Lower limb lymphostasis: treatment, symptoms,the reasons

Update: November 2018

Если вечером  обнаружить у себя отек ног, как правило,
pain and swelling of the lower limbs to the morning disappear, but if this
does not happen, or does not occur fully, you should think
and start a serious examination, during which can be identified
лимфостаз lower limbs. According to statistics, data
About 10% of people in the world suffer from the disease.

Little about the lymphatic system

The link between the cardiovascular and lymphatic networks is undeniable, so
as the latter is part of the circulatory. Lymphatic system
represented by a network of vessels located throughout the body and
which lymph circulates. Lymph forms during filtration.
blood plasma, that is, the fluid enters the extracellular
space, and from there along with the coarse squirrels
interstitial space enters the lymphatic capillaries, and
then into the lymphatic network, where the lymph is “cleaned” (in
lymph nodes), and again flows into the circulatory system in the area
lower neck.

Lymphatic system имеет свои «обязанности»:

  • with its help, tissue fluid is evacuated from interstitial
    space (warning of edema);
  • together with proteins of the interstitial space through the subclavian
    veins transporting tissue fluid back to the blood
    mainstream;
  • participates in the transfer of fat from the small intestine into the blood;
  • synthesizes lymphocytes that are part of the protective
    механизма organism;
  • filters in the lymph nodes tissue fluid and removes from it
    toxins, microorganisms, tumor cells, foreign
    substances;
  • involved in the formation of antibodies.

Lymphatic system состоит из лимфатических капилляров,
vessels, nodes, trunks and ducts. Any damage
lymphatic pathways (sticking, blocking or clogging) free
the outflow of lymphatic fluid from the tissues is disturbed, which leads to
edema, further turning into lymphostasis.

Lower limb lymphostasis: definition

Pathological condition in which the swelling of tissues increases
the area involved (in this case the lower limbs)
called lymphostasis of the legs or lymphedema (lymphatic edema).
This disease is caused by a violation of the outflow of fluid
lymphatic vessels, which leads to its stagnation in the tissue
space and swelling. Among patients with peripheral pathology
vessels 3-7% are people with lymphostasis of the legs.

Classification of Lymphedema

There are primary and secondary lymphostasis of the legs. And if primary
lymphostasis of the lower extremities is innate, then
secondary develops during life under the action of any
provoking factors. In turn, secondary lymphostasis
divided into youthful (occurs between 15 and 30
years) and adult (develops after 30 years).

The reasons

Первичный лимфостаз нижних конечностей имеет следующие the reasons
occurrence:

  • diameter of lymphatic vessels is very small;
  • insufficient number of lymphatic pathways;
  • anomalies of the lymphatic vessels (fusion, obliteration,
    doubling);
  • amniotic banners that lead to the formation
    the hems squeezing vessels;
  • genetic predisposition to lymphatic underdevelopment
    systems;
  • congenital tumor formation of the lymph system.

Secondary lymphostasis is caused by various diseases that
lead to stagnation of lymph and edema of the lower extremities:

  • damage to the lymphatic system as a result of lower trauma
    limbs (fractures, sprains, surgery);
  • scar formation and damage to lymphatic vessels
    burns, radiation exposure;
  • недостаточность сердечно-сосудистой systems;
  • chronic venous insufficiency (after suffering
    thrombophlebitis);
  • benign and malignant neoplasms
    лимфатической systems;
  • overweight;
  • inflammation of the skin of the legs (erysipelas);
  • parasitic infections (for example, the introduction of filarias in
    lymphatic vessels disrupts the lymph flow, which causes wuchereriosis – elephant
    disease);
  • hypoalbuminemia (protein deficiency);
  • surgical interventions in the chest and cage
    (including mastectomy);
  • kidney disease;
  • removal of lymph nodes;
  • prolonged bed rest or stiff legs.

Symptoms of lymphostasis of the legs

Lymphostasis of the legs in its development passes through three stages, having
different manifestations:

First stage

The initial phase of the disease is called easy or reversible.
swelling is called lymphedema. Leg edema / swelling with lymphostasis
appears in the ankle, at the base of the fingers and
между костями плюсны с тыла feet. Usually a similar phenomenon.
occurs in the evening and / or after exercise. Skin over
pale place swollen, easy to fold when
probing There is no proliferation of connective tissue, but edema itself
painless and soft enough. After sleeping or resting leg / legs
quickly bounce back.

