[Role of lymphofluoroscopy in the management of lymphedema]. / Place de la lymphofluoroscopie dans la prise en charge du lymphœdème.

The lymphatic vascular system is essential for maintaining a healthy balance between interstitial fluid production and transport. Dysregulation of this balance can lead to the formation of lymphedema, a pathology that is disabling and bothersome in the daily lives of the patients. Lymphofluoroscopy is an invaluable tool that provides static and dynamic images of the superficial lymphatic vessels, with diagnostic and therapeutic implications. This diagnostic tool is beginning to take its place in the field of lymphology, as it is minimally invasive and has virtually no side effects.

Le système lymphatique vasculaire est essentiel pour maintenir un bon équilibre entre la production et le transport du liquide interstitiel. Une dysrégulation de cette balance peut amener à la formation d'un lymphœdème, pathologie invalidante et gênante dans la vie quotidienne des patients. La lymphofluoroscopie est un instrument précieux qui permet, avec des images statiques et dynamiques, d'observer le système vasculaire lymphatique superficiel, avec des implications diagnostiques et thérapeutiques importantes. Cet instrument diagnostic commence à prendre sa place dans le domaine de la lymphologie, car il est peu invasif et quasiment sans effet secondaire.

Indocyanine green lymphography as novel tool to assess lymphatics in patients with lipedema.

OBJECTIVE: Lipedema is a chronic and progressive disease associated with lymphatic impairment at later stages. The aim of our study was to describe the functional status and anatomy of lower limb superficial lymphatic system using indocyanine green (ICG) lymphography in patients with lipedema. METHODS: Following ICG injection at the dorsum of the foot, distance (cm) covered by the dye at 10 (T10') and 25 min (T25') was measured and normalized for limb length. If the dye did not reach the groin within 25 min, patients were classified as "drainage-needing" group (DNG). Values of fat and lean distribution assessed by dual-energy X-ray absorptiometry were extracted, and correlation analysis was performed. Furthermore, anatomical patterns of superficial lymphatics were assessed. RESULTS: Overall, 45 women were included, 25 (56%) of whom were classified as DNG. Symptoms duration was significantly associated with DNG status at multivariate analysis (odds ratio 1.07; 95% CI 1.01-1.14; p = 0.047). Moreover, Spearman's analysis showed a negative correlation between symptoms duration and T25' dye migration (r = -0.469; p = 0.037). Overall, no major anatomical lymphatic changes were found. CONCLUSIONS: Present study suggests that lymphatic functioning in patients with lipedema correlates with symptoms duration. Further research on larger cohorts should verify our findings and clarify their potential therapeutic implications. Overall, ICG lymphography may be promising technique to assess both lymphatic anatomy and functioning in patients with lipedema.

Lipedema: A Call to Action!

Lipedema is a chronic progressive disease characterized by abnormal fat distribution resulting in disproportionate, painful limbs. It almost exclusively affects women, leading to considerable disability, daily functioning impairment, and psychosocial distress. Literature shows both scarce and conflicting data regarding its prevalence. Lipedema has been considered a rare entity by several authors, though it may be a far more frequent condition than thought. Despite the clinical impact on women's health, lipedema is in fact mostly unknown, underdiagnosed, and too often misdiagnosed with other similarly presenting diseases. Polygenic susceptibility combined with hormonal, microvascular, and lymphatic disorders may be partly responsible for its development. Furthermore, consistent information on lipedema pathophysiology is still lacking, and an etiological treatment is not yet available. Weight loss measures exhibit minimal effect on the abnormal body fat distribution, resulting in eating disorders, increased obesity risk, depression, and other psychological complaints. Surgical techniques, such as liposuction and excisional lipectomy, represent therapeutic options in selected cases. This review aims to outline current evidence regarding lipedema epidemiology, pathophysiology, clinical presentation, differential diagnosis, and management. Increased awareness and a better understanding of its clinical presentation and pathophysiology are warranted to enable clinicians to diagnose and treat affected patients at an earlier stage.

[Lipedema, the Unknown]. / Le lipœdème, cet inconnu.

Lipedema, the Unknown Abstract. Lipoedema patients suffer from the widespread ignorance of their pathology. Considering its chronic, progressive and invalidating character, the early diagnosis of the disease must constitute the challenge of their caregivers in order to limit medical wanderings and the occurrence of complex clinical pictures. Treatments allow the reduction of lipedema and its long-term control. Management must be individualized according to the stage of the disease. The adherence of the patient, the supervision and the support of the practitioner are essential for obtaining the best results.

[Primary lymphedema]. / Lymphœdème primaire.

Characterized by an aplasia, hypoplasia or dysplasia of the lymphatic network, the primary lymphedema takes part of rare diseases. If 10 % of cases are congenital, the majority of them are detected before 35 years, most of the time due to an intercurrent event suh as a sprain or an infection. Although rarer, some primaries lymphedemas are family forms such the syndromes of Milroy and Meige. The primary lymphedema can also be a part of more complex malformative diseases such as Klinefelter, Turner or Noonan syndromes. If the lymphatic drainage associated with the elastic contention remains the basis care of lymphedema, we have to identify these patients as well as their family, sometimes requiring multidisciplinary cares.

Caractérisé par une aplasie, une hypoplasie ou une dysplasie du réseau lymphatique, le lymphœdème primaire fait partie des maladies rares. Si 10 % des cas sont congénitaux, la majorité d'entre eux sont dépistés plus tardivement mais avant 35 ans, le plus souvent suite à un événement intercurrent tel qu'une entorse ou une infection. Bien que plus rares, certains lymphœdèmes primaires revêtent un caractère familial comme les syndromes de Milroy et de Meige. Le lymphœdème primaire peut aussi s'inscrire dans des tableaux cliniques plus complexes tels les syndromes de Klinefelter, de Turner ou de Noonan. Si le drainage lymphatique associé à la contention élastique demeure la base de la prise en charge de ces patients, il nous appartient de les identifier ainsi que leur famille, car ils nécessitent parfois une prise en charge multidisciplinaire.

[Lymphatic vascular pathologies: contribution of lympho-fluoroscopy]. / Pathologies vasculaires lymphatiques: apport de la lympho-fluoroscopie.

If clinical examination has an essential importance in lymphology disorders and requires experimented practitioners, lymphoscintigraphy and more recently green indocyanine lympho-fluoroscopy constitute precious complementary investigations in prevention, diagnosis, and treatment of lymphatic vascular pathologies. The lymphoscintigraphy interest lies in qualitative and quantitative analysis of macromolecules migration within lymphatic vessels and the deep lymphatic network. The lympho-fluoroscopy distinguishes itself from lymphoscintigraphy allowing real time superficial lymphatic vessels detailed mapping, gathering important information on their contractility, and the presence of compensatory derivations to be favored during manual lymphatic drainage to angiologist and physiotherapist.

[3rd degree chronic venous insufficiency: physiotherapy treatment]. / Insuffisance veineuse chronique stade III: Prise en charge physio- thérapeutique.

A venous ulcer is the end result of a long pathological process where venous hypertension represents the principal cause of a number of complications. The physiotherapist by adapting various different therapeutic approaches improves the vascular, joint and respiratory problems of these patients.