The Lymphatic System
The lymphatic system is highly complex and, when functioning, moves approximately three liters of fluid throughout the body every day. This is done through a channel of vessels as part of the blood flow’s cleaning and filtering system. This system may become compromised due to treatments for cancer, surgery, injury, trauma and other causes. When this system is compromised, an accumulation of lymph fluid develops in the soft tissues and swelling occurs, most often in the extremities. This is known as Lymphedema.
Lymphedema should not be confused with edema that is a result of venous insufficiency. It’s important to be aware that untreated venous insufficiency can progress into a combined venous/lymphatic disorder. The treatment for this is the same as lymphedema.
Symptoms of Arm Lymphedema
- Swelling in the arm (including the fingers)
- Heaviness or tightness in the limb
- Restriction in the range of motion
- Thick or hardened skin
Symptoms of Lower Leg Lymphedema
- a full sensation in legs
- skin feeling tight
- decreased flexibility in the ankle
- difficulty fitting into clothing in one specific area
- persistent swelling
If you experience any of these symptoms, it is very important that you seek immediate medical advice as early diagnosis and treatment improves both the prognosis and the condition.
Risk Factors for Lymphedema
- Morbid obesity can cause secondary lymphedema by “crushing” the lymphatics
- Lymph node removal for biopsies
- Surgery or trauma
- Radiation treatments, especially ones that are focused in areas that might contain “clusters” of lymph nodes
- Deep invasive wounds that might tear, cut or damage the lymphatics
- For primary lymphedema any person who has a family history of unknown swelling of a limb
- Radiation and chemotherapy for cancer
- Infection of the microscopic parasite filarial larvae, though this is more common in tropical countries
- For primary lymphedema any person who has a family history of unknown swelling of a limb
- Radiation and chemotherapy for cancer
- Serious infections that include lymphangitis, cellulitis or erysipelas.
The Use of Compression in Treatment
When lymphedema presents, excess fluid builds in the arm. This buildup of fluid is known as edema (sometimes called congestion). There are a number of ways to decongest this fluid build-up, including a massage technique known as Manual Lymph Drainage (MLD), the use of intermittent pneumatic compression pumps, wrapping with short stretch bandages and/or wearing a graduated compression garment. Once the limb has been reduced of fluid build-up, wearing the armsleeve is recommended to maintain the reduction. Compression not only improves circulation, but also aids in the upward flow of the lymphatic and venous system. This blood flow is recirculating back toward your lungs and heart causing your system to function normally. Lymphedema is a chronic condition that is not curable at present, but may be alleviated by appropriate management; if not treated it can progress and become difficult to manage.
Be Proactive
- Prevent infection and keep the skin moist (avoid needle sticks, use antibacterial ointment)
- Avoid blocking fluid flow (wear loose fitting clothing, avoid a blood pressure cuff, don’t carry heavy objects)
- Develop an exercise program with consult from a therapist (light, aerobic exercise is recommended)
- Avoid heat/sun or ice directly (may cause vasodilation)
- Keep blood flow from pooling (avoid sleeping on a bent arm)
- Wear a properly fitted SIGVARIS graduated compression garment during stress activities and air travel.
Benefits of Compression Therapy
Lymphedema may manifest as swelling of one or more limbs and may include the corresponding quadrant of the trunk. Swelling may also affect other areas, eg. head, neck, breast or genitalia. Lymphedema is the result of accumulation of fluid and other elements (eg. proteins) in the tissue spaces due to an imbalance between interstitial fluid production and transport. It arises from congenital malformation of the lymphatic system, or damage to lymphatic vessels and/or lymph nodes. Lymphedema is a chronic condition that is not curable at present, but may be alleviated by appropriate management; if not treated it can progress and become difficult to manage.
How many patients are affected?
At birth, around one person out of 6 000 will develop primary lymphedema; the overall prevalence of lymphedema/chronic edema has been estimated as 0.13-2%. In developed countries, the main cause of lymphedema is widely assumed to be treatment for cancer. However, it appears that about a quarter to a half of affected patients suffer from other forms of lymphedema, eg primary lymphedema and lymphedema associated with poor venous function, trauma, limb dependency or cardiac disease.
What are the risk factors?
The true risk factor profile for lymphedema is not known. There may be many factors that predispose an individual to developing lymphedema or that predict the progression, severity and outcome of the condition.
Classification of Lymphedema
Lymphedema is classified as primary or secondary. Primary is thought to be the result of a congenital abnormality of the lymph conducting system.
Secondary or acquired is the result of damage to the lymphatic vessels and/or lymph nodes, or from functional deficiency. Infections from insect bites, serious wounds or burns can cause lymphedema when they damage or destroy lymphatics. Any type of surgery, serious injury, or radiation for cancer treatment can also cause the onset of the disease. It may also be the result of high output failure of the lymphatic circulation.
Treatment of Lymphedema
Compression garments can be used as prophylaxis or as part of initial management in patients who have mild upper limb lymphedema. The main use of compression garments is in the long-term management of lymphedema, usually following a period of intensive therapy. In general, the level of compression used in treatment of the upper limb is lower than that required for lower limb lymphedema. (1).
Some patients – especially those who are post breast cancer treatment – may wear a low compression armsleeve (15-20 mmHg) to minimize the risk of developing lymphedema. This may be worn in “high risk” times such as during flying, exercise, or overuse of the arm in consideration. For those patients who have mild edema, or well decongested extremities, an armsleeve of 20-30mmHg might be appropriate. For a patient experiencing a high level of edema, there are several ways to achieve reduction by decongesting the limb, including manual lymphatic drainage and/or compression bandaging.
The result can be sustained by compression garments. Compression garments can be used as initial management in patients who have mild upper limb lymphedema with minimal subcutaneous tissue changes and shape distortion. Where there is considerable soft pitting edema, multi layer lymphoedema bandaging will be required to reduce and stabilize the swelling prior to the application of compression garments.
Lower pressure compression garments also have a role to play in managing symptoms in a palliative context.
How to minimize the risk of developing lymphedema?
- Take good care of skin and nails
- Follow a balanced diet
- Maintain optimal body weight
- Avoid tight underwear, cloting, watches and jewellery
- Wear comfortable supportive shoes
- Undertake exercise/movement and limb elevation
- Avoid injury at risk
- Avoid exposure to extreme cold or heat
- Use high factor sunscreen and insect repellent
- Use mosquito nets in lymphathic filariasis endemic areas
- Wear compression garments if prescribed or recommended
(1) Lymphoedema Framework: International Consensus. Best Practice for the Management of Lymphoedema. 2006, pages 19-39.
Schedule a Consultation with Missouri Vein Specialists in Kansas City and Liberty, MO
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