Second stage

This stage is characterized by irreversible lower edema.
limbs and is called fibredema. Irreversible edema phase
proceeds slowly, until several years and manifests itself overgrowth
connective tissue. Edema “rises” up, becomes
thick enough, and the skin over it stretches and thickens,
fold it becomes impossible. Edema is permanent
character, does not disappear at rest and is accompanied by pain
or feeling heavy on exertion.

In this stage, the lower limb begins to deform,
leg circumference is significantly increased, and long standing
leads to cramps in the calf muscles and joints
feet. The skin gets bluish tint, compacted
(hyperkeratosis), the appearance of warty outgrowths is possible.
Complications of this stage are wounds and ulcers in places
constant friction of the skin (contact with clothes, skin folds), they
inflamed and constantly exuding lymph. Diameter difference healthy
and sore feet can reach 50 cm.

Third stage

This is the final and most difficult phase of the disease. At this stage
the disease is called elephant disease or elephantiasis
(elephantism). Характеризуется значительным overgrowth
connective tissue under edema, the skin becomes very dense and
rough, “like an elephant,” stretched and pours a blue. Struck
the limb is greatly enlarged, its contours are lost, and
fibrosis and cystic changes develop in soft tissues. Leg
becomes like an elephant and completely loses its function.
Complications of the third stage include: the development of osteoarthritis,
contractures, eczema, trophic non-healing ulcers and erysipelas
inflammation.

In addition to local manifestations of lymphostasis of the lower extremities have
place and general symptoms:

  • general weakness;
  • fast fatiguability;
  • pain in the head;
  • tongue is coated with white bloom;
  • loss of attention and difficulty concentrating;
  • weight gain, obesity;
  • joint pain.

Diagnostics

After careful history and complaints, the vascular surgeon
(angiosurgeon, phlebologist or lymphologist) examines the lower
limbs and prescribes additional methods of examination:

Lymphography

Refers to radiological methods of examination. Is concluded
in the introduction interval (between 1 and 2 fingers) of the foot 1 – 2 dice
lymphotropic dye, and then between the bones of the metatarsus (1 and 2)
make a transverse incision of about 2 cm, in which the painted
in the blue color of lymphatic vessels. In any of the visible vessels is introduced
radiopaque substance, and take pictures.

Lymphography позволяет определить количество сосудов, их форму и
permeability, connection of collateral vessels and spare,
permeability of the lymph vessel wall. If there is a uniform
filling the vessel with the contrast with the preserved diameter of its diameter
along the entire length, then talk about maintaining patency and damage
contractile apparatus.

  • At primary lymphostasis vascular underdevelopment is noted.
  • With a secondary disturbed course of the vessels, modified forms,
    contrasting the skin network and the distribution of the substance in
    subcutaneous tissue (extravasation).

Lymphoscintigraphy

This is a method of radioisotope diagnosis (in the subcutaneous tissue
an isotopic substance is injected, from where it enters the lymphatic network, then
a special gamma camera takes pictures). The method allows
to observe the state of the lymphatic system in dynamics and
determine the nature of lymph flow: collateral, trunk or
diffuse, as well as complete lymphostasis, to assess the vascular permeability,
their crimpiness and condition of the valves.

Doppler sonography of the lower extremities

Or duplex vascular scan – ultrasound
research of vessels using the Doppler effect (allows
differentiate venous and lymphatic edema).

Other tests

  • Ultrasound of the pelvic organs – the identification of inflammatory diseases
    or tumors that disrupt the lymph flow.
  • Biochemical and complete blood count – determination of blood proteins,
    liver enzymes, identifying signs of inflammation and so on.
  • Urinalysis – to exclude kidney disease.
  • Heart test – ultrasound, an ECG
    detection / exclusion of cardiac pathology.

Treatment

When lymphostasis of the lower extremities is mandatory
being treated. Moreover, the earlier it is started, the higher the chances
for success. Disease therapy is a complex task.
which combines many techniques (health food, massage,
medication, etc.) and aims to improve the lymph outflow from
lower limbs.

