From the Guidelines
Lower limb lymphedema is primarily caused by secondary lymphedema resulting from damage to lymphatic vessels, often due to cancer treatments, infections, trauma, venous insufficiency, obesity, or immobility, as well as primary lymphedema from congenital abnormalities in the lymphatic system. The causes of lower limb lymphedema can be classified into primary and secondary lymphedema. Primary lymphedema can be further classified as congenital, praecox, or tarda, depending on the age of onset 1. Secondary lymphedema, on the other hand, is more common and can result from various factors, including:
- Cancer treatments, such as lymph node dissection or radiation therapy for gynecological, prostate, or melanoma cancers 1
- Infections, such as recurrent cellulitis or filariasis in tropical regions 1
- Trauma, which can damage lymphatic vessels and lead to impaired lymphatic drainage
- Venous insufficiency, which can cause increased pressure in the lymphatic vessels and lead to lymphedema
- Obesity, which can increase the risk of lymphedema due to increased pressure on the lymphatic vessels
- Immobility, which can reduce lymphatic flow and increase the risk of lymphedema
The pathophysiology of lower limb lymphedema involves impaired lymphatic drainage, leading to protein-rich fluid accumulation in the interstitial spaces, causing progressive swelling, fibrosis, and tissue changes 1. Early diagnosis and treatment are essential to prevent progression to irreversible tissue changes and complications such as recurrent infections and decreased mobility. Treatment options include decongestive therapy, physiotherapy, and compression therapy, as well as microvessel surgery in severe cases 1.
It is also important to note that patients undergoing pelvic surgery are at risk for lower extremity lymphedema, and regular examination is required to detect early lymphedema, which may be reversible or manageable with early physiotherapy 1. Education of patients to reduce obesity, increase physical activity, and minimize infection risk is also recommended 1.
From the Research
Causes of Lower Limb Lymphedema
- Lymphedema can result from either congenital (primary) or acquired (secondary) anomalies 2, 3
- Primary lymphedema can be sporadic, rarely familial or associated with complex malformative or genetic disorders 3
- Secondary lymphedema can occur after a trauma, a surgical procedure, a neoplasm, or a primary condition that impairs lymph vessel function 4
- Hereditary lymphedema can be nonsyndromic or associated with congenital anomalies or with abnormal physical findings 5
- Lymphedema arises due to a malfunction of the lymphatic system and can lead to massive tissue swelling 6
Classification of Lymphedema
- Primary lymphedema is classified into idiopathic and familial (hereditary) subgroups 5
- Lymphedema can be divided into primary and secondary forms 3
- Upper-limb lymphedema secondary to breast cancer treatment is the most frequent in France 3