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A Journal on Phlebology
Acta Phlebologica 2000 September;1(1):23-31
Role of veins in lymphatic microsurgery
Campisi C., Boccardo F., Napoli F., Zilli A., Macciò A.
Department of Specialistic Surgical Sciences, Emergency Surgery Unit, Lymphology and Microsurgery Center, S. Martino Hospital, Genova, Italy, University of Genova, Italy
BACKGROUND: The use of Microsurgery to treat peripheral lymphedemas requires an accurate study of particular and important haemodynamic aspects in order to obtain successful and long-term results. Apart from lymphatic circulatory investigation, the study includes the evaluation above all of venous system in the same lymphedematous limb.
METHODS: The selection of candidate patients for Lymphatic Microsurgery includes isotopic lymphography and an accurate study of the venous circulation, besides, if required (panangiodysplasias), of the arterial circulation. Over 25 years clinical experience (1197 operations) is reported and the role of Derivative and Reconstructive Lymphatic Microsurgery is particularly underlined. Derivative Lymphatic Microsurgery was represented above all by multiple lymphatic-venous anastomoses. And, for those cases where a venous disease was associated to lymphostatic pathology, Reconstructive Lymphatic Microsur-gery techniques were realized: lymphatic-venous-lymphatic-plasty. For proper outcome measures water volumetric studies and lymphoscintigraphic patterns are essential.
RESULTS: With a follow-up at 1, 3, 6, 12 months and once a year at least for the first 5 years after surgery, and in about 30% of the patients also at over 10-15 years, positive results from Lymphatic Microsurgery can be achieved in the great majority of patients, with better evidence among patients at stage II or III. The role played by standardized lymphangioscintigraphy proved to be essential to demonstrate the efficacy of derivative and reconstructive microsurgical anastomoses.
CONCLUSIONS: Long term clinical outcome of lymphatic microsurgery leads to the consideration that today lymphatic microsurgery can be advantageously used for the treatment of peripheral lymphedemas, but it is necessary to follow exact indications for each case, on the base above all of the conditions of venous circulation from both flowmetric and manometric points of view.