title: Diagnosis and treatment of primary lymphedema. Consensus document of the International Union of Phlebology (IUP)-2013.
abstract: Primary lymphedema can be managed effectively as a form of chronic lymphedema by a sequenced and targeted treatment and management program based around a combination of Decongestive Lymphatic Therapy (DLT) with compression therapy, when the latter is desired as an adjunct to DLT. Treatment in the maintenance phase should include compression garments, self-management, including self-massage, meticulous personal hygiene and skin care, in addition to lymphtransport-promoting excercises and activities, and, if desired, pneumatic compression therapy applied in the home. When conservative treatment fails, or gives sub-optimal outcomes, the management of primary lymphedema can be improved, where appropriate, with the proper addition of surgical interventions, either reconstructive or ablative. These two surgical therapies can be more effective when fully integrated with manual lymphatic drainage (MLD)-based DLT postoperatively. Compliance with a long-term commitment to MLD/DLT and particularly compression postoperatively is a critical factor in determining the success of any new treatment strategy involving either reconstructive or palliative surgery. The future of management of primary lymphedema has never been brighter with the new prospect of gene-and perhaps stem-cell oriented management.
authors.affiliation: Center for Vein, Lymphatics, and Vascular Malformation, Division of Vascular Surgery, Department of Surgery, Georgetown University School of medicine, Washingto DC, USA.
authors.forename: B B
authors.initials: BB
authors.lastname: Lee
authors.forename: M
authors.initials: M
authors.lastname: Andrade
authors.forename: P L
authors.initials: PL
authors.lastname: Antignani
authors.forename: F
authors.initials: F
authors.lastname: Boccardo
authors.forename: N
authors.initials: N
authors.lastname: Bunke
authors.forename: C
authors.initials: C
authors.lastname: Campisi
authors.forename: R
authors.initials: R
authors.lastname: Damstra
authors.forename: M
authors.initials: M
authors.lastname: Flour
authors.forename: I
authors.initials: I
authors.lastname: Forner-Cordero
authors.forename: P
authors.initials: P
authors.lastname: Gloviczki
authors.forename: J
authors.initials: J
authors.lastname: Laredo
authors.forename: H
authors.initials: H
authors.lastname: Partsch
authors.forename: N
authors.initials: N
authors.lastname: Piller
authors.forename: S
authors.initials: S
authors.lastname: Michelini
authors.forename: P
authors.initials: P
authors.lastname: Mortimer
authors.forename: E
authors.initials: E
authors.lastname: Rabe
authors.forename: S
authors.initials: S
authors.lastname: Rockson
authors.forename: A
authors.initials: A
authors.lastname: Scuderi
authors.forename: G
authors.initials: G
authors.lastname: Szolnoky
authors.forename: J L
authors.initials: JL
authors.lastname: Villavicencio
mesh_terms: D002908:Chronic Disease; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods / Q000592:standards*; D019317:Evidence-Based Medicine / Q000592:standards; D006801:Humans; D008209:Lymphedema / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome