Dean SM, Valenti E, Hock K, Leffler J, Compston A, Abraham WT, et al.
Journal of vascular surgery. Venous and lymphatic disorders. Date of publication 2020 Sep 1;volume 8(5):851-859.
1. J Vasc Surg Venous Lymphat Disord. 2020 Sep;8(5):851-859. doi:
10.1016/j.jvsv.2019.11.014. Epub 2020 Jan 25.
The clinical characteristics of lower extremity lymphedema in 440 patients.
Dean SM(1), Valenti E(2), Hock K(3), Leffler J(3), Compston A(3), Abraham WT(2).
Author information:
(1)Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner
Medical Center, The Ohio State University, Columbus, Ohio. Electronic address:
steven.dean@osumc.edu.
(2)Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner
Medical Center, The Ohio State University, Columbus, Ohio.
(3)Division of Physical Therapy, Department of Physical Medicine and
Rehabilitation, James Cancer Hospital, The Ohio State University, Columbus,
Ohio.
Comment in
J Vasc Surg Venous Lymphat Disord. 2020 Sep;8(5):860.
BACKGROUND: Lower extremity lymphedema is frequently encountered in the vascular
clinic. Established dogma purports that cancer is the most common cause of lower
extremity lymphedema in Western countries, whereas chronic venous insufficiency
(CVI) is often overlooked as a potential cause. Moreover, lymphedema is
typically ascribed to a single cause, yet multiple causes can coexist.
METHODS: A 3-year retrospective analysis was conducted of demographic and
clinical characteristics of 440 eligible patients with lower extremity
lymphedema who presented for lymphatic physiotherapy to a university medical
center's cancer-based physical therapy department.
RESULTS: The four most common causes of lower extremity lymphedema were CVI
(phlebolymphedema; 41.8%), cancer-related lymphedema (33.9%), primary lymphedema
(12.5%), and lipedema with secondary lymphedema (11.8%). The collective cohort
was more likely to be female (71.1%; P < .0001), to be white (78.9%; P < .0001),
to demonstrate bilateral distribution (74.5%; P < .0001), and to have
involvement of the left leg (bilateral, 69.1% [P < .0001]; unilateral, 58.9%
[P = .0588]). Morbid obesity was pervasive (mean weight and body mass index,
115.8 kg and 40.2 kg/m2, respectively) and significantly correlated with a
higher International Society of Lymphology lymphedema stage (stage III mean
weight and body mass index, 169.2 kg and 57.3 kg/m2, respectively, vs stage II,
107.8 kg and 37.5 kg/m2, respectively; P < .0001). Approximately one in three
(35.7%) of the population sustained one or more episodes of cellulitis, but
patients with stage III lymphedema had roughly twice the rate of soft tissue
infection as patients with stage II, 61.7% vs 31.8%, respectively (P < .001).
Multifactorial lymphedema was present in 25%. Approximately half of the patients
with lipedema with secondary lymphedema (48.1%) or primary lymphedema (45.5%)
had a superimposed cause of swelling that was usually CVI. Total knee
arthroplasty was the most common cause of noncancer surgery-mediated worsening
of pre-existing lymphedema.
CONCLUSIONS: In a large cohort of patients treated in a cancer-affiliated
physical therapy department, CVI (phlebolymphedema), not cancer, was the
predominant cause of lower extremity lymphedema. One in four patients had more
than one cause of lymphedema. Notable clinical characteristics included a
proclivity for female patients, bilateral distribution, left limb, cellulitis,
and nearly universal morbid obesity.
Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.
DOI: 10.1016/j.jvsv.2019.11.014
PMID: 31992537 [Indexed for MEDLINE]
