Management of lower limb lymphoedema in the United Kingdom

Objective. Many investigations and treatments exist for lower limb lymphoedema. I,W undertook a survey oil the management of this condition by vascular surgeons and the resources available for its treatment in the UK. Design. A questionnaire was designed to assess the management of lymphoedema. Materials and method. A postal questionnaire was sent to all members of the The Vascular Society of Great Britain and Ireland. Results. 2511440 (57%) consultant surgeons returned a completed questionnaire comprising 45.3% teaching hospital and 54.7% district general hospital (DGH) consultants. 77.9% of the consultants saw less than 10 patients annually with lymphoedema. The commonest causes of lymphoedema were primary lymphoedema (99.3%) and malignancy (37.1%). Lipoedema, a cause of limb swelling Was only seen or recognised by 46.2% of the consultants. The commonest investigations performed were a duplex scan, lymphoscintigram, full blood count and urea and electrolytes. The common methods of confirming lymphoedema were either by lymphoscintigram (54.5%) or from a diagnosis of exclusion (33.7%). Lymphoedema physiotherapy Was available only to 53.8% of the consultants. Surgery was performed by 10.5% of consultants. 73.4% of the consultants believed that lymphoedema is managed inadequately and 72.9% believed that resources are insufficient in the UK for this condition. Conclusion. In the UK the majority of vascular consultants see less than 10 patients annually with lymphoedema. Very few; patients undergo confirmation of this diagnosis with non-invasive investigation and very few consultants perform surgery. Management of this condition is perceived by file consultants to be poor, with a lack of resources and particular shortage of lymphoedema physiotherapists. Centralisation of these services may be a way of improving this condition.