What are the most frequent causes of lower limb lymphedema (lymphatic obstruction)?

From the Guidelines

The most frequent causes of lower limb lymphoedema are cancer treatments, infections, obesity, venous insufficiency, and trauma or surgery to the lymphatic vessels, as supported by the most recent evidence 1.

Causes of Lower Limb Lymphoedema

The causes of lower limb lymphoedema can be primary or secondary. Primary lymphoedema is less common and is caused by genetic abnormalities in lymphatic development. Secondary lymphoedema is more prevalent and develops due to damage or obstruction of the lymphatic system from various causes, including:

• Cancer treatments, particularly lymph node removal or radiation therapy for gynecological, prostate, or melanoma cancers 1
• Infections, such as cellulitis or filariasis in tropical regions 1
• Obesity, which contributes to lymphoedema through increased pressure on lymphatic vessels and inflammatory processes 1
• Venous insufficiency, which can lead to chronic venous disease and lymphoedema 1
• Trauma or surgery to the lymphatic vessels, which can cause damage and obstruction to the lymphatic system 1

Prevention and Management

Understanding the causes of lower limb lymphoedema is important for prevention strategies, such as:

• Early physical therapy after cancer surgery 1
• Prompt treatment of infections 1
• Weight management 1
• Compression therapy for those at risk 1 Compression therapy has been shown to be effective in reducing venous stasis, improving lymphatic drainage, and promoting wound healing in patients with chronic venous disease 1. A minimum pressure of 20 to 30 mm Hg is recommended, with higher pressures advised for more severe disease 1.

From the Research

Causes of Lower Limb Lymphoedema

The most frequent causes of lower limb lymphoedema include:

• Cancer and its treatment (surgery and/or radiotherapy) 2, 3, 4
• Infection 2, 5
• Inflammatory disorders 2
• Obesity 2
• Hereditary syndromes 2
• Trauma 6
• Surgical procedures 6
• Neoplasms 6
• Primary conditions that impair lymph vessel function 6
• Lymphatic filariasis (LF), a neglected tropical disease 5
• Damages to the lymphatic system, most often caused by cancer or its treatment 4

Classification of Lymphoedema

Lymphoedema can be classified into two types:

• Primary lymphoedema, caused by an inherent defect in the lymphatic vessels or lymph nodes 3, 4
• Secondary lymphoedema, caused by an outside force, such as tumors, scar tissue after radiation, or removal of lymph nodes, which results in dysfunction of the lymph-carrying channels 3, 4