All conservative methods of treatment are applied only on stage 1.
diseases (phase of lymphedema), when structural
изменения кожи и connective tissue. How to treat lymphostasis,
depends on the reason that caused it. First of all it is necessary (by
opportunities) to eliminate the etiological factor (for example, in the presence of
tumors of the pelvis, compressing lymphoma, shown her
removal). General recommendations for patients with this pathology:

  • It is strictly forbidden to visit the bath, sauna or sunbathe
    (thermal effect promotes vasodilatation, including
    and lymphatic, which impairs blood and lymph flow in the legs);
  • do not wear shoes with heels or with lacing (heel
    increases the load on the legs and impairs lymph flow, and lacing
    pulls soft tissues and vessels passing into them, which also
    adversely affects the disease);
  • avoid lifting weights and static loads (long
    standing or sitting);
  • treat even minor skin damage (including
    and bites) antiseptic solutions;
  • refuse to wear tight underwear and tight clothes
    (firstly, it contributes to the compression of lymphatic vessels, and, secondly,
    rubbing of the skin in places of contact with clothes provokes the formation
    trophic disorders);
  • you cannot sit, especially for a long time, with your legs crossed (by the way,
    women’s favorite posture), as this situation makes lymphoma difficult
    – and blood flow in the legs and organs of the small pelvis;
  • It is forbidden to walk barefoot outside the home (high probability
    damage to the skin of the feet and the formation of a long non-healing ulcer);
  • when taking a bath, use special oils (Balneum
    Plus), and after water procedures, wipe the skin of the feet with creams and
    lotions without perfumes and preservatives that not only cleanses the skin,
    but also softens it, and also restores the protective barrier;
  • use powder (talc, baby powder) with strong
    sweating of the legs, which reduces sweating and the risk of developing
    trophic disorders;
  • timely and carefully cut toenails;
  • during the massage exclude kneading techniques.

Medical nutrition in lymphostasis

First of all, treatment of the disease should begin with
nutritional adjustments, especially true for patients with
obesity. Diet for lymphostasis is aimed at limiting
salt intake (sodium chloride causes fluid retention in tissues
and edema) and spicy foods (cause thirst and increase consumption
fluid).

The amount of free fluid should be no less, but not
more than 2 liters per day (tea and coffee replaced with herbal teas,
compote without sugar, fruit drinks), exclude carbonated drinks.
You should also limit simple carbohydrates (bread, pastries,
confectionery, candy, etc.), which contributes to the increase
extra pounds, replacing them with complex ones (bread made from coarse flour
grinding or bran, porridge on water or diluted milk: millet,
barley, corn).

Increase the consumption of vegetables and fruits (you can bake, stew,
but do not fry), give preference to fresh vegetable salads,
seasoned with vegetable oil. Limit animal consumption
fat (about 10 grams per day), as saturated (animal) fats in
large numbers obstruct the lymph flow. And vegetable oils in
nutrition should be at least 20 grams. daily. In addition, the excess
animal fat provokes the development of atherosclerosis, which aggravates
during lymphostasis.

Also in the diet should be enough protein.
plant and animal origin that is necessary for
antibody formation and immunity enhancement. Animal fat
preference to give dairy products, sea and
offal. Sources of vegetable protein – buckwheat, legumes
cultures and nuts.

Compression treatment and kinesiotherapy

Compression therapy is to squeeze the skin and
subcutaneous tissue sore feet so that the force of pressure
growing from foot to shin and hip. The patient during the day
it is recommended to keep the affected leg as high as possible.
position, and at night put a cushion or pillow under it
(creating an angle of 45%).

Compression is carried out by elastic bandaging the bottom
limbs and wearing elastic stocking. Elastic overlay
bandage is carried out in the morning, without getting out of bed, starting with each
finger, then moving to the foot and then to the lower leg and thigh. For the night
the leg is unzipped (see choice of compression garment when
varicose veins).

The method of pneumatic compression with the help of special
devices which consists in consecutive mechanical
compressing the legs with a certain pressure. To do this, on the bad leg
a special pneumatic boot is put on, which is pumped into
air from the foot to the thigh. 10 – 14 relies on the course
procedures. After each session light gymnastic exercises are held.
exercises.

Kinesitherapy is a lymphatic drainage massage and
exercise physical therapy exercises. Massage with lymphostasis
leg supports the lymph flow, “expels” the lymph from the edematous tissues,
stimulates phagocytosis by macrophages, enhances the work of capillary
lymphatic pump. Also with the help of massage are destroyed
molecular substances that interfere with normal
lymph flow.

