Evaluation of patients presenting to a multidisciplinary lymphatic center

Lymphedema is a prevalent yet underserved condition. Expanding diagnostic and therapeutic options have increased interest in multidisciplinary care. This study examines clinical characteristics and geographic patterns of lymphedema care within a multidisciplinary lymphatic center.

A retrospective review included all patients evaluated for edema at the BIDMC Lymphatic Center between January 2018 and December 2023. The multidisciplinary team was comprised of cardiovascular medicine, radiology, plastic surgery, and physical therapy. A RedCap registry captured demographics, clinical characteristics, imaging and surgeries. Patients were stratified by edema etiology as primary or secondary lymphedema, or non-lymphatic edema. Bivariate and geospatial analyses assessed differences across groups and geographic access to care.

Of the total 2,031 participants, 76% were female, with a mean age of 60 years (±15.2) and BMI of 33.6 kg/m² (±10.7). The average duration of edema symptoms at evaluation was 9.47 years (±11.8). Secondary lymphedema was the most common etiology (n=1,104, 54%) andoften due to cancer (54%) or chronic venous disease (23%). Lymphatic imaging was performed in 549 patients (27%). Of those 549, lymphoscintigraphy (83%) and MRI (69%) were most common. Only 149 patients (11%) underwent surgery. Residing out-of-state was associated with longer symptom duration at initial evaluation (12.3 vs 9.1 years, P < 0.0001) and higher surgical rates (16.6% vs 6%, P < 0.001) compared to residing in-state.

In this large, single-center description, over one-third of patients did not have lymphedema. Lymphatic imaging was frequently performed, though few underwent surgery. Geographic barriers delayed evaluation and increased surgical intervention, emphasizing the need for broader access to multidisciplinary lymphatic care.