Long‐term results after lymphatic‐venous anastomoses for the treatment of obstructive lymphedema
Identifieur interne : 005241 ( Istex/Corpus ); précédent : 005240; suivant : 005242Long‐term results after lymphatic‐venous anastomoses for the treatment of obstructive lymphedema
Auteurs : Corradino Campisi ; Francesco Boccardo ; Angelo Zilli ; Alberto Macci ; Francesco NapoliSource :
- Microsurgery [ 0738-1085 ] ; 2001.
Abstract
Over the past 25 years, 665 patients with obstructive lymphedema have been treated with microsurgical lymphatic‐venous anastomoses; of these, 446 patients were available for long‐term follow‐up study. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Lymphangioscintigraphy, lymphangiography (in patients with gravitational reflux pathology), and echo‐Doppler were used preoperatively. Subjective improvement was noted in 578 patients (87%). Objectively, volume changes showed a significant improvement in 552 patients (83%), with an average reduction of 67% of the excess volume. Of those patients followed up, 379 patients (85%) have been able to discontinue the use of conservative measures, with an average follow‐up of more than 7 years and average reduction in excess volume of 69%. There was a 87% reduction in the incidence of cellulitis after microsurgery. In those patients who improved, drainage resulted in increased softness of the limbs. Peripheral edema (hand and foot) diminished considerably in most patients. These long‐term results indicate that lymphatic‐venous anastomoses have a place in the treatment of obstructive lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. Improved results can be expected with earlier operations because patients referred earlier usually have fewer lymphatic alterations.
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DOI: 10.1002/micr.1025
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<front><div type="abstract" xml:lang="en">Over the past 25 years, 665 patients with obstructive lymphedema have been treated with microsurgical lymphatic‐venous anastomoses; of these, 446 patients were available for long‐term follow‐up study. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Lymphangioscintigraphy, lymphangiography (in patients with gravitational reflux pathology), and echo‐Doppler were used preoperatively. Subjective improvement was noted in 578 patients (87%). Objectively, volume changes showed a significant improvement in 552 patients (83%), with an average reduction of 67% of the excess volume. Of those patients followed up, 379 patients (85%) have been able to discontinue the use of conservative measures, with an average follow‐up of more than 7 years and average reduction in excess volume of 69%. There was a 87% reduction in the incidence of cellulitis after microsurgery. In those patients who improved, drainage resulted in increased softness of the limbs. Peripheral edema (hand and foot) diminished considerably in most patients. These long‐term results indicate that lymphatic‐venous anastomoses have a place in the treatment of obstructive lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. Improved results can be expected with earlier operations because patients referred earlier usually have fewer lymphatic alterations.</div>
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<p>Over the past 25 years, 665 patients with obstructive lymphedema have been treated with microsurgical lymphatic‐venous anastomoses; of these, 446 patients were available for long‐term follow‐up study. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Lymphangioscintigraphy, lymphangiography (in patients with gravitational reflux pathology), and echo‐Doppler were used preoperatively. Subjective improvement was noted in 578 patients (87%). Objectively, volume changes showed a significant improvement in 552 patients (83%), with an average reduction of 67% of the excess volume. Of those patients followed up, 379 patients (85%) have been able to discontinue the use of conservative measures, with an average follow‐up of more than 7 years and average reduction in excess volume of 69%. There was a 87% reduction in the incidence of cellulitis after microsurgery. In those patients who improved, drainage resulted in increased softness of the limbs. Peripheral edema (hand and foot) diminished considerably in most patients. These long‐term results indicate that lymphatic‐venous anastomoses have a place in the treatment of obstructive lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. Improved results can be expected with earlier operations because patients referred earlier usually have fewer lymphatic alterations.</p>
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<abstract xml:lang="it" style="main"><p>Nel corso degli ultimi 25 anni, 665 pazienti affetti da linfedema ostruttivo sono stati sottoposti ad intervento di anastomosi microchirurgiche linfatico‐venose. Quattrocentoquarantasei pazienti sono stati seguiti anche a notevole distanza di tempo dall'operazione. I risultati sono stati valutati obiettivamente mediante volumetria ad acqua e linfoscintigrafia. Preoperatoriamente sono state utilizzate la linfoscintigrafia, linfografia (in pazienti con patologia da reflusso gravitazionale) e l'Eco‐Doppler. Abbiamo potuto registrare un miglioramento soggettivo in 578 pazienti (87%). Obiettivamente, le valutazioni volumetriche hanno dimostrato un miglioramento significativo in 552 pazienti (83%), con una riduzione media del volume in eccesso pari al 67%. Dei 446 pazienti seguiti anche a notevole distanza di tempo dall'intervento, 379 (85%) sono stati in grado di utilizzare la guaina elastica in modo discontinuo, con un follow‐up medio di oltre 7 anni ed una riduzione volumetrica media del 69%. Si è, altresì, verificata una riduzione dell'incidenza delle linfangiti dell'87% dopo microchirurgia. Nei pazienti con miglioramento del quadro clinico, il drenaggio ha permesso di riscontrare anche una marcata riduzione di consistenza del linfedema. L'edema periferico alla mano o al piede si è ridotto significativamente nella maggior parte dei pazienti. Questi risultati a lungo termine indicano come le anastomosi linfatico‐venose giochino un ruolo importante nel trattamento del linfedema ostrutivo e come siano da considerare il trattamento di scelta nei pazienti non adeguatamente responsivi alla terapia conservativa medico‐fisica‐riabilitativa. © 2001 Wiley‐Liss, Inc. MICROSURGERY 21:135–139 2001</p>