Lymphatic drainage massage is performed by a specialist and
contraindicated in trophic disorders of the skin of the sick leg,
venous thrombosis and in the presence of internal tumors and diseases
organs. Allowed and self-massage (at the initial
stages). At home, it is recommended to massage after
taking a warm bath, and after applying a special
cream

In the first 3 – 5 minutes are carried out circular stroking.
movement (it is important to remember: massage is performed along the lymph flow, then
there is from the foot up), then rubbing movements are carried out and
pushing and finish the session by clapping. Duration
Massage is 15 minutes. Recommended courses for 14 days from 1 –
2 week break. After completing the massage session
take 10 light socks or stretch 15 times
socks.

Therapeutic gymnastics (gymnastics) is held twice a day, 5 – 10
minutes and includes the following exercises (on a hard surface):

  • in a horizontal position to perform the “bike” as a patient,
    so and healthy foot;
  • lift the aching leg up (not bending) and perform circular
    movement;
  • in the sitting position to bend and unbend the fingers of the feet;
  • rotate the legs of the knee, and then the ankle joints;
  • in the sitting position to draw the feet of the “eight” and rotate
    alternately with one and the other foot.

Exercise therapy is carried out necessarily in stockings or elastic bandages. Besides
In addition, lymphostasis shows swimming and “Scandinavian” walking (with
ski sticks).

Drug therapy

Drug treatment of lower limb lymphostasis includes
a wide range of drugs that normalizes blood circulation
and lymph flow, reduce the permeability of the walls of blood vessels and increase their
elasticity:

  • phlebotropic drugs (detralex, troksevazin and gel
    troxerutin) – improve tissue microcirculation, increase tone
    veins, restore the lymph flow;
  • enzyme preparations (wobenzym, phlogenzyme) – stimulate
    immunity, fight edema, have anti-inflammatory and
    fibrinolytic action;
  • benzopyrone (coumarin) – reduce high-protein edema, liquefy
    blood, activates proteolysis by activating macrophages; also
    Calcium dobesilate is prescribed, similar in effect to
    benzopyrones;
  • homeopathic remedy – lymphoma, stimulating metabolism
    substances that improves lymphatic drainage and increases the elimination of toxins from
    organism;
  • angioprotectors (drugs from horse chestnut extract) –
    normalize the tone of the lymphatic vessels and veins, reduce
    the permeability of the vascular wall, which reduces the intensity of edema
    (escuzane, venitan, aescin);
  • diuretics – prescribed with caution under control
    a doctor;
  • antiplatelet agents (thin the blood) – trental, chimes;
  • antibiotics and anti-inflammatory drugs for trophic
    skin disorders (ulcers, eczema, erysipelas);
  • antihistamines – recommended for relapses
    erysipelas and suppress the inhibitory effect of histamine on
    contractile activity of lymphatic vessels (see all antihistamines
    facilities);
  • solcoseryl – reduces tissue swelling, has a regenerative
    action, increases the tone of the vascular wall (stimulates the formation of
    collagen in the walls of blood vessels);
  • immunomodulators (succinic acid, tincture of Eleutherococcus,
    Likopid) – stimulate the immune system, strengthen the vascular wall;
  • vitamins (ascorbic acid, vitamin E, PP, P) – strengthen
    vascular wall, reduce vascular permeability, have
    antioxidant effect.

Physiotherapy

From physiotherapy for this disease is used:

  • electrostimulation of lymph vessel contractility;
  • laser therapy;
  • magnetic therapy;
  • amplipulse therapy;
  • UVA autologous blood – reinfusion of own blood after its irradiation
    ultraviolet.

Traditional methods of treatment

Treatment народными средствами применяется как дополнительное к
primary therapy of lymphostasis and is carried out after consultation with
doctor:

  • compresses of birch tar and baked onions on sick
    leg;
  • compresses with cabbage juice or cabbage leaves
    affected limb;
  • infusion of plantain leaves;
  • infusion of garlic and honey – 250 gr. chopped garlic, 350 gr.
    honey, infused for 1 week, taking 1 tbsp. spoon 3 r / day in
    3 months one hour before meals;
  • use of beet juice;
  • taking dandelion juice and plantain;
  • decoction of immortelle flowers (2 parts), plantain and leaves
    dandelion (1 part) pour half a liter of boiling water, 6 hours give
    infuse, receive during the month 4 p / day, 100 ml before
    a meal.

But it should be borne in mind that folk therapy is effective only in
the initial stage of the disease.

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