What are the symptoms of lower limb lymphedema?

Lower limb lymphedema is a very common disease. Most people suffer from lower limb lymphedema due to their bad living habits. In the early stage of lower limb lymphedema, many people often think it is ordinary edema and do not pay special attention to it. As a result, by the time they find it, they have missed the best time for treatment. So what are the symptoms of lower limb lymphedema?

What are the symptoms of lower limb lymphedema?

The main symptom is swelling of one side of the limb, starting from the ankle and then extending to the entire lower limb. In the early stage, the skin is normal, but in the late stage, the skin becomes thickened, dry, rough, pigmented, and warts or thorns appear. The degree of lymphedema can be classified as:

1. Mild: Limb edema is pitting and may decrease or disappear after raising the limb. There is no fibrotic lesion on the skin.

2. Moderate: The edema is no longer concave when pressed, the edema does not disappear significantly when the limb is raised, and the skin has moderate fibrosis.

3. Severe: Epidermal swelling-like skin changes occur.

Acute phase: Hematoma and fistula may be blocked by blood clots at the local injury site, and thus a pulsating mass often appears within a few days. Most of them are accompanied by tremors and murmurs. In most patients, pulsation can still be felt in the distal artery of the fistula.

Chronic stage: mainly various manifestations caused by hemodynamic changes. Because high-pressure arterial blood directly perfuses the veins through the fistula, venous pressure increases, and the superficial veins proximal and distal to the fistula significantly expand, and the skin temperature rises. In areas far away from the fistula, especially at the foot, nutritional changes such as thin skin, pigmentation, and ulcer formation occur due to reduced arterial blood supply and venous congestion. The larger the fistula is, the closer it is to the heart, and the thicker the artery where the fistula occurs (such as the carotid artery, subclavian artery, iliac artery, femoral artery, etc.). Since a large amount of blood enters the vein directly through the fistula, the amount of blood returning to the heart increases greatly, which can cause the heart to enlarge and lead to heart failure. Local symptoms are often very typical: rough and continuous vascular murmurs can be heard along both sides of the fistula, the veins adjacent to the fistula are significantly dilated, and there are vascular murmurs and tremors.

The following tests can help make the diagnosis:

① Finger pressure fistula measurement (Brabham sign): For patients with a large fistula and a large shunt volume, blocking the shunt with finger pressure may cause increased blood pressure and a slower pulse rate.

② Venous pressure measurement: The pressure of the superficial veins of the affected limb is increased.

③ Determination of venous blood oxygen content: Blood is drawn from the superficial vein near the fistula, and it can be found that the blood is bright red and has a significantly higher oxygen content than the venous blood of normal limbs.

④Ultrasound Doppler imaging examination: It can be observed that arterial blood is shunted to the vein through the fistula.

⑤ Arterial angiography: For arteriovenous fistulas with larger diameters, the fistula opening can usually be directly displayed; the vein adjacent to the fistula opening is displayed almost simultaneously with the artery; the artery distal to the fistula opening cannot be displayed in its entirety, while the vein adjacent to the fistula opening is significantly enlarged. For arteriovenous fistulas of smaller caliber, the fistula opening cannot often be directly displayed, but the arteries and veins adjacent to the fistula opening are displayed almost simultaneously. Those with a history of hematoma formation often show tumor-like enlargement changes on the arterial side, the venous side, or both.

In the early stage, the changes in skin and subcutaneous tissue are relatively mild and should be differentiated from other diseases:

1. Venous edema is more common in deep vein thrombosis of the lower extremities. It is characterized by acute onset of sudden swelling of one limb, accompanied by cyanosis of the skin, obvious tenderness in the gastrocnemius and femoral triangle, and exposed superficial veins. The edema of the dorsum of the foot is not obvious. Lymphedema has a slower onset and is more common with swelling of the dorsum of the foot and ankle.

2. Angioneurotic edema Edema occurs due to the stimulation of external allergic factors. It has a rapid onset, disappears quickly, and is characterized by intermittent attacks. Lymphedema tends to gradually worsen.

3. Systemic diseases such as hypoproteinemia, heart failure, kidney disease, cirrhosis, and myxedema can all cause lower limb edema. It is usually bilaterally symmetrical and accompanied by the clinical manifestations of the respective primary diseases. Usually, the disease can be identified through detailed medical history, careful physical examination and necessary laboratory tests.

4. Lipoma. A few lipomas or adipose tissue hyperplasia with very extensive lesions may be confused with lymphedema. However, most lipomas show localized growth, a slow course of disease, and soft subcutaneous tissue without edema. If necessary, soft tissue X-ray mammography can be performed to assist in diagnosis.

Non-surgical treatment: including raising the affected limb, wearing elastic stockings, limiting water and salt intake, applying diuretics, preventing infection, and baking and bandaging therapy. Through repeated thermal moxibustion stimulation, the tissue temperature is increased, metabolic activity is enhanced, and the regeneration of blood vessels and the recovery of lymphatic return can be promoted.

There is no effective drug treatment for this disease, and physical therapy is the main treatment. If edema is caused by filariasis or erysipelas, drugs for the treatment of filariasis or erysipelas are used.

1. Raise the affected limb and apply compression bandage;

2. Limit water and sodium intake and use diuretics;

3. Treatment of filariasis or erysipelas;

4. Baking and binding treatment;

Surgical treatment: The procedures include lymphatic or lymph node-venous anastomosis; pedicled omentum transplantation; partial resection of the lesion and skin grafting. Most cases of lymphedema do not require surgery. Approximately 15% of primary lymphedema patients eventually require lower extremity plastic surgery. Existing surgical methods, except amputation, cannot cure lymphedema, but can significantly improve symptoms.