Clinical and Scintigraphic Predictors of Primary Lower Limb Lymphedema-Volume Reduction During Complete Decongestive Physical Therapy

BACKGROUND: Primary lower limb lymphedema is a chronic debilitating disorder without curative treatment. The initial treatment phase is dedicated to reducing lymphedema volume, whereas the second aims to stabilize that volume. OBJECTIVE: The objective of this study was to analyze clinical and lymphoscintigraphic characteristics during complete decongestive physical therapy (CDP) as predictors of primary unilateral lower limb lymphedema-volume reduction. DESIGN: This observational, retrospective study included all 222 consecutive patients (January 2009-January 2017; median age: 45.8 years) with lymphedema, affecting the entire lower limb, who received CDP for the first time in a specialized lymphedema-management center. METHODS: CDP consisted of low-stretch bandaging, manual lymph drainage, exercises and skin care for all patients. Lymphoscintigraphy preceded treatment. RESULTS: Median lymphedema evolution was 73 months and median excess volume was 34%. Median [IQR] lymphedema volumes were 2845 [1038-3487] mL before and 1276 [601-2195] mL after a median of 11 days of CDP, with 34% median reduction. Multivariate analyses retained age, body mass index > 40 kg/m2 and previous cellulitis, as independently associated with lymphedema-volume reduction. For each additional year of age, volume reduction increased 0.16%. Unexpectedly, log-transformed initial lymphedema volumes indicated a negative impact, ie, 4.95%, for each log-unit gain. Patients with previous cellulitis episode(s) obtained 6.9% and those with BMI > 40 kg/m2 17.1% higher lymphedema-volume reductions. Lower limb lymphoscintigraphy was available for 150 (67.6%) patients. Having dermal back flow was associated with greater lymphedema-volume reduction than not (respectively, 39% vs 31%). LIMITATIONS: This study was retrospective and only 67.6% of patients underwent lymphoscintigraphy. CONCLUSIONS: Our analysis identified clinical and scintigraphic predictors of primary lymphedema-volume reduction for patients with unilateral disease. Lymphoscintigraphy helps confirm lymphedema and predict volume reduction. Further study is required to confirm these observations.