A Closer Look at the Diagnosis and Treatment of Lymphedema

Lymphedema is largely a clinical diagnosis. When you see a vascular surgeon for the first time with this condition, they will order tests to make sure no underlying coexisting diseases are present. For example, they will order tests to rule out peripheral arterial disease (blockages in the arterial circulation), chronic venous insufficiency (vein blockages or incompetent valves in the veins due to which blood cannot go back into the heart), etc.

Once these conditions are ruled out, the rest of the management focuses on making sure that the condition does not progress and worsen. For example, meticulous skin care is of ultimate importance so that wounds or ulcers do not occur in the leg.

If either peripheral arterial disease or chronic venous insufficiency is identified, the vascular surgeon will treat these conditions by doing procedures that will help open blockages in your arteries. The treatment of chronic venous insufficiency largely depends on the identification of reflux in the superficial or deep veins in your lower extremities. 

The treatment of chronic venous insufficiency involves providing medical-grade compression therapy to the lower extremity by wearing compression stockings all the time. If this does not adequately take care of the symptoms, there are several procedures a vascular surgeon can discuss with you. Other medical treatments for chronic venous insufficiency include weight loss, decreased salt intake, increased protein intake, elevation of the legs, and regular walking to strengthen the calf muscles and help with the return of lymphatic fluid.  

The mainstay of lymphedema treatment is manual lymphatic decompression. This involves a specialized physical therapist massaging the leg to drain the lymph fluid that has leaked out of the lymphatic channels back toward the heart. Manual lymphatic decompression is carried out at specialized centers only where the physical therapist is trained for it.

Patients who are obese need to lose weight as that is the most important underlying factor responsible for lymph leakage. There are some patients who may need a referral to a bariatric surgeon who specializes in weight loss surgery. Surgical treatment of lymphedema is very rarely done but is available at specialized centers in the U.S.

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