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31.03.2015
Femoral artery is indubitably a vital artery that carries oxygenated and nutrient-rich blood to the wall of the abdomen and lower extremity of the body. Inadequate supply of blood to the lower extremity due to clogging with plaque causes PAD or Peripheral Artery Disease. The commonly experienced PAD symptom is throbbing muscle cramps in the thigh, calf or hip area when one walks, ascends the stairways or exercises. Progression in peripheral artery disease triggers agonizing sore formations over the feet and toe areas. Intermittent claudication is a preliminary sign of issues with the femoral artery typified by aching, cramping, tiredness and occasionally, burning pains felt in the leg area that are fleeting in nature (usually arises when the person walks and subsides on resting).
In the later stages, arterial blockage is so acute that resting fails to assuage the pain and discomfort felt in the leg, a condition which is termed as ischemic rest pain.
There are several signs of femoral artery problem that aren’t agonizing at all times and are generally preliminary indications of something off beam. As this condition increases the person’s chances of losing a limb as well as suffering from stroke or heart attack hence it is crucial to be aware of the symptoms and seek prompt medical assistance in such a situation. The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.
Lymphedema is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system, which normally returns interstitial fluid to the thoracic duct, then the bloodstream. Symptoms may include a feeling of heaviness or fullness, edema, and (occasionally) aching pain in the affected area.
Lymphedema should not be confused with edema arising from venous insufficiency, which is not lymphedema.
Lymphedema may be inherited (primary) or caused by injury to the lymphatic vessels (secondary).
Head and neck lymphedema can be caused by surgery or radiation therapy for tongue or throat cancer. The onset of secondary lymphedema in patients who have had cancer surgery has also been linked to aircraft flight (likely due to decreased cabin pressure or relative immobility). Some cases of lower-limb lymphedema have been associated with the use of tamoxifen, due to the blood clots and deep vein thrombosis (DVT) that can be caused by this medication. Chronic venous stasis changes can mimic early lymphedema, but the changes in venous stasis are more often bilateral and symmetric. A staging system was described in 2007 by Lee, Morgan and Bergan[11] and endorsed by the American Society of Lymphology.[citation needed] This system provides a clear technique which can be employed by clinical and laboratory assessments to more accurately diagnose and prescribe therapy for lymphedema, as well as obtain measurable outcomes.
Stage 0 (latent): The lymphatic vessels have sustained some damage which is not yet apparent.
Stage 3 (lymphostatic elephantiasis): At this stage, the swelling is irreversible and usually the limb(s) or affected area is very large. Grade 1 (mild edema): Lymphedema involves the distal parts such as a forearm and hand or a lower leg and foot.
Grade 2 (moderate edema): Lymphedema involves an entire limb or corresponding quadrant of the trunk.
Grade 3a (severe edema): Lymphedema is present in one limb and its associated trunk quadrant.
Grade 3b (massive edema): The same symptoms as grade 3a, except two or more extremities are affected. Grade 4 (gigantic edema): Also known as elephantiasis, in this stage of lymphedema, the affected extremities are huge due to almost complete blockage of the lymph channels. Treatment for lymphedema varies depending on the severity of the edema and the degree of fibrosis of the affected limb. CDT is a primary tool in lymphedema management consisting of manual manipulation of the lymphatic ducts,[14] short-stretch compression bandaging, therapeutic exercise, and skin care.
Manual manipulation of the lymphatic ducts (manual lymphatic drainage or MLD) consists of gentle, rhythmic massaging of the skin to stimulate the flow of lymph and its return to the blood circulation system. Elastic compression garments are worn by persons with lymphedema on the affected limb following complete decongestive therapy to maintain edema reduction. Compression bandaging, also called wrapping, is the application of several layers of padding and short-stretch bandages to the involved areas. Intermittent pneumatic compression therapy (IPC) utilizes a multi-chambered pneumatic sleeve with overlapping cells to promote movement of lymph fluid. Most studies investigating the effects exercise in patients with lymphedema or those at risk of developing lymphedema have examined patients with breast-cancer related lymphedema. There is a paucity of studies examining the effects of exercise in primary lymphedema or in secondary lymphedema that is not related to breast cancer treatment. Several effective surgical procedures exist to provide long-term solutions for patients who suffer from lymphedema.
Vascularized lymph node transfers (VLNT) can be an effective method for the treatment of lymphedema of the arm and upper extremity. The newly transferred lymph nodes then serve as a conduit or filter to remove the excess lymphatic fluid from the arm and return it to the body's natural circulation.
This technique of lymph node transfer usually is performed together with a DIEP flap breast reconstruction. Lymph node transfers are most effective in patients whose extremity circumference reduces significantly with compression wrapping, indicating most of the edema is fluid. Lymphaticovenous anastomosis (LVA) uses supermicrosurgery to connect the affected lymphatic channels directly to tiny veins located nearby. LVA can be an effective and long-term solution for extremity lymphedema, and many patients have results which range from a moderate improvement to an almost complete resolution of the problem.


