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Obesity and lymphedema in geriatrics: combined therapeutical approaches
BMC Geriatrics volume 10, Article number: A49 (2010)
Obesity combined with lymphedema, especially in geriatrics, is more than the sum of the two diseases  because it causes the diaphragm to be above its normal position, impairing its movement. As a consequence, a fundamental mechanism that supports lymph flow is significantly decreased. Obesity associated with lymphedema represents a cause of a highly invalidating condition. The purpose of this preliminary report is to propose a system of treatment, assessing the efficacy of a combined approach of lymphostatic disease in obese geriatric patients.
Materials and methods
A group of 6 geriatric patients affected by obesity (BMI>35) and lower limb lymphedema (II to III stage) had been enrolled in this preliminary study. Patients underwent a protocol of treatment of lymphedema by Complete Decongestive Therapy (CDT) according to Földi’s method. Patients had been under observation for six-twelve months. They were evaluated during this period of follow-up at 1-3-6 and 12 months. After 12 months those patients who were not significantly responsive to non-operative methods, without any important regression of previous lymphedema staging, had a lymphangioscintigraphy performed in order to evaluate a right indication to lymphatic-venous microsurgical anastomoses .
Two patients showed a significant reduction (>50% in comparison to previous volumetry) of lower limbs affected by lymphstasis after CDT procedures, with a high level of patient satisfaction. Four patients, on the guide of lymphangioscintigraphy showing a relevant impairment of lymph transport capacity index of lower limbs, underwent Derivative Lymphatic-Venous Bypass microsurgical procedure (LVA), performing a simultaneous operation at both groin sites (Figure1 and 2). Clinical and lymphoscintigraphic post-operative follow-up (evaluated at 3-5 years after surgery) showed a long-lasting improvement, with a marked edema and volumetric reduction maintained by a proper lifestyle, remedial exercise, elastic stockings and periodical CDT procedures.
Considering the high incidence of obesity and the not-unfrequent association with lower limb lymphedema, the method proposed of a combined approach in geriatric patients can represent an effective and long-lasting therapeutic solution.
Földi M, Földi E: Földi’s Textbook of Lymphology. 2006, Mosby-Elsevier, 2nd
Campisi C, Davini D, Bellini C, Taddei G, Villa G, Fulcheri E, et al: Lymphatic microsurgery for the treatment of lymphedema. Microsurgery. 2006, 26 (1): 65-9. 10.1002/micr.20214.
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Campisi, C., Accogli, S., Campisi, C. et al. Obesity and lymphedema in geriatrics: combined therapeutical approaches. BMC Geriatr 10, A49 (2010) doi:10.1186/1471-2318-10-S1-A49
- Geriatric Patient
- Lymph Transport
- Capacity Index