Uncovering Lymphatic Transport Abnormalities in Patients with Primary Lipedema

Abstract

Background Although lipedema is often clinically distinguished from lymphedema, there is considerable overlap between the two entities. The purpose of this study was to evaluate lymphoscintigraphic findings in patients with lipedema to better characterize lymphatic flow in this patient population. Methods Patients with lipedema receiving lymphoscintigraphy between January 2015 and October 2017 were included. Patient demographics, clinical characteristics, and lymphoscintigraphic findings were extracted. Klienhan's transport index (TI) was utilized to assess lymphatic flow in patient's lower extremities (LEs).Scores ranged from 0 to 45, with values > 10 denoting pathologic lymphatic transport. Results A total of 19 total patients with lipedema underwent lymphoscintigraphic evaluation. Mean age was 54.8 years and mean body mass index was 35.9 kg/m2. Severity of lipedema was classified as stage 1 in five patients (26.3%), stage 2 in four patients (21.1%), stage 3 in four patients (21.1%), and stage 4 in six patients (31.6%). The mean TI for all extremities was 12.5; 24 (63.2%) LEs had a pathologic TI, including 7 LEs with stage 1 (29.2%), 3 LEs with stage 2 (12.5%), 6 LEs with stage 3 (25.0%), and 8 LEs with stage 4 lipedema (33.3%). The mean TI was significantly greater for extremities with severe (stage 3/4) lipedema than those with mild or moderate (stage 1/2) lipedema (15.1 vs. 9.7, p = 0.049). Mean difference in TI scores between each LE for individual patients was 6.43 (standard deviation +7.96). Conclusion Our results suggest that patients with lipedema have impaired lymphatic transport, and more severe lipedema may be associated with greater lymphatic transport abnormalities.

Lipedema and the Evolution to Lymphedema With the Progression of Obesity

“…The vascular changes in microcirculation, especially lymphatic vessels, suggest lymphostasis [4,5,8,15]. A study involving lymphoscintigraphy demonstrated lymphatic alterations in lipedema, suggesting lymphedema resulting from the lymphatic microcirculation [15]. The treatment of these patients using lymphatic drainage results in a reduction of the symptoms and circumference of the limb, which confirms the existence of the lymphatic component [9].…”

“…The vascular changes in microcirculation, especially lymphatic vessels, suggest lymphostasis [4,5,8,15]. A study involving lymphoscintigraphy demonstrated lymphatic alterations in lipedema, suggesting lymphedema resulting from the lymphatic microcirculation [15].…”

Regulation of Lymphatic Function in Obesity

“…Lipedema, another subcutaneous adipose tissue disorder with excessive fat deposition under skin, exhibits lymphatic vessel microaneurysms causing leakage of lipids from damaged and leaky lymphatic vessels causing excessive adipogenesis (Stallworth et al, 1974;Herbst, 2000;Amann-Vesti et al, 2001;Al-Ghadban et al, 2019). Reports indicate that lymphatic transport defects are more prominent in late stage lipedema compared to early stages (Gould et al, 2020). In similar lines, research indicates that lymphedema a chronic, morbid disease characterized by tissue swelling, accumulation of fluids, fibro-adipose tissue spontaneously develops in severely obese individuals.…”

Replik auf den „Letter to Editor: Series of articles by T. Bertsch and G. Erbacher culminating in Lipoedema – myths and facts, Part 5: European Best Practice of Lipoedema – Summary of the European Lipoedema Forum Consensus“

“…Ödeme sind bekanntlich definiert als "abnorme Flüssigkeitsansammlung" im Gewebe [34]. Bisher konnten allerdings weder klinische Untersuchungen noch Bildgebungen jemals ein relevantes Ödem bei Patientinnen mit Lipödem-Syndrom nachweisen [7].…”