Lipedema, Lymphedema, & Phlebolymphedema: What’s the difference & can they be treated?

Lipedema vs Lymphedema vs Phlebolymphedema…all three seem so similar that it’s hard to keep them straight. Even for physicians familiar with these conditions, it can be difficult to make the correct diagnosis as there can be considerable overlap between these conditions. This article will explain the differences between these 3 conditions. More information can be found in the highlighted links.

Lipedema

Progression of lipedema from early to late stages

Lipedema mostly occurs in women and is characterized by the accumulation of fat, most often in the legs, along with easy bruising in the affected areas. The fat accumulation is often symmetrical or equal in both legs and can extend from the hips to the ankles, appearing column-like. Lipedema can also affect the arms and buttocks but tends to spare the feet. A women may have a normal sized upper body and from the waist below, their lower body is out of proportion to the upper body. As a result, lipedema is often mistaken for obesity. It is uncertain as to what causes lipedema and whether there is a genetic component involved. Lipedema can occur at any age and is often confused with lymphedema. Although there is no cure for lipedema, finding a physician that can accurately diagnose it and help manage its progression is important. Click here to learn more about lipedema.

Lymphedema

Differences between lymphedema & lipedema

Lymphedema is a disorder of the lymphatic system that leads to abnormal swelling of the arms, legs, or other parts of the body. The lymphatic system is part of our immune and circulatory systems. Besides playing a role in fighting off infections, the lymphatic system also absorbs interstitial fluid (fluid within tissues and organs). When our lymphatic system is working properly, we do not have swelling in our arms, legs, or other parts of the body. When our lymphatic system is not working properly, this leads to lymphedema.

There are two types of lymphedema: primary and secondary. Primary lymphedema, also known as hereditary lymphedema, is congenital and due to a lymphatic system that did not develop properly at birth. Those with primary lymphedema may have massive swelling of the arm or leg from infancy. Treatment involves managing the pain and swelling with compression therapy and/or manual lymphatic drainage. Unfortunately, there is no cure for primary lymphedema.

Secondary lymphedema generally occurs later in life and is due to damage of the lymphatic system from surgery, trauma, radiation, or infection. Arm swelling after breast cancer surgery in which the lymph nodes were removed is an example of secondary lymphedema. In specialized centers, surgical procedures such as vascularized lymph node transfer surgery is successfully being performed to treat those with secondary lymphedema.

Phlebolymphedema

Untreated CVI leading to phlebolymphedema

Phlebolymphedema is a medical condition that few patients or doctors have heard of other than recognizing that the word “lymphedema” is part of it. “Phleblo” comes from the word “phlebology” which is the study and treatment of venous disease. Lymphedema, on the other hand, is a disorder of the lymphatic system that leads to abnormal swelling of the arms, legs, or other parts of the body.

The relationship of the lymphatic vessels to the veins. Notice how close the lymphatic vessels are to the veins.

The little secret that most of us are not aware of is that the veins and lymphatic vessels are BEST friends! They love to hang out together, even though they have very different job duties. Because chronic venous insufficiency (CVI) is often not addressed by many physicians, CVI worsens over the years leading to ankle swelling, skin discoloration, and venous ulcers. The lymphatic vessels see that their best friend “the veins” are in trouble and they want to help. They say to the veins, “Hey buddy, I’m going to help you out with all this fluid and swelling in the legs that you can’t handle. I’m going to absorb some it!” While it’s a kind gesture, the lymphatic vessels bite off more than they can chew and they become overwhelmed by the excess fluid in the legs and soft tissues. As a result, the lymphatic vessels are unable to do their primary job of absorbing lymphatic fluid and so lymphatic fluid starts to leak out into the soft tissues leading to lymphedema. When lymphedema occurs as a result of untreated CVI, this is referred to as phlebolymphedema.

Many patients are often told that nothing can be done for phlebolymphedema other than compression therapy but that is incorrect. In specialized centers, aggressively treating CVI can take the pressure off the lymphatic system thereby improving the symptoms of both CVI and lymphedema. When evaluating the patient with phlebolymphedema, it’s important for the physician to determine whether the CVI is a result of superficial vein disease or the result of venous hypertension from blocked deep veins from prior deep vein thrombosis (DVT) known as post thrombotic syndrome(PTS). If phlebolymphedema is due to PTS then it is incredibly important that one see a vascular specialist experienced with deep vein recanalization as this is often what is needed to improve phlebolymphedema. Generally when one develops phlebolymphedema, it is unlikely the leg/arm will ever go completely back to normal; however, symptoms can be improved with minimally invasive procedures combined with lymphedema therapy and compression. This underscores why referral to a qualified vein specialist is vital in treating CVI in its earlier stages when it’s more manageable.

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