Clinical studies involving LVA indicate immediate and long-term results showed significant reductions in volume and improvement in systems that appear to be long-lasting.[23][24][27] In addition, a 2006 study comparing two groups of breast cancer patients at high risk for lymphedema in whom LA was used to prevent the onset of clinically evident lymphedema.
Several subdivisions of the femoral artery essentially pump blood to the part of leg between the knee and hip.
When the blood and oxygen supply doesn’t normalize then the sore formations advance to ulcerous developments that turn greyish or blackish in appearance due to lifeless tissue (a condition medically termed as gangrene).
There could also be a noticeable temperature drop in the lower part of the leg or foot, especially in comparison to the other areas of the body or the other leg. When the severity escalates then the pains are experienced even when the person is resting.
Classically, pains or tingling sensations are felt in the toe areas or foot with such severity that clothing or a bed sheet is enough to activate or aggravate the pain. The calf muscle exhibits reduction in size or withering, lack of hair in feet and toe areas and thickening noticed in nails of the toes are some of these symptoms. Excruciating ulcerous formations having a darkish appearance are also observed on the toe or foot with delayed healing. The condition can be inherited or can be caused by a birth defect, though it is frequently caused by cancer treatments, and by parasitic infections. In advanced lymphedema, there may be the presence of skin changes such as discoloration, verrucous (wart-like) hyperplasia, hyperkeratosis, and papillomatosis; and eventually deformity (elephantiasis). Lymphedema may be present at birth, develop at the onset of puberty (praecox), or not become apparent for many years into adulthood (tarda). In women, it is most prevalent in the upper limbs after breast cancer surgery, in particular after axillary lymph node dissection,[2] occurring in the arm on the side of the body in which the surgery is performed. It may also occur in the lower limbs or groin after surgery for colon, ovarian or uterine cancer, in which removal of lymph nodes or radiation therapy is required. For cancer survivors, therefore, wearing a prescribed and properly fitted compression garment may help decrease swelling during air travel. Resolution of the blood clots or DVT is needed before lymphedema treatment can be initiated. This fluid returns through venous capillaries to the blood circulation through the force of osmosis in the venous blood; however, a portion of the fluid which contains proteins, cellular debris, bacteria, etc. Color, presence of hair, visible veins, size of the legs and any sores or ulcerations should be noted.
The first signs may be subjective observations such as "my arm feels heavy" or "I have difficulty these days getting rings on and off my fingers". Lipedema can also mimic lymphedema, however in lipedema there is characteristic sparing of the feet beginning abrubtly at the medial malleoli (ankle level).
Usually upon waking in the morning, the limb or affected area is normal or almost normal in size. Fibrosis found in stage 2 lymphedema marks the beginning of the hardening of the limbs and increasing size. The tissue is hard (fibrotic) and unresponsive; some patients consider undergoing reconstructive surgery, called "debulking". The difference in circumference is less than 4 cm, and other tissue changes are not yet present. Most people with lymphedema follow a daily regimen of treatment as suggested by their physician or certified lymphedema therapist.
The technique was pioneered by Emil Vodder in the 1930s for the treatment of chronic sinusitis and other immune disorders. In the blooda€™s passage through the kidneys, the excess fluid is then filtered out and eliminated from the body through urination. Short-stretch bandages are preferred over long-stretch bandages (such as those normally used to treat sprains), as the long-stretch bandages cannot produce the proper therapeutic tension necessary to safely reduce lymphedema and may in fact end up producing a tourniquet effect. Pump therapy should be used in addition to other treatments such as compression bandaging and manual lymph drainage. In these studies, resistance training did not increase swelling in patients with pre-existing breast cancer-related lymphedema, and may actually decrease edema in some patients, in addition to other potential beneficial effects on cardiovascular health.[17][18][19][20] Moreover, resistance training and other forms of exercise were not associated with an increased risk of developing lymphedema in patients who previously received breast cancer-related treatment. Prior to any lymphedema surgery, patients typically have been treated by a physical therapist, or an occupational therpist, trained in providing lymphedema treatment for initial conservative treatment of their lymphedema. Lymph nodes are harvested from the groin area with their supporting artery and vein and moved to the axilla (armpit).
This allows for both the simultaneous treatment of the arm lymphedema and the creation of a breast in one surgery.
LVA is most effective early in the course of the disease in patients whose extremity circumference reduces significantly with compression wrapping, indicating most of the edema is fluid. The discomfort tends to heighten when the leg is hoisted up and lowers once it is suspended over the bedside. In many patients with cancer, this condition does not develop until months or even years after therapy has concluded. Surgery or treatment for prostate, colon and testicular cancers may result in secondary lymphedema, particularly when lymph nodes have been removed or damaged. Lack of hair may indicate an arterial circulation problem.[8] If swelling is observed, the calf circumference should be measured with a tape measure. These may be symptomatic of early stage of lymphedema where accumulation of lymph is mild and not detectable by any difference in arm volume or circumference.
Clear descriptors of symptoms and clinical presentation must be established at the assessment by the physician to prescribe interventions, monitor efficacy and support medical necessity.
This remains controversial, however, since the risks may outweigh the benefits, and the further damage done to the lymphatic system may in fact make the lymphedema worse.