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<abstract type="main" xml:lang="it"><p>Nel corso degli ultimi 25 anni, 665 pazienti affetti da linfedema ostruttivo sono stati sottoposti ad intervento di anastomosi microchirurgiche linfatico‐venose. Quattrocentoquarantasei pazienti sono stati seguiti anche a notevole distanza di tempo dall'operazione. I risultati sono stati valutati obiettivamente mediante volumetria ad acqua e linfoscintigrafia. Preoperatoriamente sono state utilizzate la linfoscintigrafia, linfografia (in pazienti con patologia da reflusso gravitazionale) e l'Eco‐Doppler. Abbiamo potuto registrare un miglioramento soggettivo in 578 pazienti (87%). Obiettivamente, le valutazioni volumetriche hanno dimostrato un miglioramento significativo in 552 pazienti (83%), con una riduzione media del volume in eccesso pari al 67%. Dei 446 pazienti seguiti anche a notevole distanza di tempo dall'intervento, 379 (85%) sono stati in grado di utilizzare la guaina elastica in modo discontinuo, con un follow‐up medio di oltre 7 anni ed una riduzione volumetrica media del 69%. Si è, altresì, verificata una riduzione dell'incidenza delle linfangiti dell'87% dopo microchirurgia. Nei pazienti con miglioramento del quadro clinico, il drenaggio ha permesso di riscontrare anche una marcata riduzione di consistenza del linfedema. L'edema periferico alla mano o al piede si è ridotto significativamente nella maggior parte dei pazienti. Questi risultati a lungo termine indicano come le anastomosi linfatico‐venose giochino un ruolo importante nel trattamento del linfedema ostrutivo e come siano da considerare il trattamento di scelta nei pazienti non adeguatamente responsivi alla terapia conservativa medico‐fisica‐riabilitativa. © 2001 Wiley‐Liss, Inc. MICROSURGERY 21:135–139 2001</p>
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<abstract lang="en">Over the past 25 years, 665 patients with obstructive lymphedema have been treated with microsurgical lymphatic‐venous anastomoses; of these, 446 patients were available for long‐term follow‐up study. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Lymphangioscintigraphy, lymphangiography (in patients with gravitational reflux pathology), and echo‐Doppler were used preoperatively. Subjective improvement was noted in 578 patients (87%). Objectively, volume changes showed a significant improvement in 552 patients (83%), with an average reduction of 67% of the excess volume. Of those patients followed up, 379 patients (85%) have been able to discontinue the use of conservative measures, with an average follow‐up of more than 7 years and average reduction in excess volume of 69%. There was a 87% reduction in the incidence of cellulitis after microsurgery. In those patients who improved, drainage resulted in increased softness of the limbs. Peripheral edema (hand and foot) diminished considerably in most patients. These long‐term results indicate that lymphatic‐venous anastomoses have a place in the treatment of obstructive lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. Improved results can be expected with earlier operations because patients referred earlier usually have fewer lymphatic alterations.</abstract>
<abstract lang="it">Nel corso degli ultimi 25 anni, 665 pazienti affetti da linfedema ostruttivo sono stati sottoposti ad intervento di anastomosi microchirurgiche linfatico‐venose. Quattrocentoquarantasei pazienti sono stati seguiti anche a notevole distanza di tempo dall'operazione. I risultati sono stati valutati obiettivamente mediante volumetria ad acqua e linfoscintigrafia. Preoperatoriamente sono state utilizzate la linfoscintigrafia, linfografia (in pazienti con patologia da reflusso gravitazionale) e l'Eco‐Doppler. Abbiamo potuto registrare un miglioramento soggettivo in 578 pazienti (87%). Obiettivamente, le valutazioni volumetriche hanno dimostrato un miglioramento significativo in 552 pazienti (83%), con una riduzione media del volume in eccesso pari al 67%. Dei 446 pazienti seguiti anche a notevole distanza di tempo dall'intervento, 379 (85%) sono stati in grado di utilizzare la guaina elastica in modo discontinuo, con un follow‐up medio di oltre 7 anni ed una riduzione volumetrica media del 69%. Si è, altresì, verificata una riduzione dell'incidenza delle linfangiti dell'87% dopo microchirurgia. Nei pazienti con miglioramento del quadro clinico, il drenaggio ha permesso di riscontrare anche una marcata riduzione di consistenza del linfedema. L'edema periferico alla mano o al piede si è ridotto significativamente nella maggior parte dei pazienti. Questi risultati a lungo termine indicano come le anastomosi linfatico‐venose giochino un ruolo importante nel trattamento del linfedema ostrutivo e come siano da considerare il trattamento di scelta nei pazienti non adeguatamente responsivi alla terapia conservativa medico‐fisica‐riabilitativa. © 2001 Wiley‐Liss, Inc. MICROSURGERY 21:135–139 2001</abstract>
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