Download PDF
J Reconstr Microsurg 2020; 36(02): 136-141
DOI: 10.1055/s-0039-1697904
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Uncovering Lymphatic Transport Abnormalities in Patients with Primary Lipedema

Daniel J. Gould
1   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
,
Bassim El-Sabawi
1   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
,
Pedram Goel
1   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
,
Ido Badash
1   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
,
Patrick Colletti
2   Department of Radiology, Keck School of Medicine of University of Southern California, Los Angeles, California
,
Ketan M. Patel
1   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
› Author Affiliations Funding None.
Further Information

Publication History

10 December 2018

20 August 2019

Publication Date:
23 September 2019 (online)

    Permissions and Reprints

Abstract

Background Although lipedema is often clinically distinguished from lymphedema, there is considerable overlap between the two entities. The purpose of this study was to evaluate lymphoscintigraphic findings in patients with lipedema to better characterize lymphatic flow in this patient population.

Methods Patients with lipedema receiving lymphoscintigraphy between January 2015 and October 2017 were included. Patient demographics, clinical characteristics, and lymphoscintigraphic findings were extracted. Klienhan's transport index (TI) was utilized to assess lymphatic flow in patient's lower extremities (LEs).Scores ranged from 0 to 45, with values > 10 denoting pathologic lymphatic transport.

Results A total of 19 total patients with lipedema underwent lymphoscintigraphic evaluation. Mean age was 54.8 years and mean body mass index was 35.9 kg/m2. Severity of lipedema was classified as stage 1 in five patients (26.3%), stage 2 in four patients (21.1%), stage 3 in four patients (21.1%), and stage 4 in six patients (31.6%). The mean TI for all extremities was 12.5; 24 (63.2%) LEs had a pathologic TI, including 7 LEs with stage 1 (29.2%), 3 LEs with stage 2 (12.5%), 6 LEs with stage 3 (25.0%), and 8 LEs with stage 4 lipedema (33.3%). The mean TI was significantly greater for extremities with severe (stage 3/4) lipedema than those with mild or moderate (stage 1/2) lipedema (15.1 vs. 9.7, p = 0.049). Mean difference in TI scores between each LE for individual patients was 6.43 (standard deviation +7.96).

Conclusion Our results suggest that patients with lipedema have impaired lymphatic transport, and more severe lipedema may be associated with greater lymphatic transport abnormalities.

Keywords

lipedema - lymphedema - lymphatic transport abnormalities

Note

This study was presented at the Plastic Surgery the Meeting in Orlando, Florida, October 6–10, 2017.


 

