Lymphostasis of the lower extremities
The content of the article:
- Causes of lymphostasis of the lower extremities and risk factors
- Forms of the disease
- Disease stages
- Symptoms of lymphostasis of the lower extremities
- Lymphostasis of the lower extremities in pregnant women
- Lymphostasis of the lower extremities in children
- Diagnostics
- Treatment of lymphostasis of the lower extremities
- Potential consequences and complications
- Forecast
- Prevention
Lymphostasis of the lower extremities (lymphedema, lymphatic edema) is a pathological condition that develops as a result of disturbances in the outflow of lymph from the tissues of the legs and manifests itself as persistent edema, coarsening of the skin, compaction of subcutaneous tissue, the appearance of cracks and trophic ulcers.
Lymphostasis of the lower extremities is a common pathology. According to the WHO, in varying degrees of severity, it is observed in about 10% of the adult population, and in women several times more often than in men. The progression of lymphostasis leads to a gradual increase in the size of the affected limb up to the development of elephantiasis.
Source: ovaricose.ru
Causes of lymphostasis of the lower extremities and risk factors
The causes of lymphostasis of the lower extremities can be a variety of factors. Most often, the following diseases and pathological conditions contribute to the occurrence of disturbances in the formation of lymph and its outflow:
- heart failure;
- hypoproteinemia;
- kidney disease, accompanied by a violation of their excretory function;
- chronic venous insufficiency in the stage of decompensation;
- arteriovenous fistula (pathological communication between an artery and a vein);
- post-thrombophlebitic syndrome;
- malformations of the lymphatic system;
- obstruction of the lymphatic vessels, caused by their compression by tumors or infiltrates of an inflammatory nature, cicatricial adhesions after surgery or trauma, burns.
Factors predisposing to the development of lymphostasis of the lower extremities can be:
- prostate cancer;
- removal of the inguinal-femoral lymph nodes;
- lymphoma;
- radiation therapy to the pelvic area, groin, thighs;
- recurrent streptococcal lymphangitis, arising against the background of erysipelas, phlegmon.
In inhabitants of tropical countries, lymphostasis of the lower extremities is often caused by lymphatic filariasis (synonyms: elephantiasis, elephantism, filariasis).
The causative agents are parasitic small worms (filariae), which are carried by mosquitoes and enter the body with their bites. Filariasis is manifested by the following symptoms:
- increased body temperature;
- swollen lymph nodes;
- hypertrophy of the genitals, chest, arms, or legs;
- severe pain in the affected area.
Forms of the disease
Depending on the causes, lymphostasis of the lower extremities is divided into two types:
- primary - the pathological mechanism of its development is based on congenital anomalies in the structure of the lymphatic system (valve failure, obstruction, agenesis or hypoplasia of the lymphatic vessels). Symptoms of the disease begin to appear in childhood and gradually progress. Both limbs are more often affected;
- secondary - in this case, disorders of lymph circulation are caused not by anomalies of the lymphatic system, but by diseases and injuries. The pathological process affects only one limb, initially lymphatic edema is localized in most cases in the area of the foot and the lower third of the leg.
Depending on the age at which the symptoms of lymphatic edema appeared, there are:
- juvenile lymphedema - occurs before the age of 30;
- late lymphedema - after 30 years.
Disease stages
In the clinical course of lymphostasis of the lower extremities, three stages are distinguished:
- Transient mild edema.
- Irreversible edema (fibredema)
- Elephantiasis (fibrosis, cysts).
Symptoms of lymphostasis of the lower extremities
The clinical picture of lymphostasis of the lower extremities is determined by the stage of the disease.
Transient mild edema is characterized by swelling of the affected limb. The swelling increases in the evening, and after a night's sleep it almost completely disappears. Factors contributing to its growth are:
- long stay on your feet;
- prolonged limitation of mobility;
- physical exercise.
At this stage of the disease, the patient does not have irreversible growths and changes in connective tissue, due to which the therapy prescribed during this period allows achieving a stable regression of all signs of lymphostasis of the lower extremities.
At the next stage of the disease, the edema becomes permanent and does not disappear even after a long rest. There is an overgrowth of connective tissue, the skin is stretched and thickened. There are complaints of pain in the affected limb and its increased fatigue, convulsions. When pressed with a finger, a depressed mark remains on the skin, which persists for several minutes, and sometimes hours.
The severe course of lymphostasis of the lower extremities is accompanied by the development of irreversible fibrocystic changes in soft tissues, which further disrupt the outflow of lymph. As a result, the affected limb loses its normal anatomical contours and significantly increases in size (elephantiasis), while its motor functions suffer.
Lymphostasis of the lower extremities in pregnant women
Lymphostasis of the lower extremities in pregnant women occurs often, provoked by the following factors:
- limiting physical activity;
- a sharp change in hormonal balance;
- compression of venous and lymphatic vessels by the growing uterus.