The most common treatments for lymphedema are a combination of manual compression lymphatic massage, compression garments or bandaging.
Initially, CDT involves frequent visits to a certified therapist with a doctor's prescription.
The treatment is very gentle and a typical session will involve drainage of the neck, trunk, and involved extremity (in that order), lasting approximately 40 to 60 minutes.
During activity, whether exercise or daily activities, the short-stretch bandages enhance the pumping action of the lymph vessels by providing increased resistance for them to push against. In some cases, pump therapy may help soften fibrotic tissue and therefore potentially enable more efficient lymphatic drainage[citation needed]. However, exercise should be only be performed while wearing compression garments (with the possible exception of swimming in some patients).[21] Patients who have lymphedema or are at risk of developing lymphedema should consult their physician or certified lymphedema therapist before beginning a new exercise regimen. Microsurgeons use specialized microsurgical techniques to reconnect the artery and vein to new blood vessels in the axilla to provide vital support to the lymph nodes while they develop their own blood supply over the first few weeks after surgery. The lymph node transfer removes the excess lymphatic fluid to return form and function to the arm. The procedure requires the use of specialized techniques with superfine surgical suture and an adapted, high-power microscope. Patients who do not respond to compression are less likely to fare well with LVA, as a greater amount of their increased extremity volume consists of fibrotic tissue, protein or fat. O'Brien and his colleagues for the treatment of obstructive lymphedema in the extremities.[26] In 2003, Dr. Lymphedema may also be associated with accidents or certain diseases or problems that may inhibit the lymphatic system from functioning properly. The collection of this prelymph fluid is carried out by the initial lymph collectors which are blind-ended epithelial-lined vessels with fenestrated openings that allow fluids and particles as large as cells to enter. This measurement can be compared to future measurements to see if the swelling is getting better. As lymphedema develops further, definitive diagnosis is commonly based upon an objective measurement of differences between the affected or at-risk limb at the opposite unaffected limb, e.g. Physicians and researchers can use additional laboratory assessments, such as bioimpedance, MRI, or CT, to build on the findings of a clinical assessment (physical evaluation).
Complex decongestive physiotherapy is an empiric system of lymphatic massage, skin care, and compressive garments. Once the lymphedema is reduced, increased patient participation is required for ongoing care, along with the use of elastic compression garments and nonelastic directional flow foam garments.
Resistance training is not recommended in the immediate post-operative period in patients who have undergone axillary lymph node dissection for breast cancer.
In selected cases, the lymph nodes may be transferred as a group with their supporting artery and vein, but without the associated abdominal tissue for breast reconstruction.
Good thing my wife knows how to do the massage for me since she has basic training on massaging.
In tropical areas of the world, a common cause of secondary lymphedema is filariasis, a parasitic infection.
Once inside the lumen of the lymphatic vessels, the fluid is guided along increasingly larger vessels, first with rudimentary valves to prevent backflow, which later develop into complete valves similar to the venous valve. From this, results of therapy can accurately be determined and reported in documentation, as well as in research.
Although a combination treatment program may be ideal, any of the treatments can be done individually.
Great post by the way!Sharath September 5, 2015 at 7:56 pm ReplyHi , first of all,thanks for the post,appreciate the knowledge sharing. Once the lymph enters the fully valved lymphatic vessels, it is pumped by a rhythmic peristaltic-like action by smooth muscle cells within the lymphatic vessel walls.
Pressure should be applied with the fingertips over the ankle to determine the degree of swelling. Unfortunately, there is no generally accepted worldwide criterion of difference definitively diagnostic, although a volume difference of 200 ml between limbs or a 4-cm difference (at a single measurement site or set intervals along the limb) is often used. This peristaltic action is the primary driving force, moving lymph within its vessel walls.
The assessment should also include a check of the popliteal, femoral, posterior tibial, and dorsalis pedis pulses. Recently, the technique of bioimpedance measurement (which measures the amount of fluid in a limb) has been shown to have greater sensitivity than these existing methods, and holds promise as a simple diagnostic and screening tool.[9] Impedance analysers specifically designed for this purpose are now commercially available. Just place ur feet on two to three soft pillows while sleeping,ensure that its not too high and make ur leg and joints strain or uncomfortable,let it be in a comfortable height.by doing this the excess liquid goes out of the body through urine, you can do it at night if you are comfortable waking up to empty your bladder, do it at the time of rest and trust me its the best way to get edema or swelling down. The regulation of the frequency and power of contraction is regulated by the sympathetic nervous system. When checking the femoral pulse, feel for the inguinal nodes and determine if they are enlarged. The movement of lymph can also be influenced by the pressure of nearby muscle contraction, arterial pulse pressure, and the vacuum created in the chest cavity during respiration, but these passive forces contribute only a minor percentage of lymph transport.
The fluids collected are pumped into continually larger vessels and through lymph nodes, which clean out debris and police the fluid for potential threats from dangerous microbes. The lymph ends its journey in the thoracic duct or right lymphatic duct, which drain into the blood circulation.



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