al. Vascular
endothelial growth factor C attenuates joint damage in chronic
inflammatory arthritis by accelerating local lymphatic drainage in
mice. Arthritis and rheumatism. 2011;63(8):2318-28.
26. [Medical compression in the treatment of lymphedema. Haute
Autorite de Sante]. Annales de dermatologie et de venereologie.
2013;140(6-7):479-82.
27. Cemal Y, Pusic A, Mehrara BJ. Preventative measures for lymphedema:
separating fact from fiction. Journal of the American College
of Surgeons. 2011;213(4):543-51.
28. Brown L. British Lymphology Society conference 2017: Getting the
basics right. British journal of community nursing. 2017;22(11):557-8.
29. de Kraker ME, Stolk WA, van Oortmarssen GJ, Habbema JD. Model-based
analysis of trial data: microfilaria and worm-productivity loss after
diethylcarbamazine-albendazole or ivermectin-albendazole combination
therapy against Wuchereria bancrofti. Tropical medicine &
international health : TM & IH. 2006;11(5):718-28.
30. Kar SK, Dwibedi B, Das BK, Agrawala BK, Ramachandran CP, Horton J.
Lymphatic pathology in asymptomatic and symptomatic children with
Wuchereria bancrofti infection in children from Odisha, India and its
reversal with DEC and albendazole treatment. PLoS neglected tropical
diseases. 2017;11(10):e0005631.
31. Rabe E, Partsch H, Hafner J, Lattimer C, Mosti G, Neumann M, et al.
Indications for medical compression stockings in venous and
lymphatic disorders: An evidence-based consensus statement.
Phlebology. 2018;33(3):163-84.
32. Zaleska M, Olszewski WL, Durlik M, Kaczmarek M. A Novel Clinical Test
for Setting Intermittent Pneumatic Compression Parameters Based on
Edema Fluid Hydromechanics in the Lymphedematous Calf. Lymphatic
research and biology. 2015;13(3):208-14.
33. Partsch H. Compression therapy: clinical and experimental evidence.
Annals of vascular diseases. 2012;5(4):416-22.
34. Davis MJ, Davis AM, Lane MM, Ku CW, Gashev AA. Rate-sensitive
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2019-10-16
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Rosas F, Silva I, de Almeida R. NON-SURGICAL TREATMENTS OF LYMPHEDEMA OF THE LOWER LIMBS. Angiol Cir Vasc [Internet]. 2019 Oct. 16 [cited 2024 Dec. 26];15(2):97-112. Available from: https://acvjournal.com/index.php/acv/article/view/272
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