Chronic venous insufficiency significantly increases the risk of developing lower limb lymphostasis in pregnant women.
In most cases, leg lymphedema in pregnant women is reversible and resolves on its own after birth. To prevent the progression of lymphatic edema, women are recommended to regularly wear compression hosiery.
Lymphostasis of the lower extremities in pregnant women should be differentiated from edema due to other causes (varicose veins, nephropathy).
Lymphostasis of the lower extremities in children
The cause of lymphostasis of the lower extremities in children is most often a congenital pathology of the structure of the lymphatic system (underdevelopment of the valve apparatus, increased elongation and thinning of the walls of the lymphatic vessels). Inadequately formed lymphatic vessels are not able to fully function and divert lymph from the subcutaneous tissue and muscles of the lower extremities.
At an early age in children, an improperly developed lymphatic system usually still copes with its functions. However, as the child grows and develops, as his physical activity increases, soft lymphatic edema begins to appear. They are most pronounced towards the end of the day, and in the morning, after a night's sleep, they disappear. Children complain of pain in the legs, quickly onset leg fatigue. Parents may notice that fitted shoes become cramped by the end of the day.
With the onset of puberty, hormonal changes occur in the body, against the background of which the state of malformed lymphatic vessels worsens even more. As a result, the lymphatic edema of the lower extremities grows rapidly and becomes permanent. If treatment is not started, the child develops elephantiasis, and long-term non-healing trophic ulcers appear.
Diagnostics
Diagnosis of lymphostasis of the lower extremities is not difficult due to the severity of the main symptom - edema. It is much more difficult to identify the cause that led to its development. In order to identify it, an instrumental examination is carried out, including:
- ultrasound examination of the abdominal and pelvic organs;
- lymphostincigraphy;
- X-ray lymphography;
- computer and / or magnetic resonance imaging.
Lymphostasis of the lower extremities must be differentiated from postphlebitic syndrome and deep vein thrombosis, which are characterized by mild edema, varicose veins, varicose eczema and hyperpigmentation of the skin. If it is necessary to exclude the pathology of the veins, doppler ultrasound (USDG) is performed.
Treatment of lymphostasis of the lower extremities
The main goal of treatment is to restore the normal outflow of lymph from the tissues of the affected limb. For this purpose, appointed:
- hardware pneumatic compression;
- lymphatic drainage massage;
- wearing compression hosiery;
- physiotherapeutic procedures (hydromassage, laser therapy, magnetotherapy).
Drug treatment includes the use of angioprotectors, phlebotonics with lymphotropic action, immunostimulants, enzymes.
Patients with lymphostasis of the lower extremities are advised to adhere to a diet with limited sodium chloride. In addition, it is necessary to ensure a sufficient level of physical activity (Nordic walking, swimming, physical therapy classes).
Source: anukapohudei.ru
With the development of cracks and trophic ulcers on the skin of the affected limb, their local treatment is carried out - treatment with antiseptics, anti-inflammatory drugs, with the addition of a bacterial infection - with antibiotics.
The indications for surgical treatment of lymphostasis of the lower extremities are:
- ineffectiveness of ongoing conservative therapy;
- rapid progression of lymphatic edema;
- the formation of deforming lymphatic sacs;
- severe fibrosis.
There are several methods of surgical treatment of lymphostasis of the lower extremities:
- creation of lymphovenous anastomoses;
- dermatofasciolipectomy;
- liposuction;
- transplantation of a full-fledged lymphoid complex - carried out with the primary form of lymphedema;
- the creation of tunnels through which lymph from the affected tissues is diverted into healthy ones - this type of operation is performed with the development of elephantiasis.
Potential consequences and complications
At stage II-III, lymphostasis of the lower extremities is often complicated by the development of deforming osteoarthritis and contractures, eczema, trophic ulcers, erysipelas. The accession of a secondary infection leads to the occurrence of purulent complications (boils, phlegmon, osteomyelitis), which, in turn, can cause sepsis and death of the patient from infectious-toxic shock.
Source: gstatic.com
Lymphostasis of the lower extremities is often complicated by lymphangitis. In order to prevent this complication, it is necessary to take proper care of the feet. It is recommended to abandon the edged pedicure, instead perform hardware medical pedicure, use special products for the therapeutic and hygienic care of the skin of the feet. When attaching a fungal infection, antimycotic agents are used.
Forecast
Patients with lymphostasis of the lower extremities need to undergo regular maintenance therapy throughout their lives. Refusal of therapy leads to a rapid progression of the disease, the addition of a secondary infection and the severe purulent lesions caused by it, impaired motor function of the affected limb.
Prevention
In order to prevent the development of lymphostasis of the lower extremities, it is necessary:
- timely treatment and treatment of any wounds, especially those infected;
- regular and correct hygienic care of the skin of the feet, especially the feet, and nails;
- timely diagnose and actively treat diseases of the veins, heart and kidneys.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
