Hot of the Press June 2025

Article to ponder

Assessment of bilateral lower limb lymphoedema: the use of bioimpedance spectroscopy

Leigh C. Ward, Katrina Gaitatzis, Belinda Thompson, Louise A. Koelmeyer’ Disabil Rehabil. 2025 May 6:1-12

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Key Findings on Bioimpedance Spectroscopy in Bilateral Lower Limb Lymphoedema

  • Sensitivity of BIS: Bioimpedance spectroscopy (BIS) effectively detects extracellular fluid accumulation in bilateral lower limb lymphoedema. ​
  • Lack of Specificity: BIS cannot differentiate lymphoedema from other causes of swelling, such as obesity or venous insufficiency. ​
  • Integration Required: Combining BIS with clinical history, physical assessments, and imaging methods improves diagnostic accuracy. ​
  • Diagnostic Challenges: Variability in impedance measurements and normalization methods complicates detection thresholds. ​
  • Clinical Utility: BIS is valuable for screening, early intervention, and monitoring lymphoedema progression but requires a multi-modal approach for definitive diagnosis. ​

Recommendations for clinical practice

  • Develop improved normalization methods for BIS data to reduce variability and enhance diagnostic accuracy. ​
  • Investigate combining BIS with advanced imaging techniques like ICG lymphography for comprehensive assessments.
  • Focus on distinguishing lymphoedema from other causes of swelling, such as venous insufficiency or obesity-related edema. ​
  • Promote an integrated diagnostic approach combining BIS, clinical history, and physical evaluations. ​
  • Explore the use of BIS for ongoing monitoring and treatment outcome tracking in lymphoedema management.

Key Takeaway: Bioimpedance spectroscopy is a useful, non-invasive tool for detecting and monitoring bilateral lower limb lymphoedema, especially when combined with clinical assessment. While not diagnostic on its own, it enhances early detection and supports ongoing management.

We have collated some great articles and material published over the last month. Click on the links below to read the  abstract or download the full paper.

Anatomy / Physiology /Pathophysiology

Assessing subcutaneous changes in lymphedema by subcutaneous tissue ultrasonography and pathological association

Parkpoom Piyaman, Panitta Sitthinamsuwan, Sirin Apichonbancha, Nutcha Yodrabum. Sci Rep. 2025 May 3

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Tissue engineering approaches for lymphedema: biomaterial innovations and clinical potential

Pooja Deshpande, Maya Dornbrand-Lo, Varoon Phondge, Patrick Kelly, Alex K. Wong. Front Cell Dev Biol. 2025 Apr 15. 

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May-Thurner syndrome diagnosis and management with concurrent lymphedema

Christina Kapsalis, Annie J. Bright, Janit Leonard, Fernando Mijares Diaz, Saigopala Reddy, Blair Byrd, Pragna Shetty, Adeyemi Ogunleye. Phlebology. 2025 May 21.

Background May-Thurner syndrome (MTS) is an anatomical anomaly characterized by compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA) presenting with left lower extremity swelling and venous hypertension. Persistent symptoms after MTS treatment often lead to referral for lymphedema workup to explore non-venous causes. We aimed to describe the presentation of MTS and the findings from the lymphedema workup.
Methods A retrospective review was conducted of patients with MTS and lower extremity lymphedema workup between 2013 and 2022 at a public academic hospital. Demographic data, diagnostic information, treatment details, and outcomes were collected. Descriptive statistical analysis was performed.
Results Of 523 patients identified, 390(75%) were female, 133(25%) male with a mean BMI of 29.6 kg/m2. Mean age at diagnosis and symptom onset was 54.9(±17.1) and 47.6 (±18.2 )years, respectively. 465 patients (89%) were treated operatively with a combination of stenting, venoplasty, and thrombolysis while 47 (9%) were managed conservatively with compression garments and/or anticoagulation only. The LCIV was most commonly affected, followed by the left external iliac vein. The predominant symptoms were lower extremity deep vein thrombosis in 341 (65%) patients, lower limb edema in 286 (54%), and varicose veins in 129 (24.6%). Of six patients with lymphedema workup, three(50%) showed asymmetric or delayed uptake on lymphoscintigraphy and the remaining three had normal studies.
Conclusion In our study, May-Thurner syndrome was an uncommon but significant cause of lower extremity swelling and venous thromboembolism, especially in middle-aged females. Patients with persistent symptoms after intervention may benefit from diagnostic workup for lymphedema and treatment. More research is needed on the co-occurrence of lymphedema with MTS and its pathophysiology.:10.1177/02683555251345061

Management Strategies

Children and Young People with Lymphedema: The Education Need of Health Care Professionals

Rhian Noble-Jones, Melanie J. Thomas. Lymphat Res Biol. 2025 May 19. 

Introduction: The education need of health care professionals (HCP) to provide good quality care to children and young people with lymphedema (CYPwL) was unknown. While understanding of pediatric lymphedema grows, families still report delays in accessing appropriate treatment and HCP have reported being ill-prepared.

Methods: A questionnaire was designed by phased process of literature search, focus group, and online consensus with international experts. The online survey, available in six languages, was distributed to HCP working with CYPwL by professional groups.

Results: Questionnaires were received from 507 responders from 33 countries. Specific education on the treatment of CYPwL is needed, even when HCP are adult lymphedema trained according to 80% of respondents. Greatest consensus on best practice was that a multidisciplinary team (MDT) with specialist knowledge is required to treat CYPwL, but almost one in five HCP working with CYPwL have no, or rare, access to such a team. Reducing infections and adapting compression/treatment for age and development were deemed most essential. A variety of learning resources are needed including films, videos, and webinars from clinical experts.

Discussion and Conclusion: This is the first international survey of the education need of HCP regarding CYPwL which include pathology, treatment, psychosocial care, and education of other professionals. Uppermost was knowing how to reduce infections and adapt compression and other treatments for age and development. Access to an experienced MDT was considered essential to support good clinical decision-making. Multimodal approaches are needed to address identified education need. Further research in individual countries and professions is recommended.:10.1089.0043

Enhancing outcomes in severe lymphedema through combined treatment strategies

Aidan Shulkin, Johnny I. Efanov. World J Clin Cases. 2025 Apr 26.

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Feasibility and Potential Benefits of Moderate Intensity Cycling in People Living with Lower Limb Lymphedema: A Pilot Randomized Controlled Trial

C Jonsson, Karin Johansson, M Bjurberg, C Brogardh. Lymphology. 2025.

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