Diagnostic approach to lower limb edema

Gasparis, Antonios P.; Kim, Pamela S.; Dean, Steven M.; Khilnani, Neil M.; Labropoulos, Nicos

doi:10.1177/0268355520938283

Cited by 41 publications

(22 citation statements)

References 19 publications

(50 reference statements)

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“…Lymphedema has been reported to often be underestimated or misdiagnosed [ 40 ]. A number of differential diagnosis, such as lipedema or venous diseases, need to be taken into account [ 41 ]. Further, only a limited number of medical doctors specialize in this field.…”

Section: Overview Of Lymphedemamentioning

confidence: 99%

Biology of Lymphedema

Brix

Šerý

Onorato³

et al. 2021

Biology

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This narrative review portrays the lymphatic system, a poorly understood but important physiological system. While several reviews have been published that are related to the biology of the lymphatic system and lymphedema, the physiological alternations, which arise due to disturbances of this system, and during lymphedema therapy, are poorly understood and, consequently, not widely reported. We present an inclusive collection of evidence from the scientific literature reflecting important developments in lymphedema research over the last few decades. This review aims at advancing the knowledge on the area of lymphatic system function as well as how system dysfunction, as seen in lymphedema, affects physiological systems and how lymphedema therapy modulates these mechanisms. We propose that future studies should aim at investigating, in-detail, aspects that are related to fluid regulation, hemodynamic responses, and endothelial and/or vascular changes due to lymphedema and lymphedema therapy.

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Section: Overview Of Lymphedemamentioning

confidence: 99%

Biology of Lymphedema

Brix

Šerý

Onorato³

et al. 2021

Biology

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“…Specific signs include the Stemmer sign (inability to pinch skin between the dorsum of the foot and base of the second toe) which is reflective of skin thickening of Stage II and III lymphedemas, hypertrophy of the fatty layer, "ski jump" toe nails, and hyperkeratotic skin changes in late stages. 3 Lipedema is a common but poorly understood condition that primarily affects adult women who bilaterally have large legs from the waist to just above the ankles as a result of excessive fat deposition. 8…”

Section: Clinical Evaluationmentioning

confidence: 99%

“…DUS can also be used to evaluate the abdominal and pelvic vasculature when performed by experienced operators, although it can be limited by extreme obesity and bowel gas. 3 The pelvic exam is best performed after a minimum of 6hour fast (possibly supplemented by oral simethicone pills administered hours before the exam) to minimize bowel gas and motility and optimize visualization of the vasculature. Good-quality exams can reliably visualize the common, internal, and external iliac veins, as well as the inferior vena cava (IVC) and diagnose central venous extrinsic compressions and occlusions.…”

Section: Imaging Evaluation Duplex Ultrasoundmentioning

confidence: 99%

“…Chronic edema has a significant negative effect on overall quality of life. 3 Therefore, efficient and accurate strategies to diagnose its cause(s) and evidencebased recommendations for treatment should be utilized. The diagnosis of lower extremity swelling can be challenging, as edema can sometimes be multifactorial in etiology, and patients can be referred to vascular specialists to assist in diagnosis and management.…”

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confidence: 99%

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Evaluation and Management of Patients with Leg Swelling: Therapeutic Options for Venous Disease and Lymphedema

Scherer

Khilnani

2021

Semin intervent Radiol

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Lower extremity swelling is a common condition which has a variety of etiologies and can be challenging to diagnose and manage. Swelling is usually the result of the accumulation of interstitial fluid in the subcutaneous tissues. Common etiologies include systemic, superficial, and deep venous, and lymphatic disorders. Leg swelling can occur bilaterally or unilaterally, with venous disorders being one of the most common causes of unilateral lower extremity edema.

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“…There is no consensus on a single therapy to treat lymphedema; however, manual lymph drainage [ 2 ], compression therapy [ 3 ], exercising [ 4 ], and hygienic care [ 5 ] constitute the cornerstones of treatment. Recently, other options such as mechanical lymph drainage with devices that use both passive [ 6 ] and active [ 7 ] muscle movements, psychological support [ 8 ], and myolymphokinetic activities [ 9 ] have improved the treatment in these patients.…”

Section: Introductionmentioning

confidence: 99%

Exercising and Compression Mechanism in the Treatment of Lymphedema

Barufi

Godoy

2021

Cureus

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Aim: The aim of this study was to evaluate the effect of adjustments to a compression stocking on reductions in leg volume during walking in patients with lymphedema.Method: Fourteen women and three men suffering from leg lymphedema with ages between 21 and 68 years old (mean 45.68 years) were randomly enrolled in this study. Evaluations were made by volumetry before and after each session of controlled walking. Patients were subjected to three one-hour sessions of walking slowly on the flat ground monitored by a professional. For the first session, the patients used a well-adjusted cotton-polyester compression stocking, for the second they used a badly adjusted compression stocking made of the same fabric, and for the third, no compression garment was used. The Kruskal-Wallis test was used for statistical analysis.Results: On comparing the volume before and after walking for one hour with the well-adjusted cottonpolyester compression stocking, there was a mean reduction of 46.2 mL ± 66.95 mL (p-value < 0.02) in the volume of the lymphedema. In the one-hour session of walking without any compression, the volume of the leg increased by 74.4 mL ± 99.75 mL (p-value < 0.007). On walking with the compression stocking badly adjusted, there was a mean increase in the volume of 31.6 mL ± 46.9 mL (p-value < 0.14). Conclusion:Walking is a type of muscle activity that can be transformed into a type of daily exercise when you are guided by how it is going to be performed. The exercise, in this study specifically, walking, with a strict control of speed and time of realization using a compression mechanism is well adjusted to the volume of the limb and surely effective in reducing edema.

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Diagnostic approach to lower limb edema

Cited by 41 publications

References 19 publications

Biology of Lymphedema

Biology of Lymphedema

Evaluation and Management of Patients with Leg Swelling: Therapeutic Options for Venous Disease and Lymphedema

Exercising and Compression Mechanism in the Treatment of Lymphedema

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