Cardiology and Angiology: An International Journal

A Clinical Analysis of Phlebolymphedema and Its Relationship with Physical Activity and Disability

Cardiology and Angiology: An International Journal, Volume 12, Issue 1, Page 14-23
DOI: 10.9734/ca/2023/v12i1308

Abstract


Background: The clinical features and epidemiological data about patients with phebolymphedema or lymphedema related to Chronic Venous Disease in Mexico is limited and has been understudied; at the same time, the relationships between its clinical features, physical activity level and disability remained unknown.

Methods: This is a longitudinal cohort study based on the analysis of clinical data of 90 patients gathered between 2021 and 2022. The statistical analysis was carried out using the software SPSS version 25 and GrandhPad Prism 8; a descriptive analysis was developed using measures of central tendency for the variables of a quantitative nature and frequency distribution for those categorical variables. The behavior of the variables was revealed through the Shapiro-Wilk statistic. The mean difference analysis was carried out with the Student’s T for independent samples. To identify the effect of gender, age, and severity of the disease on the study variables, a three-way analysis of variance was obtained with a Sidak comparison analysis. For the associations between qualitative and dichotomous nature variables, the Chi-Square statistic was obtained along with the odds ratio to determine the intensity of the relationships found.

Results: A total of 90 patients were included in the analysis; 71% (64) were female and 29% (26) were male; with a mean age of 62.7 years old (± 30.5). A mean BMI of 33.2, 79.9% (77) of patients reached overweight and obesity ranges. 50% (45) of patients reported disability to perform one or more daily life activities related to the disease’s condition (signs, symptoms, volume). Only 12% (10) of all patients performed at or above the minimum physical activity recommended for their population group, and 88% (80) of patients had no physical activity or performed under the proper population group’s recommendation of minimal physical activity. It was found that the practice of physical activity, the number of compromised segments, the stage of the pathology, and the presence of cardiological and metabolic antecedents provide a statistically significant association with disability. Notable statistical difference among sex as a risk factor was not found. Regarding the BMI, the only differences were observed in the level of severity of the disease, regardless of the presence of any disability (p=0.006), evidencing that the greater the severity, the higher the BMI in both men and women. About physical activity, it is observed that inactivity or minimal practice of physical activity is a risk factor for referred disability (p<0.05), since it is prolonged that the non-practice of physical activity increases by 230% the chances of referring a disability associated to the disease compared to those people who referred to practice minimal or above minimal physical activity; the presence of a cardiological and/or metabolic history is related to an increase of about 150% to 180% of presenting disability compared to patients who do not have these pathologies.

Conclusion: This study shows clinical and epidemiological features of phlebolymphedema and their relationship with the level of physical activity and reported disability of 90 patients. Further studies are needed to improve and broaden the understanding of the clinical characteristics of phlebolymphedema and its correlations.

Keywords:
  • Lymphedema
  • phlebolymphedema
  • chronic venous disease
  • disability
  • physical activity

How to Cite

López-Montoya, L., Cabanillas, Y. L., Aguirre, J. S., Saenz-Ramirez, K. G., Zarate-Sánchez M. T., Lopez, A. D., Ugarte, R., & Patiño-Palma, B. (2023). A Clinical Analysis of Phlebolymphedema and Its Relationship with Physical Activity and Disability. Cardiology and Angiology: An International Journal, 12(1), 14–23. https://doi.org/10.9734/ca/2023/v12i1308

References

Ortega MA, Fraile-Martínez O, García-Montero C, Álvarez-Mon MA, Chaowen C, Ruiz-Grande F, Pekarek L, Monserrat J, Asúnsolo A, García-Honduvilla N, Álvarez-Mon M, Bujan J. Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management. J Clin Med. 2021;10(15): 3239.

DOI: 10.3390/jcm10153239. PMID: 34362022; PMCID: PMC8348673.

Davies AH. The Seriousness of Chronic Venous Disease: A Review of Real-World Evidence. Adv Ther. 2019 Mar;36(Suppl 1):5-12.

DOI: 10.1007/s12325-019-0881-7. Epub 2019 Feb 13. PMID: 30758738; PMCID: PMC6824448.

Eklof B, Perrin M, Delis KT, Rutherford RB, Gloviczki P; American Venous Forum; European Venous Forum; International Union of Phlebology; American College of Phlebology; International Union of Angiology. Updated terminology of chronic venous disorders: the VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg. 2009;49(2): 498-501.

DOI: 10.1016/j.jvs.2008.09.014. PMID: 19216970

Farrow W. Phlebolymphedema-a common underdiagnosed and undertreated problem in the wound care clinic. J Am Col Certif Wound Spec. 2010;2(1):14-23.

DOI: 10.1016/j.jcws.2010.04.004. PMID: 24527138; PMCID: PMC3601853.

Lee BBB. Phlebolymphedema is the ultimate comorbidity/outcome of lymphedema. J Vasc Surg Venous Lymphat Disord. 2019;7(5):731.

DOI: 10.1016/j.jvsv.2019.03.001. PMID: 31421840.

Nicolaides AN, Labropoulos N. Burden and Suffering in Chronic Venous Disease. Adv Ther. 2019 Mar;36(Suppl 1):1-4.

