The prognosis of primary lymphedema of the lower limbs.

Primary lymphedema in most patients can be managed conservatively, but, in a few, severe lymphedema develops that requires surgical reduction of the limb. The five- to 20-year course of the disease has been studied in 372 patients. The eventual extent of the disease could be assessed within the first year. Further spreading of the lymphedema in the same limb occurred in only 7% of the patients after the first year and in less than 1% after five years. Only 9% of the patients suffered lymphedema of the other leg at a later time. Patients without pelvic lymphatic obstruction had a good prognosis even if the distal lymphatics were obliterated, but 32% of those with proximal obstructive hypoplasia had severe lymphedema that required surgical reduction. In this latter group, men and women were affected equally.