  • References

  • 1 Wold LE, Hines Jr EA, Allen EV. Lipedema of the legs; a syndrome characterized by fat legs and edema. Ann Intern Med 1951; 34 (05) 1243-1250
    PubMedGoogle Scholar
  • 2 Foldi E, Foldi M. Lipedema. In: Foldi M, Foldi E. , eds. Foldi's Textbook of Lymphology, 2nd ed. Munich: Elsevier GmbH; 2006: 417-427
    Google Scholar
  • 3 Buck II DW, Herbst KL. Lipedema: arelatively common disease with extremely common misconceptions. Plast Reconstr Surg Glob Open 2016; 4 (09) e1043
    CrossrefPubMedGoogle Scholar
  • 4 Szél E, Kemény L, Groma G, Szolnoky G. Pathophysiological dilemmas of lipedema. Med Hypotheses 2014; 83 (05) 599-606
    CrossrefPubMedGoogle Scholar
  • 5 Stallworth JM, Hennigar GR, Jonsson Jr HT, Rodriguez O. The chronically swollen painful extremity. A detailed study for possible etiological factors. JAMA 1974; 228 (13) 1656-1659
    CrossrefPubMedGoogle Scholar
  • 6 Greer KE. Lipedema of the legs. Cutis 1974; 14: 98-100
    PubMedGoogle Scholar
  • 7 Amann-Vesti BR, Franzeck UK, Bollinger A. Microlymphatic aneurysms in patients with lipedema. Lymphology 2001; 34 (04) 170-175
    PubMedGoogle Scholar
  • 8 Schneider M, Conway EM, Carmeliet P. Lymph makes you fat. Nat Genet 2005; 37 (10) 1023-1024
    CrossrefPubMedGoogle Scholar
  • 9 Harwood CA, Bull RH, Evans J, Mortimer PS. Lymphatic and venous function in lipoedema. Br J Dermatol 1996; 134 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 10 Bräutigam P, Földi E, Schaiper I, Krause T, Vanscheidt W, Moser E. Analysis of lymphatic drainage in various forms of leg edema using two compartment lymphoscintigraphy. Lymphology 1998; 31 (02) 43-55
    PubMedGoogle Scholar
  • 11 Bilancini S, Lucchi M, Tucci S, Eleuteri P. Functional lymphatic alterations in patients suffering from lipedema. Angiology 1995; 46 (04) 333-339
    CrossrefPubMedGoogle Scholar
  • 12 Kleinhans E, Baumeister RG, Hahn D, Siuda S, Büll U, Moser E. Evaluation of transport kinetics in lymphoscintigraphy: follow-up study in patients with transplanted lymphatic vessels. Eur J Nucl Med 1985; 10 (7–8): 349-352
    PubMedGoogle Scholar
  • 13 Cambria RA, Gloviczki P, Naessens JM, Wahner HW. Noninvasive evaluation of the lymphatic system with lymphoscintigraphy: a prospective, semiquantitative analysis in 386 extremities. J Vasc Surg 1993; 18 (05) 773-782
    CrossrefPubMedGoogle Scholar
  • 14 Lohrmann C, Foeldi E, Langer M. MR imaging of the lymphatic system in patients with lipedema and lipo-lymphedema. Microvasc Res 2009; 77 (03) 335-339
    CrossrefPubMedGoogle Scholar
  • 15 Okhovat JP, Alavi A. Lipedema: a review of the literature. Int J Low Extrem Wounds 2015; 14 (03) 262-267
    CrossrefPubMedGoogle Scholar
  • 16 Forner-Cordero I, Oliván-Sasot P, Ruiz-Llorca C, Muñoz-Langa J. Lymphoscintigraphic findings in patients with lipedema. Rev Esp Med Nucl Imagen Mol 2018; 37 (06) 341-348
    PubMedGoogle Scholar
  • 17 Shin BW, Sim YJ, Jeong HJ, Kim GC. Lipedema, a rare disease. Ann Rehabil Med 2011; 35 (06) 922-927
    CrossrefPubMedGoogle Scholar
  • 18 Mehrara BJ, Greene AK. Lymphedema and obesity: is there a link?. Plast Reconstr Surg 2014; 134 (01) 154e-160e
    CrossrefPubMedGoogle Scholar
  • 19 Greene AK. Diagnosis and management of obesity-induced lymphedema. Plast Reconstr Surg 2016; 138 (01) 111e-118e
    CrossrefPubMedGoogle Scholar
  • 20 Greene AK, Grant FD, Slavin SA, Maclellan RA. Reply: obesity-induced lymphedema: clinical and lymphoscintigraphic features. Plast Reconstr Surg 2016; 137 (03) 648e
    PubMedGoogle Scholar
  • 21 Warren Peled A, Kappos EA. Lipedema: diagnostic and management challenges. Int J Womens Health 2016; 8: 389-395
    CrossrefPubMedGoogle Scholar
  • 22 Patel KM, Lin CY, Cheng MH. A prospective evaluation of lymphedema-specific quality-of-life outcomes following vascularized lymph node transfer. Ann Surg Oncol 2015; 22 (07) 2424-2430
    CrossrefPubMedGoogle Scholar
  • 23 Pusic AL, Cemal Y, Albornoz C. , et al. Quality of life among breast cancer patients with lymphedema: a systematic review of patient-reported outcome instruments and outcomes. J Cancer Surviv 2013; 7 (01) 83-92
    CrossrefPubMedGoogle Scholar
  • 24 Chang DW. Lymphaticovenular bypass for lymphedema management in breast cancer patients: a prospective study. Plast Reconstr Surg 2010; 126 (03) 752-758
    CrossrefPubMedGoogle Scholar
  • 25 Chang DW, Suami H, Skoracki R. A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema. Plast Reconstr Surg 2013; 132 (05) 1305-1314
    CrossrefPubMedGoogle Scholar
  • 26 Rockson SG. Lymphedema. Am J Med 2001; 110 (04) 288-295
    CrossrefPubMedGoogle Scholar
  • 27 Zampell JC, Yan A, Elhadad S, Avraham T, Weitman E, Mehrara BJ. CD4(+) cells regulate fibrosis and lymphangiogenesis in response to lymphatic fluid stasis. PLoS One 2012; 7 (11) e49940
    CrossrefPubMedGoogle Scholar
  • 28 Aschen S, Zampell JC, Elhadad S, Weitman E, De Brot M, Mehrara BJ. Regulation of adipogenesis by lymphatic fluid stasis: part II. Expression of adipose differentiation genes. Plast Reconstr Surg 2012; 129 (04) 838-847
    CrossrefPubMedGoogle Scholar
  • 29 Zampell JC, Aschen S, Weitman ES. , et al. Regulation of adipogenesis by lymphatic fluid stasis: part I. Adipogenesis, fibrosis, and inflammation. Plast Reconstr Surg 2012; 129 (04) 825-834
    CrossrefPubMedGoogle Scholar