DOI: 10.1007/s12325-019-0882-6. Epub 2019 Feb 13. PMID: 30758739; PMCID: PMC6824337.

Executive Committee of the International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology. Lymphology. 2020;53(1):9. PMID: 32521126.

Lee BB. Phlebolymphedema: Neglected Outcome of Combined Venous and Lymphatic Insufficiency. Vasc Specialist Int. 2020;36(1):1-3. D

DOI: 10.5758/vsi.2020.36.1.1. PMID: 32274370; PMCID: PMC7119152.

Lurie F, Malgor RD, Carman T, Dean SM, Iafrati MD, Khilnani NM, Labropoulos N, Maldonado TS, Mortimer P, O'Donnell TF Jr, Raffetto JD, Rockson SG, Gasparis AP. The American Venous Forum, American Vein and Lymphatic Society and the Society for Vascular Medicine expert opinion consensus on lymphedema diagnosis and treatment. Phlebology. 2022;37(4):252-266.

DOI: 10.1177/02683555211053532. Epub 2022 Mar 8. PMID: 35258350; PMCID: PMC9069652.

Ulloa H, Cifuentes S, Figueroa V, Uden VE, Bravo JA MD, Amore M, Ramirez J. Phlebolymphedema: an up to date review. Phlebolymphology. 2021;104(28)2:49-58 ISSN 1286 0107‬

Available:https://www.phlebolymphology.org/phlebolymphedema-an-up-to-date-review/#:~:text=Phlebolymphedema%20is%20a%20pathology%20with,it%20cannot%20be%20cleared%20away.‬‬‬

Endicott K., Laredo J, Lee BB. Diagnosis and Management of Primary Phlebolymphedema. In: Lee, BB., Rockson, S., Bergan, J. (eds) Lymphedema. Springer, Cham; 2018.

DOI: 10.1007/978-3-319-52423-8_72

Montoya LL, Cabanillas YL, Aguirre JS, Luna C, Alcaraz I, Lopez AD. Lymphedema in Mexico: A Clinical and Epidemiological Overview. Cardiology and Angiology: An International Journal 2022;11(1):21-31.

DOI:https://doi.org/10.9734/ca/2022/v11i130186

Dean SM, Valenti E, Hock K, Leffler J, Compston A, Abraham WT. The clinical characteristics of lower extremity lymphedema in 440 patients. J Vasc Surg Venous Lymphat Disord. 2020;8(5):851-859.

DOI: 10.1016/j.jvsv.2019.11.014. Epub 2020 Jan 25. PMID: 31992537.

Secretaría de Salud. “Guía de práctica clínica. Tratamiento del cáncer de mama en segundo y tercer nivel de atención” Evidencias y Recomendaciones Catálogo Maestro de Guías de Práctica Clínica: IMSS-232-09 Ciudad de México. Marzo 2017;ISBN: 978-607-8270-69-9.

Available:http://www.cenetec.salud.gob.mx/contenidos/gpc/catalogoMaestroGPC.html

Secretaría de Salud. “Guía de práctica clínica. Prevención, Diagnóstico y Tratamiento de la Insuficiencia Venosa Crónica” Evidencias y Recomendaciones Catálogo Maestro de Guías de Práctica Clínica: IMSS-232-09 Ciudad de México. 2009; ISBN 978-607-8270-47-7

Available:http://www.imss.gob.mx/sites/all/statics/guiasclinicas/175GER.pdf

Espejel-Blancas JA, Chinchilla-Hernández RAJ, Garcés-Martínez MAG, et al. Insuficiencia venosa crónica y enfermedad hemorroidal en México: Opinión de expertos. Rev Mex Angiol. 2018;46(4): 204-212.

Sánchez-Nicolat NE, Guardado-Bermúdez F, Arriaga-Caballero JE, et al. Revisión en úlceras venosas: Epidemiología, fisiopatología, diagnóstico y tratamiento actual. Rev Mex Angiol. 2019;47(1): 26-38.

Nettal, Franciso, Rodríguez Neftali, Nigro Juan, et.al. Trabajo original Primer consenso latinoamericano de úlceras venosas. Revista Mexicana de Angiología. 2013;41(3):95-126.

Bushman, Barbara A. Ph.D., FACSM, ACSM-CEP, ACSM-EP, ACSM-CPT. Exercise for Prevention of Chronic Diseases. ACSM's Health & Fitness Journal: 1/2 2020;24(1):5-10.

DOI: 10.1249/FIT.0000000000000533

American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 10th ed. Philadelphia (PA): Lippincott Williams & Wilkins. 2017;472.

Soydan E, Yılmaz E, Baydur H. Effect of socio-demographic characteristics and clinical findings on the quality of life of patients with chronic venous insufficiency. Vascular. 2017;25(4):382-389.

DOI:10.1177/1708538116685945

Natour AK, Rteil A, Corcoran P, Weaver M, Ahsan S, Kabbani L. Socioeconomic Status and Clinical Stage of Patients Presenting for Treatment of Chronic Venous Disease. Ann Vasc Surg. 2022;83:305-312.

DOI:10.1016/j.avsg.2021.12.010

  • 287 times
    PDF Download: 77 times

Download Statistics

Make a Submission

Information

Current Issue