The Effect of Pharmaceutical Agents on Lymphedema

Abstract

Lymphedema is the abnormal accumulation of protein-rich fluid in the interstitial spaces that results from inadequate lymphatic function. 1 Lymphedema can be primary, suggesting abnormal growth and development of the lymphatic, or secondary, structures due to acquired damage to the lymphatic system. Fluid homeostasis is main-tained by a balance between capillary hydrostatic pressure, plasma oncotic pressure, interstitial hydrostatic pressure, and interstitial oncotic pressure. Chronic edema results when there is an imbalance caused either by increased capillary hydrostatic pressure that occurs during infection and the inflammatory process or by increased capillary pressure as seen in congestive heart failure or venous disease. 2 In addition, edema can be caused by decreased plasma oncotic pressure resulting from decreased protein in the blood as seen with liver disease or malnutrition. Lymphedema also occurs with normal capillary filtration but damage to the lymphatic system from surgery, radiation, or trauma leading to a decreased transport capacity. 1 The gold standard of lymphedema management is complete decongestive therapy (CDT), which consists of an intensive phase and a maintenance phase. 3 The goal of the intensive phase is to reduce the volume of edema and normalize the tissue texture, followed by the maintenance phase to maintain the volume reduction. 3 Before initiat-ing