Could there perhaps be any edema with Lipedema? Some experts question whether or not the lymphatic system is impaired in women with lipedema. Today, I will tell you about a study entitled “Uncovering Lymphatic Transport Abnormalities in Patients with Primary Lipedema” which was done by Daniel Gould and colleagues at USC.
This study sought to characterize the lymphatic flow in women with lipedema. It was previously presented at a plastic surgery meeting in 2017 and was published in the Journal of Reconstructive Microsurgery in 2020.
Who are the subjects?
Patients who were being evaluated for surgical intervention for their lipedema were subjects in this study. Women who had excessive fat or swelling that did not spare the feet, Dercum’s disease, or other fat disorders were excluded from the study. 19 women were enrolled in the study.
What methods did they use?
19 lipedema patients underwent lymphoscintigraphy of the legs. A lymphoscintigraphy injects a tracer between the first and second toes on each foot. Images are then taken every minute for the first 15 minutes, then at 30 minutes, 60 minutes, and 90 minutes post-injection. If needed, images were also done at 2 and 3 hours post-injection.
They then applied a numeric transport index to quantify the functioning of the lymphatics in each participant. This score looked at things like the speed of uptake of the tracer in the foot, how long it took for the tracer to get to the inguinal lymph nodes at the groin and the distribution pattern of the tracer in the extremity.
What did they find out?
Their results found that 63.2 % had lymphatic impairment. It was very common for both legs to be affected, usually with one leg more severe than the other. Only 4 women presented with impaired lymph flow in only one leg, while the other had normal flow. Examples of the kinds of lymphatic impairments that were visualized included: delayed uptake of the tracer by lymph capillaries, collateral (alternative) lymphatic pathways, dermal backflow into the leg, and slower than normal flow to the inguinal nodes at the groin.
Although lymphatic impairments were also found in milder (stage 1 and 2 lipedema), they found there was a significant correlation between the severity of lipedema and worsened lymphatic functioning. This suggests a possible relationship between the severity of lipedema and the impairment of the lymphatic system.
So… is edema caused by lipedema?
The authors suggest that the results of this study show women with lipedema should be screened for lymphatic impairment that may lead to swelling that requires treatment. This study agrees with several others that have been performed in recent years that edema is a common characteristic of lipedema, including a study by Forner-Cordero in 2018.
In this study, 47 % of participants had lymphatic abnormalities. Unfortunately, it’s not clear if the subjects in this study also had a diagnosis of obesity which can also impair lymphatic functioning. Is edema the result of obesity or lipedema or both? There is still more for us to learn.
For more related content, be sure to check out Lipedema Simplified’s Flash Briefings, our daily mini-podcast with tips, tools, helpful research, and other resources pertaining to lipedema.
~ Leslyn Keith, OTD, CLT-LANA
Board President, Director of Research | The Lipedema Project