Research Information System
8th International Congress of Update in Cardiology and Cardiovascular Surgery, Turkey, 1 - 04 December 2008, vol.31, pp.45
Background. Lymphedema (LE) is excessive accumulation of interstitiel fluid as a consequence of impaired lymphatic drainage due to congenital or acquired causes. Patients and method. In the last six years, we reviewed 47 patients with chronic limb LE, who were managed in our department. The patients with phlebolymphedema occurred as a result of chronic venous insufficiency, the ones with LE due to congenital vascular malformations, and the other patients that had been managed previously surgically in our department (i.e., with debulking procedures or lymphovenous anastomoses) were excluded from this study. Median age was 34 years (range, 1 month to 78 years). Most of the patients were women (78.7%). The ratio of involvement of upper/lower extremity LE was 1/8.4. They had usually unilateral LE (83%); bilateral lower limb were involved in seven patients. The left side was more commonly affected than the right side in both upper and lower limbs (2.1/1) (Figure 1). Diagnostic tools were isotope lymphoscintigraphy, magnetic resonance lymphangiography (MRLA) and/or ultrasonography. Management included exercise, elevation, graduated elastic compression stockings (GECS)/sleeves, multiple-layer bandaging, lymphagogue venoactive drugs (VAD), manual lymphatic drainage (MLD), intermittent pneumatic compression (IPC), proper hygiene, education, and prophylaxis (e.g., low-dose penicillin or erythromycin) for acute inflammatory attacks (i.e., cellulitis or lymphangitis). Results. The majority of the patients in our study had primary LE (I-III) (83%), and lymphedema praecox (II) was predominant (57.4%). Seven of ten patients were in clinical Grade II, it was followed by Grade I (19.2%) and Grade III (10.6%). A female patient with right lower limb LE had yellow-nail syndrome. Complications were cellulitis (12.7%) and fungal infection (10.6%) (Figure 2). Three female patients, BMI>40, had a concomittent lipedema (6.4%). Lymphoscintigraphy depicted lymphatic delay or absence (75%); lymphoscintigraphic staging was as follows: Stage I two (11.1%), Stage II 12 (66.7%) and Stage III four (22.2%) (Figure 3). MRLA revealed lymphatic dilatation and “puddles” (Figure 4). In most of the cases (85.1%), GECS (Class III/IV) and VAD were administered. Seven patients were hospitalized and managed with aggressive elevation, MLD, and IPC (Figure 5). Conclusion. Disabling outcomes of chronic lymphedema, a challenging problem, with poor quality-of-life and unfavorable psychosocial effects can be avoided by decisive and long-term therapy and prophylaxis.