Dr. Margarita Correa:
Lymphedema is a condition that arises from the accumulation of lymphatic fluid due to an obstruction, absence or dysfunction of the lymphatic system. Primary lymphedema is congenital or hereditary and secondary lymphedema is acquired due to diseases such as cancer, post radiation, post-surgical, post-trauma, etc.
Indocyanine green (ICG) lymphography is a scan of the superficial lymphatics, helps define lymphatic dysfunction and delineate individualized lymphedema treatment. This scan also helps visualize lymphedema in the asymptomatic limb. Superficial lymphatics accounts for 70% of the lymphatic system.
Indocyanine green (ICG) is a contrast that fluoresces in the near infrared range and therefore needs a special camera to be seen after injection. Low dose ICG injected into the subcutaneous tissue has been used to map lymphatics; this is known as ICG lymphography. The ICG binds to a protein called albumin, which is taken up into the lymphatics, and transported within the lymph fluid. In this way, the function of the lymphatics can be assessed.
In case of primary and secondary lymphedema, ICG scan will help define individual characteristics and pattern of lymph flow that with help customize decongestive therapy.
Higher risks for lymphedema development in cancer includes lymph nodes removal and/or radiation. After completion of cancer treatment, ICG scan can detect early signs of lymphedema and initiate preventive measures and/or treatment.
The most common treatments for lymphedema are a combination of manual lymphatic drainage (MLD), application of compression bandaging, skin care, exercises, compression garments and intermittent sequential gradient pumps.
Certain patients with lymphedema may qualify for surgical options such as vascularized lymph node transfer (VLNT) and/or lymphovenous anastomosis (LVA) to help re-establish lymph flow. Suction Assisted Protein Lipectomy (SAPL) lymphedema surgery is a procedure to remove the excess solids (fibrosis and fat) that have accumulated in chronic advanced lymphedema.
Lipedema is a chronically progressive, symmetrical accumulation of fat in the subcutaneous tissue with orthostatic edema occurring almost exclusively in women. Primarily lower extremities are affected with feet sparing and may occur in combination with upper extremities. Lipedema is characterized by tenderness and easy bruising. Additionally, lipedema patients can present with microangiopathies and lipomas.
Currently, the best way to diagnose lipedema is performing manual inspection by a trained physician. A definitive blood test for lipedema does not currently exist. Tests to consider are thyroid levels, markers of inflammation, immune system, hormones, vitamin levels such as D, B, etc. At some stages of the disease it may be possible to see evidence of lipedema or lipo-lymphedema via ultrasound, CT scan, MRI and/or lymphoscintigraphy.
Lipedema is often accompanied by co-morbidities, secondary conditions which affect the patient’s health. Joint and venous diseases, lymphedema, obesity, and psycho-social disorders are often seen with lipedema patients.
Lipedema treatments are conservative such as manual lymphatic drainage (MLD), decongestive therapy, compression garments and devices, exercise, nutritional modification, supplementation; and surgical options such as lymph sparing tumescent or water-jet assisted liposuction (WAL).
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