Oedema present at the 26th World Congress of Lymphology

Friday, October 13, 2017



Oedema was present at the 26th World Congress of Lymphology in Barcelona. Some of our board members gave a presentation about a specific topic in lymphology.


Prof. Nele Devoogdt gave a presentation about the ICC compression questionnaire. It is a reliable and valid tool that evaluates different kinds of compression materials worn by subjects with lymphedema and chronic venous disease. This tool evaluates different aspects in relation to compression, such as dosage, comfort, complications, disease-related symptoms, functioning, fitting and skin.

The next presentation by Prof. Nele Devoogdt was about the Conservative Decongestive Lymphatic Therapy for the treatment of lymphedema. At first, the role of manual lymph drainage was discussed. She concluded that currently the additional effect of (traditional) manual lymph drainage, to the other components of the Decongestive Lymphatic Therapy, is limited. Recently, a new method of lymph drainage has been developed, i.e. fluoroscopy-guided lymph drainage. This fluoroscopy-guided lymph drainage improves lymphatic transport during one session. However, the clinical effect on the lymphedema during different sessions of fluoroscopy-guided lymph drainage has never been examined. Therefore, recently, a study about the additional effect of fluoroscopy-guided lymph drainage, to decongestive lymphatic therapy, compared to traditional or placebo lymph drainage, has been started (i.e. EFForT-BCRL trial).  In contrast to manual lymph drainage, compression therapy and exercise therapy are effective. Consequently, more attention has to be given to compression and exercise therapy in the treatment of lymphedema.


Dra. Hanne Verbelen gave a presentation on the development of a questionnaire for breast edema in breast cancer patients. Breast edema is a common morbidity after breast cancer treatment, but is largely underdiagnosed in clinical practice. A possible explanation is the lack of a uniform definition and the lack of a standard assessment tool. Relevant information on breast edema is collected through a systematic review of the literature, through health care professionals specialized in breast cancer treatment and through breast edema patients. Based on this information the BreQ-questionnaire is developed. To cover all health-related QOL aspects, we wanted to look at the bio-psychosocial framework. The ICF covers all domains of disability. In the first part of the questionnaire, impairments in body functions or structures are assessed on a scale from 0 to 10 to assess the symptoms of breast edema. Relevant symptoms we collected were pain, heaviness, swelling, tensed skin, redness, pitting, enlarged skin pores and hardness of the operated and irradiated breast. In the second part of the questionnaire we assessed activity limitations and participation restrictions. Currently, clinimetric properties are being tested in a group of breast cancer patients.


Jean Paul Belgrado gave a presentation about deep infrared imaging to identify venous impairment after breast cancer surgery. Breast cancer related lymphedema (BCRL) is commonly attributed to axillary lymph node dissection (ALND) and reduction of lymph flow. Impairment of the axillary vein seems to contribute also to BCRL, leading to a deep pitting edema of hand and forearm. When a patient with axillary vein impairment stands up, hand skin looks rapidly hyperaemic, due to a vasodilation of the capillaries. This vascular situation may result from removal of the fatty tissue containing lymph nodes, and disruption of the good emptying of the axillary vein. The orthostatic intermittent venous stenosis induces superficial venous collateralizations which are derivative evidence of the axillary vein impairment. DIRI and its reading grid seems to be a useful tool in daily clinical practice to evaluate the hemodynamic changes of the axillary vein in BCRL patients. This evaluation gives us more insight in the (future) development and eventual treatment of BCRL. Dr Liesbeth Vandermeeren is currently investigating the possibility to use lipofilling as a possible treatment for this pathology.


Furthermore we had a very interesting presentation by Dr. Tobias Bertsch of the Földi clinic in Germany. He spoke about obesity and lymphedema, and the misdiagnosis of lipedema, an unpopular and underestimated topic. The increasing prevalence of obesity worldwide will have a dramatic increase of obese patients with lymphedema as a result. But at the same time the obese patient with lymphedema is also a very unpopular patient, unpopular in medical practices, clinics, as well as among lymph therapists. Traditional therapy is to stimulate weight loss and to exercise. However, long term results of this treatment are not good. The body of these obese patients resists long term weight loss and 95% of all dieters will regain weight or even gain more weight after 3 years. Since 2007 the Földi Clinic developed a multimodal program for severe obese patients with lymphedema and lipedema. In this program bariatric surgery plays the central role. Together with exercise and QOL improvement they see a good improvement, long term, of their obese patients and also of the lymphedema. Dr. Bertsch also suggested that we should not refer to lipedema as a progressive disease. He states that clinically we see a lot of patients with stabilized lipedema because their weight stays stabile. Another statement was that there is no place for manual lymph drainage in the treatment of lipedema. Surgery, exercise, compression and improvement of QOL are the keystones in the treatment of obesity, lipedema and associated lymphedema. 


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