| Surgical Treatment for Secondary Lymphedema of Lower Extremity: Combined Intraluminal Stent Placement and Open Surgery 2010-08-02 02:47:38 |
Surgical Treatment for Secondary Lymphedema of Lower Extremity: Combined Intraluminal Stent Placement and Open Surgery
Wen-Hsien Hsu Ting-Chen Chang Teng - Chin Tsai
Vascular and Lymphatic Treatment Center
Taipei Medical University- WanFang Hospital , Taipei, Taiwan
Purpose:
To alleviate the lymphedema of lower extremity that occurred after sustaining recurrent thrombophlebitis and /or cellulitis related to the preceding treatment of gynecological malignancy.
Methods:
Between Jan. 2007 and Dec.2009, 118 consecutive patients ( median age 55, range 32 to 82) with chronic lymphedema of lower extremity in 138 limbs were studied prospectively with the intent to treat any venous occlusion due to extrinsic compression or irradiation-associated stenosis. The establishment of diagnosis was verified by the iliac venogram with multi-detector computed tomography (MDCT). Data from history, clinical examination, surgical procedure and follow-up were recorded in data base. The preoperative indicators of venous pathology were radiographic evidence of occlusion, stenosis, venous collaterals and impedance of venous flow in the phleborheography. The operation was a hybrid procedure including operative angiolysis(OA) through retroperitoneal approach to release iliac vein cicatrisation combined with balloon dilation and intraluminal stent(IS) placement. The proper postoperative physical therapy was applied.
Results :
Thirty patients(25.4%) underwent incision and drainage of lower limb due to severe lipodermatofibrosis in addition to the OA and IS procedures. Eighty-eight patients only received OA and IS. The technical success rate was 98.30% (116/118) with 88 Zilver stents deployed in 68 patients and 65 Wallstents deployed in 50 patients. Patency rate at 3 months, 6 months and 12 months were 98.3 % , 96.6 % and 84.7 % respectively. Clinical symptoms improved significantly in terms of pain, swelling and function. There was no surgical mortality and the morbidity was in the acceptable range.
Conclusion:
Secondary lymphedema of lower extremity in the long-term survivors after cancer treatment should be evaluated for possible pelvic venous pathology. Patients will be benefited by the open angiolysis and iliac vein stenting should the venous pathology exists. The long-term follow up is necessary to verify the value of this hybrid procedure.
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