ORIGINAL ARTICLES  LIMPHOEDEMA 

International Angiology 1999 March;18(1):14-24

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Lymphoedema: modern diagnostic and therapeutic aspects

Campisi C.

From the Department of Emergency Surgery - Lymphangiology and Microsurgery Center University of Genoa, San Martino Hospital, Genoa, Italy

The ­author ­reports his clin­i­cal expe­ri­ence regard­ing the diag­nos­tic assess­ment of ­patients with lym­phe­de­ma and the selec­tion cri­te­ria for those ­assigned to micro­sur­gery.
Patients were clas­si­fied accord­ing to aetio­lo­gy and stag­es and sites of the lym­phe­de­ma and under­went a diag­nos­tic pro­to­col con­sist­ing of lym­phos­cin­tig­ra­phy, lym­phog­ra­phy (in select­ed cases), Doppler ­venous flow­me­try and manom­e­try, lym­phan­gio-RM and, in the case of angio­dys­pla­sias, phle­bog­ra­phy and arter­i­og­ra­phy. This pro­to­col is essen­tial in decid­ing the appro­pri­ate micro­sur­gi­cal tech­nique in those select­ed for sur­gery, wheth­er deriv­a­tive lym­pho-­venous anas­tom­o­sis or recon­struc­tive lym­phat­ic-­venous-lym­phat­ic plas­ty. The ­results of sur­gery were ­assessed both clin­i­cal­ly (with the aid of pho­to­graphs, water volum­e­try and meas­ure­ments of limb cir­cum­fer­ence) and by lym­phan­gios­cin­tig­ra­phy, and were clas­si­fied as ­marked, mod­er­ate or mild regres­sion of oede­ma. The over­all ­results were very encour­ag­ing, par­tic­u­lar­ly those of ­patients in the ear­li­er stag­es of the con­di­tion. With ­regard to sec­on­dary pre­ven­tion, early diag­no­sis plays an impor­tant role as does the iden­tifi­ca­tion of ­patients at high risk for the onset of lym­phos­tat­ic dis­ease after onco­log­i­cal lym­phad­e­nec­to­mies, espe­cial­ly when asso­ciat­ed with radio­ther­a­py. In such cases, in order to com­bat right from the out­set those lym­phe­de­mas which, based on sta­tis­ti­cal prob­abil­ity, are expect­ed to show unre­lent­ing pro­gres­sion if untreat­ed, early micro­sur­gery is a rea­son­able ­option.